Dangling
the Carrot: Rewarding Healthy Behavior
I recently read a review of a wellness program based on goal
setting, progress tracking and social networking with monetary incentives to
promote healthy behaviors. The concept was to pay people to make healthy
choices.
The premise assumes that people will do better if promised a
reward. The limitation of this assumption is that offering incentives, what is
know as extrinsic motivators by Behavioralist, is usually more successful with
short term or temporary compliance to change. There is limited research
available to support the use of incentives to promote long-term behavioral
change. However, this program does not seem to just reward healthy behaviors.
Rather, the program could be viewed as enhancing goal setting and other
behavioral change strategies with monetary rewards placed at incremental
progress points. When we set up a goal-setting program, don’t we encourage our
clients to celebrate benchmarks with rewards?
Who
is using incentives?
Using incentives to promote behavior change is not a new
concept. According to the Harvard Public Health Review, IBM, the State of
Alabama and Scotts Miracle-Gro all use some form of an incentive program to
encourage healthy behaviors and some use disincentives to discourage unhealthy
behaviors. For example,
- IBM offers
employees $150 twice a year if they complete an internet-based assessment
and meet specific weight loss and fitness goals.
- Employees of
the state of Alabama receive health insurance discounts for not smoking
and meeting standards for blood pressure, cholesterol, glucose and BMI. Employees
that use tobacco pay an additional monthly premium.
- Scotts
Miracle-Gro refunds fitness center membership fees after 120 uses, and
provides free health coaching, medical services and generic prescriptions.
Employees that do not participate pay an additional insurance surcharge.
Do
incentives work?
In 2007, ABC News reported positive results for a study
examining monetary incentives for weight loss. Eric Finkelstein, a health
economist, and researchers at the University of North Caroline-Chapel Hill
recruited more than 200 overweight and obese employees in North Carolina and
randomly assigned them to one of three groups: no monetary reward for weight
loss, $7 for every 1 percent reduction in body weight, and $14 for every 1
percent lost. The participants were not giving a structured diet or exercise
program. At the end of three months, the group receiving $14 for every 1
percent decrease in body weight lost an average of 5 pounds, the $7 group lost
an average of 3 pounds and the group receiving no money lost an average of 2
pounds. Finkelstein concluded that the participants in the $14 group were more
likely to lose 5 percent of their body weight, which is the recommendation for
health benefits. However, whether or not
the participants could maintain the weight loss was not examined.
I must admit I still have reservations about the use of
extrinsic motivation for successful behavior change. Still, there is evidence
that incentives produce short-term results even though the long-term effects
still need to be investigated. This does present an interesting idea; how can
incentives be used to promote healthy behaviors in our personal training
businesses? What carrot can we dangle?
Karen Moreno, MA Candidacy Kinesiology/Exercise Physiology
BA Social Science/Education
Reference:
Hand,
L. (2009). Employer health incentives. http://www.hsph.harvard.edu/news/hphr/winter-2009/winter09healthincentives.html
Hellimich,
N. (2007). Financial incentives can encourage weight loss. Abc News
Technology & Science. http://abcnews.go.com/Health/TenWays/story?id=3585618&page=1&page=1
Comments