Does Paying People to Lose Weight Work?

The notion that the reason people with obesity are not losing weight is that they aren't sufficiently incentivized to do so is toxic.

It denies the impact of the thousands of genes and dozens of hormones involved in our individual levels of hunger, cravings, and fullness. It denies the torrential current of our ultraprocessed and calorific food environment. It denies the constant push of food advertising and the role food has taken on as the star of even the smallest of events and celebrations. It denies the role of food as a seminal pleasure in a world that even for those possessing great degrees of privilege is challenging, let alone for those facing tremendous and varied difficulties. And of course, it upholds the hateful notion that if people just wanted it badly enough, they'd manage their weight, the corollary of which is that people with obesity are unmotivated and lazy.

Yet the notion that if people want it badly enough, they'd make it happen, is incredibly commonplace. It's so commonplace that NBC aired their prime-time televised reality show The Biggest Loser from 2004 through 2016, featuring people with obesity competing for a $500,000 prize during a 30-week-long orgy of fat-shaming, victim-blaming, hugely restrictive eating, and injury. It's also so commonplace that studies are still being conducted exploring the impact of paying people to lose weight.

The most recent of these — "Effectiveness of Goal-Directed and Outcome-Based Financial Incentives for Weight Loss in Primary Care Patients With Obesity Living in Socioeconomically Disadvantaged Neighborhoods: A Randomized Clinical Trial" — examined the effects of randomly assigning participants whose annual household incomes were less than $40,000 to either a free year of Weight Watchers and the provisions of basic weight loss advice (exercise, track your food, eat healthfully, et cetera) or to an incentivized program that would see them earning up to $750 over 6 months, with dollars being awarded for such things as attendance in education sessions, keeping a food diary, recording their weight, and obtaining a certain amount of exercise or for weight loss.

Results-wise — though you might not have gathered it from the conclusion of the paper, which states that incentives were more effective at 12 months — the average incentivized participant lost roughly 6 lb more than those given only resources. It should also be mentioned that over half of the incentivized group did not complete the study.

That these sorts of studies are still being conducted is depressing. Medicine and academia need to actively stop promoting harmful stereotypes when it comes to the genesis of a chronic noncommunicable disease that is not caused by a lack of desire, needing the right incentive, but is rather caused by the interaction of millions of years of evolution during extreme dietary insecurity with a modern-day food environment and culture that constantly offers, provides, and encourages consumption. This is especially true now that there are effective anti-obesity medications whose success underwrites the notion that it's physiology, rather than a lack of wanting it enough, that gets in the way of sustained success.

Follow Yoni Freedhoff on Twitter: @YoniFreedhoff

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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Does Paying People to Lose Weight Work? - Medscape - Dec 12, 2022.

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