JAMA: Handing Out Anti-Obesity Cash – Why Not?

BankomatWe’re going to file this under “C” – for cluelessness. A new study in JAMA adds to the list of wellness strategies from people who have little understanding of obesity as a chronic disease. People who don’t understand that one-and-done weight loss does little to resolve the problem. The well-intended concept here is to pay people to lose weight – hand out anti-obesity cash like a Bankomat.

The implication is that these people are too unmotivated to live healthy lives unless you pay them for it.

Pounds for Pounds?

Researchers assigned 585 men with a BMI greater than 30 to three different groups. One of the groups served as the control and got nothing but assignment to a waiting list for this wonderful program. Another received 12 months of text messages to motivate them to lose weight. The third group got those messages plus the promise of up to £400 (about $490) if they could meet all the weight loss goals that the people running the study assigned them. They had to lose 5% of their weight in the first three months, 10% of their weight within six months, and then keep it off at the end of 12 months. They could get partial credit and a portion of their anti-obesity cash, even if they didn’t hit all of the goals their research overseers assigned them.

If you think this is condescending, you’re not alone.

Can we imagine that researchers would give cancer patients cash incentives for shrinking their tumors – while witholding medical therapy known to be more effective than the force of will? Nope.

But, hey, if you think these men did it to themselves, this arrangement makes perfect sense.

A Significant Benefit?

What came from promising to dispense anti-obesity cash? The average result was for people in the two “treatment” groups to miss their goals. People in the control group lost 1% of their weight. In the text message group, they lost 3%. In the group with texts plus bribes (a.k.a. incentives) they lost 5%. The difference between the text group and the controls fell short of statistical significance. So did the difference between the text group and the text plus bribes group. But the text plus bribes group was statistically better than the control group.

In other words, the bribes were better than nothing. In the end, few people met their goals and it is pretty clear that their lower weight status will not be sustained after the bribes are gone. In a commentary alongside this study, Jamy Ard gently puts his finger on the flaw in this thinking:

“The idea that minimal intervention or modest education and behavioral guidance alone should be a first-line treatment for all may be a central fallacy.”

This is an absurd way to go about treating a chronic disease like obesity. We do not withold treatment for hypertension, high cholesterol, or cancer. We encourage people to follow a regimen that works.

Obesity is no different – except for the false presumption that people with obesity don’t deserve effective care. No wonder the problem keeps growing.

Click here for the study, here for Ard’s editorial, and here for a commentary in the Telegraph that takes the hostility toward people a step further.

Bankomat, photograph by Automatid2012, licensed under CC BY-SA 3.0

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May 16, 2024

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