Money is a big motivator. And the prospect of a cash payoff in any sort of gamble is alluring — just think of the Powerball buzz this week.
So, what happens when financial incentives are tied to weight-loss goals? A growing body of evidence suggests that it's not necessarily a slam dunk.
Just last week, our sister blog, Shots, reported on a workplace initiative that promised to cut workers' health insurance premiums if they lost weight. Turns out, the initiative failed. Workers, on average, lost less than two pounds.
Why? Well, for starters: "People are motivated by immediate awards," explains Mitesh Patel of the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, one of the study authors.
Telling people to look for a few extra bucks in a future paycheck due to a discounted health insurance premium, it turns out, just isn't very sexy, or motivating.
So, here's an alternative that's gaining traction: a good old-fashioned wager. Through programs such as HealthyWage, people are betting on their own weight loss.
Another company called StickK uses a similar approach. Participants set up personal contracts for weight loss and other types of goals. As I reported in 2008, when the company was launching, if you don't live up to your end of the contract, StickK will give your money to charity or a person you designate.
And one strategy to motivate people: have them pick an organization or charity they don't agree with (or whose views they oppose). For instance, a bird-watching pacifist who would be in favor of stricter gun control would pledge money to the National Rifle Association if they didn't meet their goal. Or a Republican would pledge money to the Democratic National Committee.
HealthyWage as a concept appealed to Ben Carnes, a schoolteacher and football coach in Westfield, Ind., whose weight had crept up to 370 pounds.
"I knew that if I put money on the line, it [would be] a double-motivating thing," Carnes tells us. He signed up with HealthyWage in 2014. The idea behind the program is to use both carrot (the opportunity to win a cash prize) and stick (the threat of loss) to motivate people.
"I didn't want to lose the money I was putting in," Carnes says. "[And] my wife and I agreed that if I won, I got to spend it on anything I wanted." So, this was the motivation to get started.
Ben Places His Bet
Here's how his wager worked: He put down about $60 a month, aiming to lose close to 100 pounds. If he achieved his goal, he'd double his money. And if he failed to meet his weight-loss goal, he'd lose his money. (Over a yearlong wager, he'd put in $720.)
In the early months, the weight fell off. But then things got tough.
At one point midway through the wager, Carnes says, his weight had hit a plateau. "I was feeling sorry for myself. I hadn't lost any weight for like a three- or four-week span," he says. He wanted to go eat burgers and fries — and bail.
"My wife actually at one point called me out. ... She kinda yelled at me and said, 'We're paying way too much money for you to just bail on this now.' "
Carnes' — and his wife's — aversion to losing the more than $700 they'd put into the bet turned out to be a powerful motivator to stick with it.
And this "loss aversion" is part of what makes this model successful. "We know from studies that people [can be] more motivated by losses than gains," says Patel. "People don't want to lose something they already have."
In the end, Carnes won his bet. He reached his goal in December 2015. He lost 100.2 pounds. And he cashed a check for about $1,500.
He's currently training for a triathlon and says he no longer needs to take high-blood pressure or cholesterol medicine. "I feel much better," he tells us.
So, how many people who bet on their own weight loss succeed? And how often does the house win?
I put that question to the founder of HealthyWage, David Roddenberry, a former health care consultant. "About 30 to 40 percent of participants win [their] challenge," he told me.
The others? Yep, they fail to reach their goal weight. And they lose the bet.
But Roddenberry says the model is sound. He points to a study published in JAMA that found dieters with a financial incentive to lose weight were significantly more likely to reach their target compared with those who had no money at stake.
So, good odds? You be the judge.
DAVID GREENE, HOST:
You know, on the show, we've been talking about new ways to cover food. After all, it's something many of us talk about often. So we asked one of our correspondents at the NPR food blog The Salt to come by and surprise us with a story. And I swear, at this moment here, I had no idea what was about to happen.
ALLISON AUBREY, BYLINE: Hello.
GREENE: Allison Aubrey.
AUBREY: I come bearing gifts.
GREENE: You come bearing something...
AUBREY: I come bearing gifts.
GREENE: ...Looking like a dessert.
AUBREY: A chocolate cake, I made it this morning.
GREENE: For me?
AUBREY: Yeah, sort of.
GREENE: Oh, cool. Well, that's generous.
AUBREY: Yeah, this is really going to help tell our story here.
AUBREY: So, you know, it's sort of the January doldrums, right?
GREENE: Yeah, I'm feeling them.
AUBREY: It's a time when New Year's resolutions might sort of fade away. But a lot of people are still trying to lose weight, get in shape. So I'm going to ask you a personal question, David.
AUBREY: Would you put yourself into this category?
GREENE: I've been in that category for the past year or longer or maybe my whole life, so yes.
AUBREY: OK, so one of the latest strategies for weight loss...
GREENE: Is chocolate cake.
AUBREY: No, is actually getting paid to lose weight.
GREENE: How much are we talking about?
AUBREY: Well, here. I am going to get out my checkbook here. I'm going to write you a check. OK, 2016.
GREENE: This is - look, I don't want to distract you from this process.
AUBREY: OK, so this is $1,500 to David Greene. But you don't get it yet.
GREENE: That's cruel.
AUBREY: (Laughter) And do you want to know what you'd have to do?
AUBREY: Well, to find out, I want to introduce you to this guy.
