Handle of a Money Box

Can Money Prompt Weight Loss? Should It?

In JAMA Pediatrics yesterday, a new RCT tells us that promising money to adolescents with severe obesity can prompt weight loss with meal replacements. Every teen in this study received free pre-portioned and calorie-controlled meals. But half of them received a $20 gift card for every 0.5% they lost from their body weight at the start of the study. Each group followed the program for 52 weeks.

The teens getting the meals plus the payout reduced their BMI by seven percent. Without the payout, the control group cut their BMI by only one percent. The authors conclude:

“It is possible that incentives allowed participants to better adhere to the meal plan over the course of the year, resulting in meaningful BMI and body fat reduction.”

In other words, following a meal replacement program for a whole year might be a bit of a stretch for adolescents unless there’s a financial reward for doing it.

A Sound Study, but Maybe Not the Best Strategy

This was clearly a rigorous study. Subjects received random assignments to their group – without knowing that the financial incentives (or lack of them) was the whole point of the study. Patients in the control group only learned about the financial incentives after the fact.

But money for weight loss might not be the best strategy for helping teens cope with severe obesity. Pediatrician Aaron Carroll expresses reservations in an editorial published alongside this study. He says he would typically cheer for results like this. Given all the other options we now have for obesity treatment, though, he writes “I just can’t.”

“One reason researchers have been trying to create successful interventions for weight loss is that obesity is so bad for health, especially in the long term. Behavioral interventions keep getting more and more complicated because they don’t work well, except in extreme circumstances, and often in ways that defy implementation. Maybe it’s time to stop focusing on them. While I applaud the authors of this article for their efforts, there’s a part of me that hopes this is the last such study I’ll need to review.”

Yes, the world is moving on from old ways of thinking about obesity and its treatment.

Click here for the study, here for the editorial, and here for perspective on another such study in adults.

Handle of a Money Box, photograph © by August Geyler, licensed under CC BY-SA 4.0

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June 18, 2024

4 Responses to “Can Money Prompt Weight Loss? Should It?”

  1. June 18, 2024 at 6:46 am, Alfred B Lewis said:

    What we learned from the old outcomes-based wellness programs with $1000 at stake, and even watching Oprah Winfrey, who had more money at stake in weight loss than anyone on earth, is that money can prompt weight loss (in adults) but not weight maintenance.

    Might be different in children.

  2. June 18, 2024 at 8:12 am, Marta Kostka said:

    I think that the editorial was written by Aaron E. Carroll, not Aaron Kelly.

    • June 18, 2024 at 9:54 am, Ted said:

      Corrected. We regret the error.

  3. June 18, 2024 at 9:35 am, Allen Browne said:

    Physiology cannot be bribed. But now we know how to make it healthier.