Paying for Weight Loss

Weight loss is one of the most confounding, complicated topics in all of nutrition — no one seems to truly know all of the factors that determine whether or not someone loses weight (and keeps it off) and how these factors interact. But as researchers attempt to put together the weight-loss puzzle, some of the pieces may be surprising — such as the relationship between financial incentives and weight loss.

As we noted here at Diabetes Flashpoints a few years ago, giving people a financial incentive to lose weight can have dramatic effects in a study setting. In that study, people who were given financial incentives to lose weight and stay in a weight-loss program lost an average of over 9 pounds, while those who participated in an otherwise identical program without incentives lost only 2.3 pounds. But some researchers have also speculated that incentives to lose weight may work in the other direction — that if you pay for a weight-loss program out of your own pocket, you’re more likely to succeed at it than someone who has no investment at risk.

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To test this hypothesis, in a recent study published in the journal Obesity, researchers looked at a weight-loss program that enrolled both 480 people with employer-provided insurance — who paid nothing to participate in the program — and 463 people who paid out-of-pocket. There were some notable differences between the two groups — for example, participants with insurance tended to be younger and have a lower body-mass index (BMI), while those paying out-of-pocket tended to live in higher-income neighborhoods.

As noted in an article on the study at MedPage Today, after 12 months, there were no significant differences in weight loss between the two groups, after controlling for factors that could have affected the results like age, starting BMI, sex, and neighborhood income status. Members of both groups lost a significant but virtually identical percentage of their body weight, on average: 13.4% for the insured group, and 13.6% for the out-of-pocket group. The only significant difference was that people who paid out-of-pocket were more likely to drop out of the study, with a dropout rate of 17.6% versus 12.7% for the insured group.

This study appears to debunk the idea that having your own money at stake makes you more likely to succeed at a weight-loss program — in fact, you may be less likely to succeed, since you’ll always have a financial incentive to drop out if you’re not pleased with the program for any reason. Providing weight-loss programs for free, through insurance — or even paying people to participate — seem to be better strategies for maximizing both participation and total weight lost.

What’s your view on paying for weight-loss programs — would you pay for a program out-of-pocket? Do you think you’d be more likely to participate in a program, and stick with it, if it were free? Should insurance plans consider paying overweight or obese people to take part in weight-loss programs, or is this unfair to people who don’t need to lose weight? Leave a comment below!

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