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Apr 17

Is money an effective weight-loss incentive? – Toronto Star

Personal Trainer Kia Khadem uses incentives to help his clients follow the workout regiment and lose weight. Here, Raymond El Khoury one of those successful clients, works out with Khadem at Anytime Fitness on Yonge St. ( Cole Burston / For Toronto Star )

For some, the joy of exercise is enough to inspire early morning runs in the park.

Others can easily decline a second helping of chocolate cake, knowing moderation today may one day lead to better health.

But many of us need extra motivation to reach for our running shoes or forgo that second treat. And there is growing consensus that when it comes to losing weight, a big-time motivator can be cold hard cash.

Money either getting it or losing it can make the difference to someones weight-loss success, says Tricia Leahey, an obesity researcher at the University of Connecticuts Institute for Collaboration on Health, Intervention, and Policy.

Most people in our field would say that financial incentives, when delivered thoughtfully, can change behaviours especially in the short-term, says Leahey, who is also a clinical health psychologist. Money, in and of itself, is motivating for everyone.

Researchers point to two key studies that seem to have taken the idea of dieting for dollars mainstream.

A 2008 study, published in the Journal of the American Medical Association, found people who were given financial incentives to lose weight were five times more likely to meet their dieting goals than those without cash motivation.

And in 2013, researchers from the Mayo Clinic reported that people who had financial incentives tied to their weight-loss (they got paid $20 or penalized $20, depending on whether they met their monthly target) lost an average of nine pounds over the course of the study, compared to just two pounds in the group with no monetary perks.

These studies, among others, have inspired web-based programs, such as DietBet and HealthyWage, which use financial incentives to persuade people to meet their weight-loss goals.

Marc Mitchell, a post-doctoral fellow at Torontos University Health Network, says web-based programs that reward people for making healthy choices, whether walking more, getting a flu shot or losing weight, all draw on behavioural economics, a field that tries to figure out how and why people make decisions.

These apps are designed to nudge people into making the right decision, says Mitchell, who has spent seven years researching links between incentives and healthy behaviour.

Though the apps differ in approach some require you to make a bet on yourself to win money; others ding your credit card if you dont reach your goal they do have one common denominator: the smartphone.

Theyve changed the face of how these apps work, Mitchell says. Rewards can be immediate. You can see money drop in your bank account. They log your walking steps (if your phone has an accelerometer). Using GPS, your phone can confirm that you went to the gym.

When you increase the efficiency of how rewards are delivered, that changes the game.

It makes sense that money motivates people to lose weight.

After all, the chance of a jackpot win drives sales of lottery tickets, while the fear of fines will force us to pay for street parking. But why is the promise of cash or the fear of losing it more of a motivator to lose weight than the potential for living a longer, healthier life?

Scientists are still trying to figure that out.

Abigail Scholer, an associate professor of psychology at the University of Waterloo, says the main reason its hard to adopt healthy behaviours say getting up early to work out is that the rewards of doing that behaviour are experienced in the future, whereas the pleasure of staying in a comfortable bed provides instant gratification.

These immediate results are more salient, more in our face, says Scholer, who holds the Canada Research Chair in Motivated Social Cognition.

We see them and feel them and they often act as guides to our behaviour, rather than these potential, distant rewards, such as feeling better when were older, or looking better in a dress in a few years.

While financial incentives can help people adopt healthy behaviours, Scholer says the social aspect of programs, such as DietBet, which bring participants together in online groups, also likely help people succeed.

There is accountability in those groups, says Scholer. By making your commitment public, you may also be more likely to engage in action-planning.

Research shows that having a specific action plan, rather than just good intentions, helps people meet their goals, she says.

Despite its promises and the millions of people who have joined programs questions remain about tying weight-loss to cash rewards and penalties.

So far, there is limited evidence that financial incentives work to help people lose weight and keep it off over the long-term.

Part of the problem is our changeable nature; the rewards we find so appealing at the start of a weight-loss challenge can become boring as months pass.

And, adds Scholer, cash rewards usually arent forever.

If incentives go away, you may be more likely to stop your new healthy behaviour.

