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Dieting for dollars? More US workers trying it

By Mike Stobbe | June 24, 2010, Thursday | Print Edition

HOW much money would it take to get American workers to lose some serious weight? US$100? US$500?

Many employers in the United States are betting they can find that price. At least a third of US companies offer financial incentives, or are planning to introduce them, to get their employees to lose weight or get healthier in other ways.

"There's been an explosion of interest in this," says Dr Kevin Volpp, director of the University of Pennsylvania's Center for Health Incentives.

Take for example OhioHealth, a hospital chain whose workforce is mostly overweight. The company last year embarked on a program that paid employees to wear pedometers and get paid for walking. The more they walk, the more they earn, up to US$500 a year.

Anecdotal success stories are everywhere. Half of the 9,000 employees at the chain's five main hospitals signed up, more than US$377,000 in rewards already have been paid out, and many workers tell of weight loss and a sudden need for slimmer clothes.

Will this kind of effort really put a permanent dent in America's seemingly intractable obesity problem? Not likely.

"It's probably a waste of time," says Kelly Brownell, director of Yale University's Rudd Center for Food Policy and Obesity.

Brownell's assessment is harsher than most. But the science seems to back him up. Only about 15 to 20 US studies have tried to evaluate the effect of financial incentives on weight loss. Most of those studies were small and did not look at whether such measures worked beyond a few months. None could make conclusions about how much money it takes to make a lasting difference for most people.

Perhaps the largest effort to date was an observational study by Cornell University. It looked at seven employer programs and the results were depressing: The average weight loss in most was little more than a pound (450g).

Sure, there are grounds for optimism. Smaller experiments report some success. Other studies have shown promising results against tobacco. One study published last year in the New England Journal of Medicine, coauthored by Volpp, found that cash rewards of a few hundred dollars nearly tripled quit-smoking rates.

One problem: "Food is more difficult than tobacco," says Steven Kelder, an epidemiology professor at the University of Texas School of Public Health.

While cigarettes can be addictive, people do not need to smoke to live, and advertising and clean-air restrictions curb tobacco's presence. People must eat, however, and sugary drinks and fatty snacks are everywhere, Kelder and others say.

Health officials lament that more than two-thirds of American adults are overweight and one-third obese, and they lecture on fat's role in deaths from diabetes, heart disease and other conditions.

In a campaign led by US First Lady Michelle Obama, federal officials are emphasizing several approaches to slim the nation. Food companies, worried about potential anti-obesity rules and laws, have endorsed the message of the president's wife and recently pledged to offer lower-calorie foods, change recipes and cut portion sizes.

While watching to see if food makers follow through, some experts remain fascinated by the idea of using economics to get people to eat better and exercise.

Sales taxes have been used to drive up the cost of cigarettes and drive down smoking rates, and Brownell and others are pushing for similar taxes on soda.

Companies tend to be more interested in incentives than disincentives like taxes. But the perquisites they attach to wellness programs come in a variety of forms and sizes.

Some reward employees just for having a health evaluation or simply enrolling in a class, regardless whether they complete it. Others require measurable weight loss or exercise achievement, sometimes structuring it in a contest along the lines of "The Biggest Loser" television show.

Some companies offer money, some vacation trips. Some refund the cost of Weight Watchers classes. Others reduce health insurance premiums.

The value of rewards can range from measly to thousands of dollars.

Hunches and human resources budgets, not research, often drive decisions about financial incentive details. Companies are quite frank about it.

OhioHealth set the maximum reward for its step-counting program at US$500.

"It just sounded right to us. We thought that would be a big enough number to help people think twice," says Lisa Meddock, OhioHealth's benefits manager.

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