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The Weight-Loss Incentive That Works Better Than Cash

A little intra-office competition can go a long way.


Trying to hit the gym and shed that winter insulation? With bikini season just around the corner, weight loss seems to be—once again—the water-cooler topic du jour. And for employers and health insurers both, that’s good news.

Encouraging workers to get a little competitive on the elliptical by offering them cash incentives may be the best way to help them lose pounds—and to slow companies’ spiraling health care costs.

That’s what researchers from Michigan and Pennsylvania discovered when they implemented a dollars-for-dieters program among the medical staff at Philadelphia’s Children’s Hospital.

Each participant was given a monthly weight-loss goal, based on his or her body-mass index, and assigned to one of two cohorts.

Members of the “individual incentive” cohort were eligible to win 100 dollars for every month that they hit their goal; if they fell short, the hospital simply kept the money.

Members of the “group incentive” cohort were given similar terms, but with a lucrative twist: they were “competing” against a pool of four other employees for a guaranteed 500-dollar payout. If all five workers in the pool hit their goals, they each received 100 bucks; but if, say, only two in five did, the victors got to split the pot and take home 250 dollars apiece. “Group” participants, in other words, could win as much as 500 bucks if their pool-mates fell short. But sneak too many Ding-Dongs, and they would have to watch their cash go to someone else.

Both strategies cost the hospital the same amount of money to implement. But they differed dramatically in their results.

“Individual” participants, competing only against themselves, lost an average of 3.7 pounds in six months; 12 weeks later, they’d regained half that weight. “Group” participants, meanwhile, motivated by the possibility of a jackpot payout, lost an average of 10.6 pounds, and had far better success at keeping the weight off.

“We were surprised that the individual incentive was not more effective,” lead author Jeffrey Kullgren, of the University of Michigan, told me. He and his colleagues, who published their findings this month in the Annals of Internal Medicine, had imagined that 100 dollars would be more than enough to motivate better eating habits. Instead, he says, “individual” participants fared little better than a control group, which was given minimal counseling and no cash incentive.

Kullgren suspects that two quirks of behavioral psychology, known as “loss aversion” and “hostile takeover,” were responsible for successful results produced by the “group” incentive.

He explains: “We framed the incentive in a way that we made clear to people, ‘Money has been set aside for you. You have a goal to meet. If you don’t achieve that goal, the money is going to be given to somebody else.’ That has a different feeling to it than if the allocation simply disappears into thin air.”

And even though the names within each pool remained anonymous—“You can imagine there’d be a lot of workplace sabotage going on,” Kullgren jokes—the social comparison that came with being in competition with one’s colleagues was an important form of feedback. “If everyone around you is trying to achieve the same goal, and you’re having a hard time doing so, the fact that others are able to do it can be a potent motivator," Kullgren says.

Workplace weight-loss campaigns, like anti-smoking ones, are becoming increasingly common; already, two-thirds of employers are thought to use them. And beginning in 2014, a provision of the Affordable Care Act will allow employers to use up to 30 percent of the premiums they collect from workers to incentivize (or penalize) good (or bad) health behaviors.

But public health researchers caution that not all workplace campaigns are created equal. “The way in which incentives are designed and delivered matters a lot,” Kullgren says. “Details can be really important here.”

For instance, because we humans are both irrational and emotional about money, there’s a big difference between receiving a 100-dollar check in the mail and having the same amount automatically deducted from your monthly premium. (Behavioral economists call this “mental accounting.”) The net effect is the same, of course, but a cash windfall is a more powerful motivator than a credit posted to your account, or a rebate buried in your paycheck. In other words, unless employers and insurers design their incentives correctly, no amount of throwing money at anti-smoking or weight-loss campaigns will produce lasting results.

"These are important questions that we as a health care system, and as a country, need to be asking," Kullgren says. "The costs of chronic disease are so impressive. We really need to be thinking about novel approaches to move the needle."