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Cash incentives work when it comes to losing weight

When it comes to losing weight, cash incentives do work scientists say and reward-based programmes could be the easy way of promoting a healthier diet and fight off diseases associated with excess pounds. 

Overweight and obesity are increasingly prevalent conditions worldwide and they lead to non-communicable diseases such as cardiovascular disease, diabetes and cancer. They have also increased absenteeism among employees and raised private and public healthcare costs. However, they are largely preventable by making healthier food choices and engaging in regular physical activity.

But people have trouble in maintaining a healthy diet as they give in to temptation and they fail to keep  up with a regular exercise schedule. But scientists form Duke-NUS Medical School and Singapore General Hospital led a research that shows that selling rewards programmes to participants entering a weight loss programme is a low cost strategy to increase both the magnitude and duration of weight loss.


Professor Eric Finkelstein from Duke-NUS used insights from behavioural economics to develop a Rewards programme aimed to address the disconnect between long-term health and short-term temptation. He then teamed up with Dr Kwang Wei Tham from SGH to test it out among overweight or obese adults.

In the randomised eight month long Singapore-based Trial on Incentives for Obesity, 161 participants paid S$234 to access a 16 week intensive weight loss programme. The programme required participants to attend weekly sessions at the Lifestyle Improvement and Fitness Enhancement Centre where they were taught skills to maintain a healthy lifestyle and encouraged to lose at least 5% of their body weight.

Participants also paid an additional $165 for the Rewards programme. Participants in the intervention arm could earn monthly rewards either in cash or as a lottery ticket with a one in 10 chance of winning 10 times the cash amount if they met monthly weight loss and step goals.

Additional rewards were offered for meeting 5% or 8% weight loss goals at months four and eight. The maximum possible reward value over the eight month period was $660 if all weight loss and step goals were met.

Those randomised to the control arm had their money returned and were ineligible for rewards.

Scientists fount that after four months, participants in the Rewards group lost twice as much weight than those in the control group. After eight and twelve months, the weight loss remained grater.

The average payout to participants in the Rewards arm was $225.00. After subtracting the fee to access the rewards, third party costs were $60.00 per participant. Moreover, although only 42% of participants earned more than they paid in,  about 80% reported satisfaction with the rewards scheme.


“Our findings not only show the value of rewards to increase weight loss and weight loss maintenance, but they show it can be done in a manner that minimizes third party payments, such as those by employers or insurers. This should help to expand access to these types of programmes.” said senior author Dr Finkelstein, a professor in the Duke-NUS Programme for Health Services and Systems Research.

And scientists argue that even losing a little bit of the excess wight will be beneficial in the long run by decreasing the risks of non-communicable diseases.

“Even small amounts of weight loss, sustained over time, confer great health benefits and can help prevent chronic disease. This study shows that the enhancement and maintenance of weight loss is feasible through a rewards programme with participant ownership, coupled with an evidence-based, medical weight loss programme,” said Dr Kwang Wei Tham, Director of the LIFE Centre.

Since 1980, worldwide obesity has more than doubled. More than 1.9 billion adults are overweight and millions are obese. 41 million children under the age of 5 were overweight or obese according to the latest World Health Organization data.

Sylvia Jacob