A growing body of evidence suggests that paying people to lose weight could be an effective treatment for obesity. While this seems to imply that the condition boils down to just lifestyle choices – an idea doctors have moved away from in recent years – it probably isn’t that simple.
Worldwide, , a figure that has more than doubled among adults and quadrupled among teenagers since 1990. Obesity is linked to a higher risk of heart disease, type 2 diabetes and some types of cancer, making it a top healthcare priority, particularly in high-income countries.
For decades, the solution was pinned on encouraging people to eat less and move more. Yet this rarely leads to lasting and significant reductions in weight. People who participate in weight-loss programmes , for instance.
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Part of the issue is adherence. Consuming fewer calories activates brain cells that cause intense hunger, making it difficult to stick with a weight-loss diet. Potentially adding to the challenge is the contentious idea that people can be addicted to certain foods, such as those high in sugar and fat.
Seeking new treatment options, some researchers have recently investigated whether financial incentives could help people with obesity lose weight, and the results are promising.
For example, offered 660 people with obesity in socioeconomically disadvantaged neighbourhoods the chance to take part in a one-year weight-loss programme, made up of a personalised nutrition plan. About a third of the participants could also receive up to $750, depending on how much weight they lost. After six months, about 49 per cent of those with the prospect of getting paid had lost 5 per cent of their body weight, which is often considered the benchmark for a successful weight-loss intervention. The same was true for only 22 per cent of the participants who were just given the nutrition plan.
A similar involved researchers sending daily text messages with weight-management advice and educational resources to nearly 400 men with obesity, of whom 196 were told they would get £400 ($490) at the end of the one-year trial. The catch? The sum would dwindle if they didn’t hit certain weight-loss goals. Weight fell by around 5 per cent, on average, in the financial incentive group, compared with about 3 per cent in the text-only group.
To see if this strategy also works in adolescents, at the University of Minnesota and her colleagues provided meals designed for weight loss to 126 teenagers with severe obesity for a year. Half of the participants also received $20 gift cards for every 0.5 per cent drop in body weight. The team found that in the group getting gift cards.
One issue with all these studies is that we don’t know if the participants maintained their weight loss once the financial incentives stopped. When it comes to the long-term cost-effectiveness of such an approach, only Gross’s team attempted to calculate this, discovering that the benefits that came with the gift cards worked out as more cost-effective than those from the meals alone.
The team didn’t compare the approach’s cost-effectiveness to any other weight-loss interventions. But the participants in the financial incentive group received about $330, on average, in gift cards over the year, while an annual supply of the popular weight-loss medication .
One also has to consider the cost of treating obesity-related conditions. – more than £1.5 million an hour – treating diabetes, with type 2 diabetes making up the vast majority of these cases. It remains to be seen whether financial incentives for weight loss would make a meaningful dent in this expense.
The prospect of money or gift cards probably increases motivation to lose weight, but they could also help people afford the produce that makes up a nutritious diet, as well as other expenses. “It costs money to buy healthy fruits and vegetables,” says at the University of Stirling in the UK. “It costs money because your clothes don’t fit.”
As to whether lifestyle changes alone can treat obesity, it probably isn’t that simple. For starters, the weight reductions achieved in these studies pale in comparison with those attained via Wegovy or the drug Zepbound, which decrease weight by about 15 to 20 per cent, on average, in trials.
Obesity is also “extraordinarily complex”, says Hoddinott. People may live in “food deserts”, areas without affordable, nutritious options, or in places without parks or other spots that are conducive to exercise, says Gross. Our genetics also plays a role in our weight. “We’re going to need a lot of tools in the toolkit to treat it,” says Gross.
This is why paying people to lose weight probably won’t suffice on its own, but it could be combined with other interventions. It may also be a better fit for certain people, like those who have intolerable side effects from weight-loss drugs, says Hoddinott. “Whatever you do for weight loss, when the intervention stops, people put on weight,” she says.
