Self-Pay for Obesity Care Yields More Dropouts

Add this to the list of tobacco control ideas that just don’t work in obesity. When quitting smoking, people seem to succeed more if they have more “skin in the game.” But a new study published today in Obesity finds just the opposite in obesity care. People who self-pay are more likely to drop out than people who have insurance that covers weight management. And among the people who stick with it, self-pay and insurance-pay participants have the same outcomes.

A Pervasive Belief, Unsupported by Facts

Jamy Ard, the study’s lead author, explains the presumption that led to this study:

A rather pervasive idea is that patients who pay more out of pocket for a weight-loss program, who have more “skin in the game” so to speak, will engage more with the treatment. This idea suggests they will consequently have better outcomes than people with insurance paying for the treatment. But our data suggest that bearing responsibility for the majority of the treatment cost is not required to achieve engagement and clinically meaningful weight loss in a comprehensive medical weight-loss program.

Smoking Cessation and Weight Management Are Very Different

Contingent payments or making people pay upfront are arrangements that can improve the odds of people quitting smoking successfully. Careful studies have shown that people respond to incentives for smoking cessation. People who pay at least something for smoking cessation are more likely to quit for good.

So why don’t these ideas work so well in weight management?

Consider the big differences between smoking and obesity. Smoking is optional. Eating is not. Smoking is a behavior. Obesity is an outcome. People get pleasure from smoking and often have mixed feelings about quitting. Living with obesity is not pleasant.

Bottom line, people don’t need incentives to lose weight. They need the means to manage their weight and maximize their health. Quitting smoking is not easy. But overcoming obesity is very different. And it’s even harder.

Click here for the study by Ard et al. And thanks to our friend Joe Gitchell for sharing his decades of wisdom about tobacco control.

Check, Please! Photograph © Steve Snodgrass / flickr

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May 25, 2017