Just about anyone over the age of 10 can tell you the dangers of being overweight or obese: increased risk of developing arthritis, breathing problems (such as sleep apnea), cancer, diabetes, heart disease, high cholesterol, and more. Then then there are the quality of life issues: anxiety, depression, shame, guilt, sexual problems, discrimination (including lower salaries), and others. Given all that, it’s no surprise that at any given moment, tens of millions of people are on some kind of diet. But diets by themselves don’t work. In fact, they may do more harm than good (more on that below). So if the prospect of a longer, healthier life doesn’t motivate people to lose weight—and keep it off—what does? Two words: Carrots and sticks (we’re talking metaphors here, not food groups).
The Carrot: Money and Stuff
“Portion sizes at U.S. restaurants are often two or three times what they were 20 years ago, which is also distorting how much we eat at home,” says Deborah MacInnis, a professor of marketing at the University of Southern California (USC). “The increase in portion size directly parallels the increase we observe in obesity.” Quite a few studies have shown that it’s possible to incentivize people to skip the super-size portions and eat smaller meals by offering them non-food incentives, such as money or products. For example, MacInnis and her colleagues at USC and the University of Arizona ran several experiments. In one, the team offered sixth-graders a choice between a 9-inch sandwich and a 4.5-inch sandwich plus a pair of earbuds. Most went for the earbuds. In another, they got adults to cut their portions in half by dangling the possibility of winning a $100 Amazon gift card or 10,000 frequent-flyer miles. In 2011, the British National Health Service started a program called “Pounds for Pounds,” where they flat out bribed people to lose weight. 400 participants enrolled in the program and chose a weight-loss plan based on their target weight. The financial pounds ranged from £70 to £425 (roughly $108 to $650). Nearly half of the participants (44.8 percent) lost more than 5 percent of their starting body weight, and 23.6 percent lost more than 10 percent. The average weight loss was 8.8 pounds and the average payout about 180 pounds ($277).
The Sticks: Pay Up, Buddy
The biggest objection people have to “we’ll-pay-you-to-lose-weight” programs like Pounds for Pounds is the fear that the weight will come rolling back as soon as the payments stop. That could be true. But most people (estimates range from 90 percent to 98 percent) who lose weight on a diet slap the pounds back on for reasons having nothing to do with money. In fact, many dieters end up actually gaining weight. Here’s how it works: When dieters shed pounds, they’re losing a mix of both fat and muscle, according to Mark Hyman, MD, bestselling author and director of the Cleveland Clinic Center for Functional Medicine. But when they start putting those pounds back on, it’s nothing but fat. “And since muscle burns seven times as many calories as fat, their metabolism is slower than when they started the diet,” says Hyman. The result? They gain weight more quickly because they aren’t burning it off. So while throwing money at the problem might get people to stick to their diets—at least in the short term—adding in penalties for not hitting their weight-loss targets might be the most successful approach. The Mayo Clinic did a fascinating study that proved that exact point. The researchers followed 100 otherwise-healthy-but-obese employees for a full year. Everyone had a goal of losing four pounds per month, monthly weight-loss counseling, and a gym membership, but half also got a financial incentive. The participants were all weighed every month. The ones in the financial group would receive $20 at each weigh-in if they met the 4-pounds/month target; if they fell short, they’d have to pay $20 into a pool. At the end of the year, everyone who completed the study would be entered into a lottery to win the pool. Here’s how it went:
- 62 percent of those in the incentive group completed the study compared to only 26 percent of those in the non-incentive group
- Those in the incentive group lost an average of 9 pounds over the year vs. only 2.6 pounds in the non-incentive group
- Those who paid any penalties along the way were especially likely to complete the study
Wanna bet that I can lose more than you?
So far, we’ve been talking about individual incentives and penalties. But what would happen if we added in an element of competition? Researchers from the University of Michigan, Carnegie Mellon University, and the University of Pennsylvania decided to find out. They had two groups of clinically obese subjects (those with a BMI of 30 or more). Each one was given a specific weight-loss goal that was based on their BMI. Then they were assigned to one of two groups. In one, individuals would receive $100 for each month in which they met their weight-loss goals. The other group was divided into subgroups of five. Each person in the subgroup could receive $100 for hitting the monthly target. But the five were also competing against each other to get up to $500 for the month. For example, if everyone in the group met the goal, each would get $100. But if only three did, they would split the $500 three ways. (None of the group-incentive people knew the identities of any of the others they were competing against. Can you imagine how much sabotaging there would have been otherwise?) Participants in the individual incentive group lost an average of 3.7 pounds over six months. They put half of that weight back on over the next 12 weeks. The group incentive participants lost an average of 10.6 pounds and kept it off for longer.
Group Support vs. Incentivizing Yourself
One of the reasons so many people fail to lose weight on diets is that they’re trying to go it alone, without support. Having someone in there with you can make those goals a lot easier to reach and a lot more likely to stay reached over time. If you can’t get anyone in your corner, there are a number of apps and online programs that will pay you for reaching goals you set (whether that’s for weight loss or gym workouts) and penalize you when you fall short. Some also incorporate friendly competition. But if necessary, you can do it yourself. Rather than set a huge goal of losing 100 pounds, set small ones—maybe losing one pound every week. At the same time, reward yourself along the way with things other than chocolate cake, such as seeing a movie or going fishing.