There are few variables that matter more in dealing with a weight issue than the almighty MOTIVATION. Successfully losing weight is a function of 1) starting and 2) sticking with it. At some very basic level, it’s really not much more complicated than this. Of course, motivation is an easy word to toss around, but it’s not such an easy quality to summon and keep with us. Motivation has a nasty habit of not being there when it’s most needed. It also has a bad habit of becoming suddenly shy and receding into the dark corners of our minds.
All of this begs the question about how exactly to find motivation and how to make it stick around. It’s obvious to state that motivation is much easier to find when we are, well, motivated. When something truly matters to us, it’s easier to stay motivated. When we have a goal that we truly desire, we can stay motivated. If there is someone pushing us, it can help maintain motivation. Given this, there must certainly be external aids that help us find motivation and then keep it around.
Over the past few years, I’ve had the opportunity to be exposed to a fascinating little corner of the world of health, known as healthcare economics. A big part of healthcare economics centers around the notion of how money and incentives can help nudge us into doing things that we might not otherwise be fully motivated to do. This is hardly an alien concept in the world we live in. We work hard with the hopes of making money. We save with the hopes of keeping our money. We invest with the hopes of making our money bigger. It may sound mercenary and shallow, but there is no avoiding the magnetic forces of financial incentives.
There are a group of folks that are dedicated (at least partially) to the study of how incentives can influence behaviors when it comes to health. One particular group of these researchers that I’ve had the opportunity to get to know pretty well belong to a research group at the University of Pennsylvania Medical School, called the Center for Health Incentives and Behavioral Economics. It’s a joint effort between academics and researchers at U Penn and Carnegie Mellon. Some of their notable members include Kevin Volpp, George Lowenstein, Scott Halpern among others. They are an interesting group in that they are all at once practicing physicians and psychologists as well as being economists. They study the application of incentives to areas such as smoking cessation, obesity and others. They are crazy smart, but also incredibly nice guys who are trying to make a positive impact in the world — no matter how scary the subject matter can sound (!).
Kevin Volpp asked me to write a piece on the subject of health incentives to weight loss, and I agreed. It then occurred to me that it might be an interesting subject for a blog post. So here you go! For all you fellow Mathletes (yes, I was one, so please don’t give me a wedgie), put on your seat belts.
Back to motivation… How could finance incentives be potentially used as a weapon in our arsenal to make this very difficult change in our life? It’s a big wide open topic that I could never hope to do full justice in a brief(ish) piece, but allow me to take a brief crack at it.
Let’s start with a discussion about where motivation is needed. In my last magazine column, I summoned my inner-nerd (maybe it’s outer too) by referencing a principle of physics: the force required to set an object into motion is greater than the force required to keep an object in motion. The reason force is required at all is for the simple reason that there is friction all around us. It is what keeps us from sliding across the floor, and it is the force that causes a refrigerator to sit still even when you try to push it. The greater the friction, the greater the force required to create motion. Because friction is always around, objects have a tendency to revert to a point of rest.
It’s easy to see how this applies to the process of becoming healthy. In the case of weight issues, friction can come in the form of ingrained habits that are hard to dispel. Friction can be the powerful wants in our brains for foods that aren’t particularly good for us. A huge source of friction for many of us is procrastination, rivaled by the friction of boredom. These forces seem perfectly oriented to keep us from getting started or making progress.
So if we need to overcome these frictions, what are forces we can use to push past them? Can want for money be used in a constructive way? To test the theory, let’s break the problem into two areas:
1: Getting started
The cards in the obesity deck are frankly stacked against us. As much as we’d all like to weigh less and be healthier, we all know that it takes work. We all recognize we will have to give up some of the things (at least in quantity) that gave us our weight problem in the first place. We know that there is no easy fix and that it will require effort. Worse, we also know that most of the health issues associated with a weight condition are years down the line, yet that damnable blueberry muffin is right in front of us. Hence, there are few things easier on Earth than procrastinating the process of changing our lifestyle and habits and becoming healthier. Seriously, can’t it wait?
The inherent issue with procrastination is that it reflects the basic challenge of long term benefit vs short term indulgence. We are all human, and the short term indulgence wins the race more frequently than we can count. However, what if the the long term benefit suddenly became a right now benefit? This is where a financial tool could come into play. If someone were to tell me that I could have a million dollars if I lost a pound, I’d take that deal. More practically, I’ve seen people use the specter of a life insurance exam to get their head into the game and lose weight. Other examples could include:
- Agreeing to lower your health insurance premium if you agree to reach a goal
- Giving you the chance to win a lottery if you hit a certain goal
- Giving you a monetary award up front, but allowing you to keep it only if you reach your goal
- Doing the above with a group of people
2: Keeping going
For many of us, the big challenge in keeping a weight loss effort going is having it matter week after week. It’s one thing to pull together the energy and resolve to get started, but it’s all too easy to see this early vigor fade away. How might we use money rewards or penalties to keep our heads in the game?
- One that’s become increasingly popular is to form a challenge where the winning team to win a pot of money at the end if they do the best
- Weight loss bets are a time-honored tradition among guys losing weight. At the beginning of the challenge, everyone puts money in the pot. Those that don’t meet their goal, lose their money while those that do get to split all the money left in the pot.
- One website, stickk.com, uses a novel approach in which you put money in upfront, and if you don’t reach your goal, the cash gets sent to the charity of your choice.
- There are increasing examples of companies that will set up rewards programs, like frequent flier, that allow you to win prizes, gifts and cash the more you participate and achieve
There is a lot of research behind all of the above. One thread of work shows that we humans would rather not lose money vs. winning money. It’s called loss aversion — this is the theory behind the program at stikk.com. There is other research showing the promise of team efforts and lotteries.
For me personally, I used a weight loss bet with four of my colleagues to jump start the weight loss effort that finally got me to my goal. Ironically, I didn’t get to my goal by the end of the bet, but it got me most of the way there. I think I still owe my friend Mike about a hundred bucks (he was too nice a guy to collect from the losers).
Research is showing that all of the above can have a pretty positive effect in helping to stimulate and motive change in our behavior. Keeping engagement going and having a weapon to fight off procrastination can give us the nudges we need to be successful. However, I also have misgivings. A carrot for one person can turn into a stick for someone else, and I firmly believe that obesity should never be punished. Getting a reward for achieving a goal can be something positive if done the right way for the right reasons. It’s a pretty slippery slope, but I’ve seen it done well.
Thank you for suffering through a particularly long post. Since you’ve gotten this far, I would love to hear from any of you that have used money to push your weight loss effort along. Think of it as your contribution to research!