Paying for Weight Loss?

Over the next little while, I will be taking a few days off and so I will be reposting some of my favourite past posts. The following article was first posted on Dec 15, 2008:

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