If you fund them, will they run?

March 10, 2016



Financial incentives for weight loss and physical activity, especially those linked to worksite wellness programs, are a hotly contested issue. Recently, the New York Times reported on a study examining three different modes of financial incentives (gain, loss, and lottery) in a smart phone based worksite wellness programs. Instead of looking at whether incentives were or were not effective, the authors examined if the way that participants are receiving financial incentives for physical activity made a difference in their daily physical activity levels.


Participants were randomly separated in to three groups—

1. Gain Incentive: Participants received the reward when the physical activity goal was met;

2. Loss Incentive: Participants lost the reward daily if the goal was not met; or

3. Lottery Incentive: Participants were entered into a lottery for a larger reward ($50) each day, however only participants that met the physical activity goal were eligible. If participants won and did not achieve the goal, they received an email saying they would have won if they had achieved the goal—with each group having the potential to receive the same quantity of money.


The authors drew heavily on the desire to avoid regret as a motivating factor, which intuitively makes sense to me – people in general tend to be loss averse (i.e., strongly prefer avoiding losses to acquiring gain). Perhaps the most succinct example of loss aversion is seen in casinos. There, fun-seekers and hardcore gamblers alike all follow the same pattern: The first round they play to win. The second round? It’s to recoup losses. The participants in this study followed this trend, with those in the loss incentives group showing the best results of the three groups.




In talking with fellow scientists about my work, the question of “How do you convince people to change their behavior long term?” always arises and the topic of financial incentives, or incentives in general is produced as a solution. It’s a struggle because, as seen in this article, financial incentives are effective in the short term, producing great results you can write up and publish, key for a graduate student (and all academics). However, on a more pragmatic level, what is the long-term sustainability of these incentives? (I wouldn’t be doing my graduate training justice if there weren’t a RE-AIM shout out)  Who pays for it? Who is coordinating these incentives and developing these programs? What are the barriers to widespread dissemination of a relatively simple solution to an extensive problem?


As we talked through these issues and more in lab meeting, none of us could come to consensus on how such a system would work, even in an ideal world. Some balked at the idea of providing rewards or incentives long-term to participants, arguing good health should be incentive enough. Others thought this was an ideal system and questioned why it was not already in practice throughout health insurance systems. Which brings us back to the question of “How do we convince people to adopt health promoting behaviors long term and how does this fit within the current system?” I left the discussion without much clarity on how to navigate through a complex problem embedded within an intricate and complicated system, but with the certainty that I will not lack for future employment as we try to develop sustainable, pragmatic solutions.


What are your thoughts?


-Nithya Ramalingam




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