Researchers from the Duke-NUS Medical School (Duke-NUS) and Singapore General Hospital (SGH) have shown that selling rewards to people who are trying to lose weight makes for a very cost-effective way of improving both the magnitude and the duration of their loss.

Image credits Andrew Martin.

Today’s abundance of food, coupled with the relative lack of physically active jobs, have dramatically increased the prevalence of overweightedness and obesity. With these, the occurrence of non-communicable diseases associated with these two factors — such as cardiovascular disease, diabetes or cancer — has also gone up, promoting absenteeism among employees, rising healthcare costs both for the private and public sector, and impacting the quality of life for those affected.

Weighing in

The good news is that weight (in most cases) can be kept in check simply by making healthier food choices and exercising regularly. The bad news is that junk- and fast-food is like catnip for your brain, and it’s also not big on you spending calories. It’s why we feel lazy when we think about exercise, but temptation when thinking about chocolate-covered chocolate. In other words, the effects of jogging will become visible (making you feel good) in time, but eating the whole bucket of ice cream will feel good now. And “now” is a very convincing argument.

In a bid to paint the benefits of long-term health with the bling of short-term temptation, Duke-NSU Professor of Health Services and Systems Research Program Professor Eric Finkelstein and Dr. Kwang Wei Tham from SGH used some tricks from behavioral economics to create and test a Rewards programme which they hope will make people lose weight — and feel good while at it.

Over an eight-month long Trial on Incentives for Obesity (TRIO) held in Singapore, 161 overweight or obese participants paid S$234.00 (US$170.00) to enroll in a 16-week intensive weight loss programme. It required participants to attend weekly sessions at the Lifestyle Improvement and Fitness Enhancement (LIFE) Centre in SGH, where they were taught how to maintain a healthier lifestyle and were encouraged to shed at least 5% of their body weight. They also paid a further S$165.00 (US$119.50) for the Rewards programme.

As part of the Rewards programme, they could earn monthly rewards for meeting monthly weight loss and step goals. These could be either a straight-up cash sum or as a lottery ticket with a one in ten chance of winning 10 times that sum. Additional rewards were offered for reaching the 5% or 8% weight loss goal at months four and eight of the programme. . Participants who were randomized to the control group had their money returned but were ineligible for rewards.

Slimming out

The Reward group had markedly better results than the control participants overall. The average weight loss was as follows (Reward group vs control group):

• 3.4 kgs vs 1.4 kgs / 7.5 lbs vs 3lbs after the first 4 months, with 40% vs. 12% of participants reaching or surpassing the 5% weight loss mark.
• 3.3 kgs vs 1.8 kgs (7.3 lbs vs 3.9 lbs) at month 8, with 41% vs 21% participants reaching or surpassing the 5% weight loss mark.
• 2.3 kgs vs 0.8 kgs / 5 lbs vs 1.75 lbs at month 12, with 28% vs. 17% participants reaching or surpassing the 5% weight loss mark.

Overall, the walked away with a S$225.00 (US162.90) reward — meaning that if this program was founded by an employer, their costs would be around S$60.00 (US$43.50) per participant (rewards minus initial fees). That’s a huge boost to employee’s health, quality of life, and implicitly productivity, for a comparatively minor investment.

It also made a huge difference for the employees. Although only 42% of them made more money than they initially paid, around 80% reported being happy or very happy with the programme — and I dare you to find a gym where 80% of people are enjoying themselves.

“Our findings not only show the value of rewards to increase weight loss and weight loss maintenance, but they show it can be done in a manner that minimizes third party payments, such as those by employers or insurers. This should help to expand access to these types of programmes.” said senior author Dr Finkelstein, a professor in the Duke-NUS Programme for Health Services and Systems Research.

The best part is that over time, that tiny investment on the part of the company can domino into huge savings and quality of life improvements for their workforce. Even small amounts of weight loss, if sustained over time, lead to great health benefits and help prevent chronic disease, meaning less expenditure on health insurance by the company, as well as a happier, healthier employee base to boost productivity.

In the end, everyone wins.

The paper “Applying economic incentives to increase effectiveness of an outpatient weight loss program (TRIO) – A randomized controlled trial” has been published in the journal Social Science & Medicine.