ATLANTA - How much money would it take to get you to lose some serious weight? $100? $500?
Many employers are betting they can find your price. At least a third of U.S. companies offer financial incentives, or are planning to introduce them, to get their employees to lose weight or get healthier in other ways.
"There's been an explosion of interest in this," said Dr. Kevin Volpp, director of the University of Pennsylvania's Center for Health Incentives.
Take OhioHealth, a hospital chain whose workforce is mostly overweight. The company last year embarked on a program that paid employees to wear pedometers and get paid for walking. The more they walk, the more they win - up to $500 a year.
Anecdotal success stories are everywhere. Half of the 9,000 employees at the chain's five main hospitals signed up, more than $377,000 in rewards have already been paid out, and many workers tell of weight loss and a sudden need for slimmer clothes.
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But does will this kind of effort really put a permanent dent in American's seemingly intractable obesity problem? Not likely.
"It's probably a waste of time," said Kelly Brownell, director of Yale University's Rudd Center for Food Policy and Obesity.
Brownell's assessment is harsher than most. But the science seems to back him up.
Only about 15 to 20 U.S. studies have tried to evaluate the effect of financial incentives on weight loss. Most of those studies were small and didn't look at whether such measures worked beyond a few months. None could make conclusions about how much money it takes to make a lasting difference for most people.
smoking easier to give up
Perhaps the largest effort to date was an observational study by Cornell University. It looked at seven employer programs, and the results were depressing: The average weight loss in most was little more than a pound.
Sure, there are grounds for optimism. Smaller experiments report some success. And other studies have shown promising results against tobacco. One study published last year in the New England Journal of Medicine, co-authored by Volpp, found that cash rewards of a few hundred dollars nearly tripled quit-smoking rates.
One problem: "Food is more difficult than tobacco," said Steven Kelder, an epidemiology professor at the University of Texas School of Public Health.
While cigarettes can be addictive, people don't need to smoke to live, and advertising and clean-air restrictions curb tobacco's presence. People must eat, however, and sugary drinks and fatty snacks are everywhere, Kelder and others said.
Health officials lament that more than two-thirds of American adults are overweight and one-third obese, and lecture on fat's role in deaths from diabetes, heart disease and other conditions. The problem has a huge economic impact, too, with obese workers costing U.S. private employers an estimated $45 billion or more annually in health-care costs and lost labor. That's according to a report by the Conference Board, a research group focused on management and the marketplace.
Companies tend to be more interested in incentives than disincentives like taxes. But the perks they attach to wellness programs come in a variety of forms and sizes.
Some reward employees just for having a health evaluation or simply enrolling in a class - whether they complete it or not.
Some companies offer money; some, vacation trips. Some refund the cost of Weight Watchers classes. Others reduce health-insurance premiums.
The value of rewards can range from measly to thousands of dollars. Hunches and human resources budgets - not research - often drive decisions about financial-incentive details. Companies are quite frank about it.
firms taking their best shot
Companies "are making their best guesses about what might work and giving it a shot," said Robert Jeffery, a University of Minnesota professor. He's been experimenting with financial incentives and weight loss since the 1970s and is perhaps the most veteran researcher in the field.
If companies asked the experts, they might be counseled to make their incentives more dramatic - more cash or a bigger penalty in premium costs.
Psychologists say people are more motivated by the risk of losing their own money than by a chance they'll win somebody else's. Applying that idea to weight loss, some studies have set up refundable bond systems: Volunteers sign a contract agreeing to lose a certain amount of weight by a certain date or they forfeit their deposited money.
Such programs are voluntary. But critics say that while they may work for a few very motivated people, they may not be effective for most.
Some employers worry that if they go too far, it may seem coercive and even grounds for a lawsuit. "They're very nervous about doing anything that might seem invasive," said Helen Darling, president of the National Business Group on Health.
Online
• Penn research: www.med.upenn.edu/ ldichi/docs/issue_brief_feb _091.pdf