In the long-term, she says, intrinsic motivation your love of running, for example, or satisfaction in eating well to achieve better health will be a better motivator than money.

Leahey, the obesity expert at the University of Connecticut, is researching how to prevent unwanted pounds from creeping back on after someone stops being rewarded for losing weight.

It may be, she says, that very small financial incentives no more than $2 or $3 a week can be effective motivators without causing that unwelcome rebound effect.

Until researchers fine-tune how financial incentives best work to promote healthy behaviours, Leahey suggests following a personalized program that suits your lifestyle and specific goals.

For example, she says, reward yourself with a predetermined amount of money for every five days you step on the scale and for every five days you are physically active.

Do that every single week, for as many weeks as you want. And give yourself periodic bonuses for weight-loss. See how those kinds of incentives boost your success.

Kia Khadem, a 27-year-old Toronto-based personal trainer, is cautious about how he uses cash rewards with his clients.

In his experience, its better to tie a persons fitness or weight-loss success to the thrill of exercise itself; mastering a new sports skill, for example, or beating a personal best in running.

Last year, though, Khadem did organize a fitness challenge for a group of clients that was tied to money. Participants paid to join the month-long challenge the dollars went to charity and the winner, determined by who completed the most tasks, won a month of free fitness coaching from Khadem, valued at $200.

Most participants, he says, found the challenge to boost their motivation. A few, though, did not.

Going forward, Khadem says he will make weight-loss and fitness challenges that are tied to money even more personalized to maximize a participants motivation.

Everything that comes to exercise and weight-loss should be done on a case-by-case approach, he says. There is no one-size-fits-all, even when it comes to the psychology of it.

APPS

DietBet

How it works: Participants (called players) join a group and put money in a pot. Those in the group who meet their weight-loss goal split the pot; DietBet keeps a cut (between 10 and 25 per cent) of the pot.

Verification: DietBet has human referees that monitor before and after photos of participants, which include images of them standing on scales, to ensure players do not cheat.

Stats: More than 490,000 people (about 7 per cent are Canadians) have logged on since the site launched in 2013. The company says 97 per cent of its participants lose weight, with a total of $32.5 million (U.S.) paid out to players.

HealthyWage

How it works: Participants make a bet on how much weight they will lose during a challenge. They choose the amount of money they want to bet each month and the number of weeks/months they have to meet their goal. An online calculator computes the potential cash prize. Participants who miss their goal, lose their money. Those who meet their goal win back their money plus the extra cash prize.

Verification: Participants must prove their weight at the beginning and end of a challenge, following specific step-by-step instructions. One method is to submit a 30-second video of stepping on a scale.

Stats: More than 500,000 people have signed up since the site launched in 2009. Since then, the company says participants have lost a combined total of more than $6 million (U.S.) and have been paid out more than $15 million.

Stickk

How it works: Participants must sign a commitment contract, in which they state their goal it can be any goal, from quitting smoking to losing weight to keeping a tidy kitchen outline steps to achieve that goal and decide if they want to lose money if they dont meet that goal. Participants get to decide who will get their money, should they not succeed; a friend, family member or a charity they would not usually support.

Verification: Participants submit reports to Stickk. They can also choose a friend, family member or acquaintance to be their referee.

Stats: The company, founded in 2008 by professors and a student from Yale University, claims that participants who sign up to have a referee monitor their progress are two times more likely to meet their goal, while those who stand to lose money are three times more likely to meet their goal. The company says about 40 per cent of their participants choose to make Lose Weight Commitments.

Carrot Rewards

How it works: This is not a weight-loss smartphone app. But Carrot Rewards does reward Canadians for choosing healthy behaviours, such as getting a flu shot, watching a video on healthy eating and meeting daily step goals. Rewards are in the form of loyalty points from Aeroplan Miles, SCENE and Petro-Points

Stats: Currently, the program, funded in part by the federal government, is only available in Ontario, British Columbia and Newfoundland and Labrador.

The company says they have more than 250,000 registered users, with 120,000 of those in Ontario.

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Is money an effective weight-loss incentive? - Toronto Star

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