Monday, December 15, 2008

Paying for Weight Loss?

This post is not about the incredible sums of money you can pay for the often incredulous weight-loss products or services offered by the weight-loss industry.

No, this post is literally about someone paying YOU for losing weight (and keeping it off).

Incentive-based weight-loss programs have been around for a while (see my previous post on Lifescales, a Toronto-based company that helps employers provide weight-loss incentives). But how effective are these kind of programs in practice?

This question was now examined in a randomized controlled trial by Kevin Volpp and colleagues from the Veterans Affairs Medical Center, Philadelphia, PA, just published in JAMA.

In this study, 57 healthy participants aged 30-70 years with a body mass index of 30-40 were randomized to 3 weight loss plans: monthly weigh-ins, a lottery incentive program, or a deposit contract that allowed for participant matching, with a weight loss goal of 1 lb (0.45 kg) a week for 16 weeks. No formal behavioural interventions or treatments for weight loss were provided.

After 16 weeks, the incentive groups lost significantly more weight than the control group (albeit only around 4 lbs more). The lottery group lost a mean of 13.1 lbs and the deposit contract group lost a mean of 14.0 lbs. About half of those in both incentive groups met the 16-lb target weight loss, while this was achieved by only 10% of participants in the control group.

Although the net weight loss between enrollment in the study and at the end of 7 months was larger in the incentive groups than in the control group (4.4 lb), these differences were not statistically significant. However, incentive participants weighed significantly less at 7 months than at the study start whereas controls did not.

The authors conclude that the of economic incentives produced significant weight loss during the 16 weeks of intervention that, however, was not fully sustained.

To me, this study raises several important issues:

1) I am not comfortable with the ethics of sending otherwise healthy (albeit overweight/obese) people off to try and lose weight on their own – given the recidivism of this condition, my advise to the participants would have been to first and foremost STOP GAINING WEIGHT and to focus on being as active and eating as healthy as they possibly can. Remember, we currently have no evidence to support the notion that otherwise healthy overweight or moderately obese individuals will indeed experience any health benefits from simply losing weight.

2) The idea of providing a financial incentive for weight loss reeks of weight bias and discrimination – Are we paying smokers to quite smoking and to never touch a cigarette again? Are we paying patients with diabetes to religiously measure their blood sugars and inject their insulins? Are we paying heart attack victims to exercise regularly and take their medications? Why single out patients with obesity for this kind of program?

3) The whole concept that obesity is something that can be “conquered” if only people were motivated enough (in this case by providing a financial incentive) further reinforces the prevailing notion that people are generally obese due to “choice” (read: their own idiocy, lack of motivation, indulgence, sloth). I have previously blogged on how the promotion of “healthy lifestyles” only serves to reinforce weight bias and discrimination.

Not lost on me is the fact, that even after only 16 weeks, all groups regained a significant amount of the weight lost (anyone can lose weight – see my post on weight-loss challenges).

When will folks recognize that obesity truly is a chronic condition that requires long-term treatment? Any strategy based on a short-term intervention (such as this incentive program), is senseless and doomed to failure.

AMS
Edmonton, Alberta

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3 Responses to “Paying for Weight Loss?”

  1. Jill says:

    Reminds me of when I was in high school, my parents paid me $100 to lose 10 pounds during the month they were away on a holiday. $100 to a teenager in the eighties was a lot of money, so naturally I starved myself, took diet pills, threw up my suppers, etc, all to lose the 10 pounds. Of course, I gained all the weight back within a couple of weeks. Shame of them for doing that to me!

  2. Aisling says:

    It’s ironic that the workplace should pay someone to lose weight when the workplace is one of the hardest places to eat healthily. This month alone at my office I have an office trip to the dinner theatre, two Christmas luncheons, one cocktail party, two birthday cake days, a number of corporate gift baskets arriving for group consumption and everyone bringing in their holiday baking. For a society that seems to be so disgusted by overweight people, they are certainly making it difficult for a person to avoid overeating.

  3. Christine says:

    Hear hear! It seems to me that the entire weight loss industry is committed to promoting methods that are proven to fail.

    So yes, long-term treatment/support is required, personally-tailored to the individual, and this treatment should consist of both education, and behavioural change strategies (not willpower).

    Indeed, any attempt to alter compulsive or addictive behaviour by willpower is not only doomed to failure, but highly-destructive to the psychological wellbeing of the client.

    What Jill has described is much like the “Biggest Loser” mentality. A show that purports to teach people to lose weight healthily, but actually demonstrates the most dangerous and failed weight loss strategies anyone could dream up.

    Aisling, I take your point, but there’s nothing wrong with feast time, and even fat people are entitled to engage in ceremonial feasting. After all this is an important aspect of the social “glue” that unites families and communities. There’s absolutely nothing wrong with the *occasional* good old pig out.

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