Should people with obesity be paid to lose weight? Studies suggest that financial incentives lead to weight loss, but whether the approach is sustainable or cost-effective remains to be seen,
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, 1 in 8 people have obesity, 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 tend to regain more than 75 per cent of the lost weight within five years, for instance.
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, a 2022 US study 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 (JAMA Internal Medicine, doi.org/m49p), 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 UK study published in May 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 (JAMA, doi.org/m49q).
$330 Average reward given to adolescents paid to lose weight in one study
