There are plenty of reasons for Welmoed Sisson to lose weight. She'd feel better, be healthier and fit into that skirt she wore 20 years ago before she became obese. She knows all this, and yet there may be only one incentive powerful enough to get the 49-year-old resident of Gaithersburg, Md., to pass on the delicious steaks her husband cooks. The motivator? Cold, hard cash.
Financial incentives are the latest wellness craze, inspiring at least some of the nearly two-thirds of Americans who are overweight or obese to try to ditch their potato chips. A few years ago, in an effort to cut overall health care costs, companies started dangling gift cards, free cruises and even cash prizes to employees who shed excess pounds. Now an independent website is offering to pay anyone who drops a certain amount of weight over the course of a year.
Since HealthyWage.com launched in October, Sisson and some 5,000 other hopefuls have signed up for the site, which gets corporate sponsors to give a cash reward to obese users who during a specified time period move from an unhealthy to a healthy body mass index (BMI). (This typically translates into a weight loss of between 30 and 80 lb.) Members can either sign up for free according to a company rep, the final deadline to enter the next 12-month challenge is Jan. 20 and win $100 or "super-size" their weight-loss incentives by putting as much as $300 of their own money on the line in order to up the stakes to $1,000.
"Sure, I'd like to look and feel better," Sisson says, "but it is so subjective. Money is a better motivator because it is tangible. You can hold it in your hand."
And Sisson isn't the only person who feels this way. According to a 2008 study published in the Journal of the American Medical Association, dieters who had a financial incentive to lose weight were nearly five times as likely to meet their goal when compared with dieters who had no potential for a financial reward.
"Employers and individuals are desperate for a new approach," says Dr. Kevin Volpp, lead author of the study and director of the Center for Health Incentives at the University of Pennsylvania School of Medicine and the Wharton School. "We will undoubtedly see more of these programs and initiatives in the future."
HealthyWage, which makes money through advertising and sponsorships, claims it can save the health care system $1,150 in obesity-related costs for each person who slims down to a healthy BMI. But the challenge is hardly an easy payout. Sisson, who tips the scales at just over 200 lb., will have to lose 50 lb. in a year and check in with the site about her food intake and physical activity every week. She also has to get her physician to call HealthyWage to verify her weight at the beginning and end of the challenge.
That makes it tough for Sisson to cheat, which she says is a "good thing." Last year, she signed up for stickK.com, a site founded by Yale economics professor Dean Karlan, whose research has shown that signing commitment contracts and publicly announcing a goal helps people stick to it. (The extra K in stickK is shorthand in legal writing for "contract.") Users are not required to wager any money when they sign up, but the serious ones do. Some 30% fork over their credit card information upfront and specify how much money should be automatically charged if they fail to reach their goal. These users also designate a recipient: a person, a charity or, as an additional incentive, an "anti-charity," i.e., an organization on either side of several highly controversial issues. (Think pro-life or pro-choice advocacy groups or the presidential libraries of Bill Clinton or George W. Bush.)
Telling your friends about your goal and staking some money on your success is a powerful combination. Says Karlan: "It increases the price of vice and lowers the price of virtue. We think of it as Facebook with a purpose."
Since stickK was first launched in January 2008, more than $3 million has been put on the line. But the site relies on the honor system, and with a self-reported 70% success rate among users who pledge money, only $116,000 is scheduled to be paid out in 2009. (For various reasons, disbursements to charities are made in lump sums at the end of the year.) Karlan knows there are cheaters among the site's 50,000 users, and Sisson admits that she is one of them. She says she lied in 2008 about achieving her goal of losing 25 lb. in three months so she wouldn't have to cough up the $200 she had pledged to an anti-charity. Because there's such an easy out, Karlan encourages people to assign an independent referee such as a friend or co-worker to monitor their progress. Next year, the site will begin partnering with corporations like Staples that want to use the platform to help motivate employees to achieve performance-related goals.
After her flameout on stickK, Sisson is working hard to make good on her goal on HealthyWage. With a steady weight loss of 4 lb. in four weeks, she may win the prize money in 2010. But the even greater challenge, Volpp says, will be keeping the weight off. Little is known about the link between financial incentives and long-term weight loss. Maybe by 2011 a website will start offering cash bonuses to users who maintain a healthy weight.