Financial incentives and weight control

Abstract

This paper reviews research studies evaluating the use of financial incentives to promote weight control conducted between 1972 and 2010. It provides an overview of behavioral theories pertaining to incentives and describes empirical studies evaluating specific aspects of incentives. Research on financial incentives and weight control has a history spanning more than 30 years. Early studies were guided by operant learning concepts from Psychology, while more recent studies have relied on economic theory. Both theoretical orientations argue that providing financial rewards for losing weight should motivate people to engage in behaviors that produce weight loss. Empirical research has strongly supported this idea. However, results vary widely due to differences in incentive size and schedule, as well as contextual factors. Thus, many important questions about the use of incentives have not yet been clearly answered. Weight-maintenance studies using financial incentives are particularly sparse, so that their long-term efficacy and thus, value in addressing the public health problem of obesity is unclear. Major obstacles to sustained applications of incentive in weight control are funding sources and acceptance by those who might benefit.

Figure 1

Effects of No Contract and Deposit Financial Contract on Weight Loss. Harris and Bruner, 1972. A self-control study involving the use of bahavior modification techniques was compared with a with a contract system and attention-placebo control group. Department of Educational Foundations, University of New Mexico, Albuquerque NM, 1971.

Figure 2

Effects on Weight Loss of No Treatment, Non-specific Instruction, Specific Instruction, and Specific Instruction plus Deposit Financial Contract. Abrahms and Allen, 1974. A data analysis facilitated by NSF grant GJ-9 to the University Computer Center. 49 overweight women participated in a study comparing relative effectivenss of financial remuneration, situational eating management and social pressure procedures in a weight reduction program. University of Connecticut Researach Foundation. 1973.

Figure 3

Effects on Weight Loss of larger Financial Contracts for Attendance, Behavior Change and Weight Change. Jeffery, Thompson and Wing, 1978. 31 severely obese adults participated in three behavioral weight control groups utilizing powerful monetary contracts. Stanford Heart Disease Prevention Program, Stanford University, Palo Alto CA. 1977.

Figure 4

Effects of Varying Financial Contract Amounts on Willingness to Enroll in Treatment. Jeffery, Bjornson-Benson, 1984 60 women and 55 men recruited participated in a weight loss reduction program with financial contracts. Eligibility criteria included weight ε 20 lb (women) or ε 30 lb (men) above ideal and absence of medical or behavioral contraindications. University of Minnesota, Division of Epidemiology, School of Public Health, Minneapolis, MN. 1983.

Figure 5

Effects of Varying Financial Contract Amounts on Weight Loss. Jeffery, Bjornson-Benson, 1984 60 women and 55 men recruited participated in a weight loss reduction program with financial contracts. Eligibility criteria included weight ε 20 lb (women) or ε 30 lb (men) above ideal and absence of medical or behavioral contraindications. University of Minnesota, Division of Epidemiology, School of Public Health, Minneapolis, MN. 1983.

Figure 6

Effects of Group and Individual Financial Contracts on Weight Loss. Jeffery, Gerber, et al, 1983 89 overweight men were assigned randomly to 1 of 6 treatment groups for weight reduction. All groups participated in a 15-week behaviorally oriented program. Each involved a monetary contract in which participant deposits were returned contingent on weight loss. Laboratory of Physiological Hygiene, School of Public Health, University of Minnesota, Minneapolis, MN. 1981–83.

Figure 7

Effects of Constant and Increasing Financial Contracts on Weight Loss. Jeffery, Bjornson-Benson, et al, 1984 60 women and 55 men recruited participated in a weight loss reduction program with financial contracts. Eligibility criteria included weight ε 20 lb (women) or ε 30 lb (men) above ideal and absence of medical or behavioral contraindications. University of Minnesota, Division of Epidemiology, School of Public Health, Minneapolis, MN. 1983 .

Figure 8

Effects of External Financial Incentives on Weight Loss. Jeffery, Wing, et al, 1993. Participants in this study were 101 men and 101 women recruited from two urban communities (Pittsburgh, PA and Minneapolis-St. Paul, MN) Individuals 25–45 years of age, required to be 14–32 kg overweight according to 1993 insurance industry standards, and were randomized within center and sex to 1 of 5 treatment groups.

Figure 9

Effects of Varying Financial External Incentive Amounts on Weight Loss. Finkelstein, Linnan, et al. 2007. Pilot study 2006, Research Triangle Park, NC and the University of North Carolina at Chapel Hill, support from the Centers for Disease Control and Prevention (P30CD000138-01 and RO1-D-DP000102).

Figure 10

Effects of Deposit Contracts and Lottery Financial Contracts on Weight Loss. Volpp, John, et al, 2008. Participants (57 healthy participants aged 30–70 yrs with a BMI of 30–40 randomized to 3 weight loss plans) were recruited May–August 2007 at the Philadelphia VA Medical Center, Pennsylvania, and were followed up through June 2008