Tuesday, December 16, 2008

How much role does cash play in weight loss?

Tonight is the finale of the popular television show, The Biggest Loser. If you're not familiar with the show, basically, it's where obese individuals lose extreme amounts of weight in a short period of time through excessive hours of exercise and supposedly proper nutrition. I believe the show starts out with 14 or 15 contestants and one gets voted off per week depending on how much weight they have lost. The person who has lost the most amount of weight, aka "The Biggest Loser" receives a cash prize of $250,000.

I find this all so fitting, especially with a recent article that came out last week in the Journal of American Medical Association about the financial incentive for weight loss. Researchers at the University of Pennsylvania studied 57 obese, but otherwise healthy individuals and randomly assigned them to three weight loss plans: a lottery incentive program, a deposit contract program, or monthly weigh-ins (control group).

In the lottery incentive program,
individuals received money if they reached their weight loss target. The deposit contract group consisted of participants investing a small amount of their own money per day. If they reached their weight loss target, they would also receive a bonus, otherwise, they lost their money at the end of the month.

At the end of four months, the incentive groups lost more weight compared to the control group with about half reaching their target weight loss. However, seven months later, when there were no longer financial incentives, weight loss was not sustained among the incentive groups.

The idea behind the research was based on the loss aversion theory. Researchers say they wanted "
to create a mechanism where loss aversion would help drive people's motivation...we wanted to create a reward system which gave them rewards in the present."

I'm not sure how to feel about the financial incentives for weight loss (for those who may need to clinically speaking). It adds such another factor into the mix of real motivations for weight loss or anything for for that matter. Rachel at The F-Word wrote a post awhile back titled The Biggest Loser or the Cash Cow? which made you think twice about the show.

What I find even more interesting is turning the tables--instead of weight loss, weight gain. How come we don't give cash incentives for that? Even so, it wouldn't matter, because weight gain is looked down upon in society, except for those with eating disorders or other medical illnesses where weight restoration is important. Even if those with EDs were given a cash incentive to gain weight, it is highly doubtful that they would embark on it. The motivations are different and money, objects, etc. aren't powerful enough.

In the end, however, for most with eating disorders, their motivations to gain weight (and I say this lightly as weight gain is difficult) and hopefully recover actually turn into more intrinsic values. The value of health and vitality, the motivation to (excerpt activity here), the ability to self
nurture, and the list goes on and on all become more important than living a life with an eating disorder.


Rachel said...

Instead of offering people money to lose weight, they should instead offer them money to sustain the weight that they lost. Come back in five years (the kind of remission point for weight loss) and if you've still maintained xx percent weight loss, here's your cash prize.

Kim said...

I agree with you and Rachel -- the real challenge is sustaining the initial goal. At the worst of my anorexia, I was offered money for each pound I would gain. I even had a very stupid therapist say she would give me $100 if I got my period back. Well, I got it, laughed all the way to the bank, then restricted again. Incentives only work short-term. People who have long-term success do so because they really WANT it and they are committed to WORKING at it. They know that a silly incentive doesn't represent the immensity of their achievement. It just doesn't. If someone offered me money to gain weight now, I would laugh and say, "If only something like money could kill this beast." It's just not that simple, unfortunately.

Kara said...

I always thought that The Biggest Loser TV show was bad because they make the participants lose weight so FAST. The faster you lose weight, the faster you gain it back. It's not heathy. I just recently found out though that the winner gets a cash prize. I agree with Rachel and Kim that it would be better to give them cash for maintaining their weight.

Gaining Back My Life said...

Ha ha ha - I got a good laugh about the weigh GAIN incentive idea. And unfortunately, I think Kim is absolutely spot on.

It's about learning to be accountable to yourself, despite any monetary or otherwise 'bribery' rewards.

In the end, it's all depends on whether or not you choose to live.

Tiptoe said...

Good points everyone.
Rachel, it would be an interesting experiment to see how the cash incentive worked after sustained weight loss. My feeling is that people would either forget about it or that their incentive would change. Therefore, the money would just be an added bonus.

Kim, you're right that incentives are only short-term and hard work is what wins out in the long haul.

Kara, yeah, it is kind of scary how fast they lose the weight even if the bulk may be water weight initially.

GBML, I wondered whether you'd laugh about the weight gain money incentive. ;-) But yes, you're right these things only go on for so long and you have to come to a point of wanting to live for yourself.

Sarah said...

To be honest, a cash incentive may have worked for me during my weight gain period. We did Maudsley (though I was 20 years old) and instead of a positive reward, things were withheld from me (i.e if you don't gain weight you can't return to college, you can't go to your friends' this weekend, etc.) I always thought this was unfair. Some weeks my body just wouldn't cooperate and put the weight on even though I had worked really hard and eaten 100% of my MP that week. It seemed weird to be "punished" (not in the true behavioral sense of that word) for my metabolism's natural process.

I do remember telling my dad once while we were car shopping for him, "if you would promise me this Hybrid Ford Escape, I would definitely recover." He looked at me like I was insane and said "you shouldn't need a motivational tool to be healthy and happy!" Blah, way to reflect an amazing understanding of eating disorders, dad...

My husband has now promised me a trip to Greece or Italy when I am finally recovered enough to ENJOY and not freak out over a trip like this, which is great motivation for me.

anon mom said...

I agree with Sarah that incentives might be helpful to me ... particularly sustained incentives that fuel motivation continuation long enough to make me "sit with" weight gain and stay in treatment. I always get uncomfortable, get antsy in my own skin, feel trapped in the hospital or a program or by treatment parameters ... and I literally and/or figuratively "run." From myself and recovery and the hard things. Not that starving isn't a hard life at its core.

My biggest incentives and disincentives are financial. If I feel money pressure, I cut back on food, treatment, self-care, etc. I avoid a higher level of care or leave AMA as the anxiety about the mounting bill ... mounts.

If I had a deal similar to a private university near me, it might work. If you complete your degree with agreed-upon grades, your tuition is forgiven. You owe nothing.

Similarly, if hospital treatment and physician fees were forgiven if I actually ever completed a program to the degree the treatment team had recommended ... I think I would stick with it. For it to continue to work, though, there would have to be a similar *disincentive* in that if I relapsed and lost weight/dropped out of follow-up care/OP treatment, missed appointments, etc. ... then the balance would revert to me.

If I could maintain my wellness program for two years, I would be free and clear. Two years would probably be enough time to underwrite the behaviors, thoughts, nutrition, and emotional/psychological progress to "make it."

Tiptoe said...

Sarah and Anon mom, thanks for adding to the discussion.

Sarah, I can see where you are coming from. You were were able to have incentives that were powerful enough to you to continue in recovery. Theses helped you in the interim to get further in recovery.

I think the trip to Greece or Italy is a great motivation to reach full recovery. Much luck to you.

Anon mom, it sounds like for you that yes having some incentives to keep in recovery would be a good thing for you.

I can understand the financial issues at hand, but in the end, your health is important. Otherwise, you're not there
to live it.

I'm wondering if you have ever considered a research based program? Then, treatment is free as long as you fit the criteria. Might be something to think about.

Good luck to you in recovery.