Paying cash to people with obesity for losing a specific amount of weight or completing weight-reducing activities works better than many other methods, a new study shows.
Cash beats offering stand-alone free tools, such as weight-loss programs, diet books, and wearable fitness trackers, the researchers report.
Similarly, paying other study volunteers an average of $303 over the initial study period to meet weight-loss goals, such as attending at least two weight-loss counseling classes each month, weighing themselves at least three times per week, or exercising for at least 75 minutes per week, was also effective. Some 39% of these study participants lost 5% of their starting weight after six months, and almost 42% lost the minimum amount of weight after 12 months of monitoring.
The researchers offered all study participants a free one-year voucher for the Weight Watchers program, which included classes, counseling, and tips for losing weight. They also provided wearable fitness devices (Fitbits), digital scales, and food journals so that trial volunteers could keep track of their weight during the study and thereafter.
One in five of those who received zero financial incentives and who were only offered the free tools lost the minimum weight after six months. But this grew to almost a third after a year.
Moreover, while incentives tied to actual weight lost performed better in the short term, incentives tied to weight-loss goals evened out after a year. Jay says this suggests that goal-focused financial rewards may last longer than others in the long run.
Further research is needed among more diverse groups in which obesity is a problem for many, she says, not just urban Hispanics living with obesity. Such groups include Black people, Native Americans, and United States military veterans, who have been identified by federal health agencies as disproportionately affected by obesity.
Interventions are needed to address the persistent obesity epidemic in the US. National reports estimate that more than 40% of American adults are obese, defined as having a body mass index, or BMI, above 30, a measure of height and weight.
“New tools are needed beyond encouragement and education to help some people struggling to cope with obesity,” says Jay, who also serves as director of NYU Langone’s Comprehensive Program on Obesity.
For the study, which took place from November 2017 to May 2021, researchers enlisted volunteers from hospital-based clinics in New York City and Los Angeles, where diet, exercise routine, and weight reductions could be readily tracked through monthly visits. Participants ranged in age from 18 to 70, and all came from neighborhoods with a median income of less than $40,000. For those receiving cash incentives, payments were made monthly as weight was lost or goals were met.
Additional coauthors are from the University of Florida, UCLA, Albert Einstein College of Medicine, Cornell University, and NYU.
The National Institutes of Health supported the work.
