Paying people to lose weight

Winton Rossiter, of London weight-loss firm 'Weight Wins', was in the news this week, following the completion of a trial in which obese patients were paid to lose weight.

Weight Wins asks participants to pay £45 and then £10/month to participate, and then pays them for achieving, and maintaining, their target weight. The maximum payment, for extremely obese patients who lose nearly all their weight, is £3000. Most payments will be much more modest: for example, a 250lb person who hits a target of 200lb after a year may earn £300, of which £150 is a bonus for hitting the goal.

This system is designed to work partly by giving participants a financial incentive to lose weight, but also by enforcing regular weigh-ins and providing clear weight loss targets. But it's the financial incentive which has put the scheme in the spotlight.

Walter Sinnott-Armstrong spoke to us recently about a similar program carried out in the USA, in which addicts were paid money to abstain from heroin. As I recently wrote, many obese people are essentially addicted to food, so the two treatment trials should be seen as sister projects. This is an idea that is gradually gaining steam.

Julian Savulescu and I have recently published an article in which we argue that the reason people habitually overindulge (in food or in heroin) is that they have come to place an unhealthily high value on food or heroin. Addicts are not insensitive to incentives to stop, but they just need greater incentives than non-addicts. We see this clearly in the drug use statistics: every time the price of heroin goes up, a huge number of apparently intransigent addicts simply stop using the drug.

Of course, only a minority of addicts will stop using drugs for in exchange for a small amount of money, or in response to a modest increase in the price of drugs (or food). These are the addicts who want to quit nearly as much as they want to take drugs. The point of payment schemes like the one used by 'Weight Wins' is that they allow us to slightly tip the scales and save the people who are close to quitting on their own. Unless we are prepared to pay huge amounts of money, these schemes are never going to cure everyone.

It's also not currently clear whether Weight Wins' 'Pounds for Pounds' programme is cost-effective. They saw an average 5% reduction of bodyweight, and 12% among those who completed the programme, but the dropout rate was very high. There are also some ethical difficulties with such schemes being administered by for-profit companies, who make more money if patient fail to lose weight. Such programmes should be administered by government bodies or non-profit groups.

Nevertheless, if it turns out that these schemes like these can be effective at reducing the cost of obesity, then we should employ them on a wide scale.

Some people will object that this amounts to giving the non-obese and non-addicted a financial incentive to become obese and addicted, especially given that these two conditions are heavily correlated with poverty. It may be true that these are real risks. But current treatment regimens for both addiction and obesity are just not sufficiently effective to stem the rising tide of health care expense.

According to the NHS, the cost of treating the obese was as much as £49 million in 2002, while the cost of obesity-related illnesses was as much as £1075 million — this corresponds to roughly £75 per obese person per year. This number, which the NHS considers to be an underestimate, only counts the treatment of obesity-related symptoms, and leaves out losses to productivity and other costs. These numbers are expected to balloon out of control as the burgeoning obese population gets older, developing joint problems, diabetes and heart disease. New approaches are definitely required.

More data is required, but this is certainly an avenue worth investigating.

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3 Responses to Paying people to lose weight

  • Julian Savulescu says:

    The State should not be paying people to encourage prudence. The obese maybe irrational and weak willed, but just in the ordinary sense. Rather than nonobese pay them to behave better, they should pay the nonobese, internalising the costs of their behaviour through taxes on caloric, fatty, unhealthy food and subsidies for healthy food. We should employ fat taxes, in the same way we tax cigarettes, and not use tax payer money to incentivise prudence.

    Of course, a win-win solution might be create fat taxes and subsidise such incentive schemes from those taxes. But not from the NHS budget.

  • Bennett says:

    If paying people to be more prudent led to better outcomes and lower costs, I would be all for it, whether we’re talking about obesity, drugs, gambling, internet use or credit card debt.

    It can seem repugnant to reward people for barely-responsible behaviour which ought to be the norm, but remember that the obese and addicted are not just suffering in terms of health, but in terms of money. If we instead paid the non-obese and non-addicted for their good sense, we would widen the financial gap between the healthy and the unhealthy, and perpetuate the problem.

    For the purposes of these programmes, it is just irrelevant that people who are addicted and obese are in full control of their actions. We can pay a 250lb person £300 now, or we can pay hundreds of times that amount 20 years from now.

  • M Coleman says:

    I disagree with the assertion that the government or non-profit organizations should run these weight-loss programs. As I see it, knowing that my money will wind up as profit for some company (as opposed to being given to the NHS or some other non-profit) gives extra incentive to reach my weight-loss goals. Among other things, such a scheme eliminates the secondary excuse mechanism wherein an individual can say “Well, I didn’t make my goal this month, but at least my money is going to a good place.” Additionally, a private company has no overt obligations to the state, is unencumbered by changes in the political atmosphere, and would be restricted to those individuals who chose to opt-in to the program.

    In the United States, at least, I could see such a program being run by for-profit insurance companies, who would stand to benefit by the lower health-care payouts.

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