AUBREY: He's a schoolteacher in Indiana. His name is Ben Carnes. He's in his early 30s. He was a lacrosse and football player. But then his weight started to really creep up to more than 350 pounds, and he had tried almost every diet he'd heard of. Now he was really starting to get worried. Doctors had already put him on lots of medicines that were related to his weight and to diet.
BEN CARNES: Cholesterol, medicine and high blood pressure medicine, I had a high liver count. I had pretty much everything that they measured, and my blood work was bad. And here I was taking three prescription drugs at age 30.
GREENE: At 30 years old, he's really struggling.
AUBREY: That's right. He was feeling really desperate. So one day, he was, you know, googling around, doing an Internet search for weight loss programs, and he came across something called HealthyWage, and he signed up. So here's how it works. Ben starts putting $50 down a month on a bet that if he loses a certain amount of weight over a year that he'd get a big payout. But if he doesn't meet this goal weight, he's out, all the money, $600. So basically, we have a gamble here. He's betting on his own success, and he said that that really appealed to him.
CARNES: Well, I knew that if I put money on the line that - it was kind of a double motivating thing. It was one, I didn't want to lose the money I was putting in, but two, my wife and I agreed that if I won, I got to spend it on anything I wanted. So, you know, kind of both of those played into it.
GREENE: So this really worked for him?
AUBREY: This really worked. In his first wager, he lost about 40 pounds. Since then he's lost about 60 more.
GREENE: Oh, my God.
AUBREY: Yeah, a total of 100 pounds, so yes, in the end, he did end up getting this $1,500 check. But it was not easy. At one point, he told me about midway through, his weight had plateaued, he wasn't anywhere near his goal weight, and he was really, really frustrated.
CARNES: My wife, actually, at one point called me out. You know, I was feeling sorry for myself. I hadn't lost any weight for like a three or four-week span, and I was like, this is stupid. It's a waste of time, I'm not going to meet my goal, and I'm going to go have a burger and some fries. And she kind of yelled at me and said, we're paying way too much money for you to just bail on this now.
GREENE: That's the thing about diets. I mean, one thing is you sometimes do plateau, and you start to get frustrated, and frustration not seeing the results change can lead you to say, forget it, it's not worth it, I'm going to have a burger. I mean, that's really the struggle with it.
AUBREY: That's right. And I think what's interesting here is losing that money was the thing that freaked him out. I mean...
GREENE: And his wife.
AUBREY: Right, his wife, right. Now it would be nice to think that willpower is enough, right? But it's not. I mean, I've got this cake sitting here that I just told you about. I mean, look at this. My daughter on the way out this morning took her finger and just ran a big smudge through it. She's like, why are you holding on to me, mom?
GREENE: That's adorable.
AUBREY: It just shows this sort of temptation, right? So I think when it comes to resistance, a lot of people just need more strategies. And that's what Ben's story really shows, that in the end, the big motivator for him was not the prize money. It was what he heard from his wife, that fear of losing the money. And it really turns out that Ben's story is not so unique. Scientists who study financial incentives for a behavior change or weight loss say most of us operate this way without really ever knowing it. We're highly risk-averse. I spoke to this one researcher, Mitesh Patel, at the University of Pennsylvania, and he put it this way, that the fear of loss can be more powerful than the reward of winning.
MITESH PATEL: And so if you have some skin in the game, that really tends to drive behavior change. And people tend to not want to lose something they feel like they already have.
AUBREY: But, you know, I have to say, as compelling as this is, a lot of workplaces are having these kind of weight loss challenges, and they don't always work. For instance, there was a study published just this month in the journal Health Affairs, and it looked at this workplace wellness program where they basically discounted people's health insurance premiums if they lost weight. And it was not successful at all because the payoff isn't significant enough. I mean, who's going to notice at the end of three or four months that you had a few more dollars in your pay stub?
GREENE: Some people might notice, but it's not the same as thinking about $1,500 you could literally hold in your hands and go buy something.
GREENE: It's really important to you.
AUBREY: The immediacy of that, right, so the more successful formula here seems to be this blending of skin in the game, this sort of wager approach, with plenty of social support.
GREENE: What would skeptics say? I mean, among other things, I can imagine you might have someone who just doesn't have $50 to put up. I mean, the budget is that tight.
GREENE: But are there other reasons that skeptics say, come on, this is just not the best idea?
AUBREY: Sure. I mean, I can think of two right off the bat. If someone needs to lose a huge amount of weight, they might need more oversight, and they might need a lot more instruction about what they should be eating, how they should be exercising. Another thing to think about is how well will someone like Ben be able to keep it off. What is it about this wagering approach that might help someone keep it off in the long term? And that we don't really know.
GREENE: And that check I guess is not going to fall into my hands, so...
AUBREY: Well, you know, I've got it here, so you want to work towards this $1,500?
GREENE: I do.
AUBREY: Or, you know, here, I can slice up a little sliver of cake for you.
GREENE: Could I have that and still succeed in getting the $1,500? Is that possible?
AUBREY: You know, I think it is possible. It's not mutually exclusive. You could in theory eat a very tiny sliver here and cut back on portions overall and still achieve your weight loss goal.
GREENE: I like that.
AUBREY: (Laughter) OK, here you go.
GREENE: Allison Aubrey, I'm so happy you stopped by, really interesting stuff.
AUBREY: Thanks, David.
GREENE: A conversation with NPR's Allison Aubrey that began with a chocolate cake and a checkbook. Transcript provided by NPR, Copyright NPR.