Employer Threats and Bribes: No Impact on Obesity

Yet another study shows that employer threats and bribes have no impact on obesity. Researchers from the University of Pennsylvania published a randomized controlled trial of employer incentives for weight loss in Health Affairs and concluded:

In this yearlong randomized trial, we found that three different types of incentive programs using either health benefit premium adjustments or lottery-based financial incentives were not effective for promoting weight loss in a workplace setting.

There is often a presumption that the size of the reward is all that matters. In reality, incentive systems vary in effectiveness according to how well designed they are and whether their designs are successful in engaging people and motivating them to change behaviors that are often difficult to change.

For people who don’t know much about obesity, the idea of incentives and penalties is like catnip. We often hear a false presumption that people with obesity just need a shot of motivation to improve their condition.

Reality is quite different from that presumption. People who are living with obesity have often spent much of their lives trying to lose weight, only to discover that powerful biological processes make this very difficult over the long term. People spend literally billions of dollars on weight loss products and programs. People who need bariatric surgery often pay for it themselves because they get tired of fighting with discriminatory health plans that want to penalize them for having obesity.

In light of growing evidence that financial incentives to lose weight don’t work, one has to wonder why some employers keep pursuing them. Is this just an expression of weight bias? Does penalizing people with obesity feel like some sort of perverse justice? Or is it simply a way to shift the increasing costs of healthcare to employees?

But increasingly, employers are looking like hypocrites when they push these penalties and don’t cover obesity care in their health plans.

Click here for more from NPR and here to read the study in Health Affairs.

The Trap, photograph © Aftab Uzzaman / flickr

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January 10, 2016