Weight loss incentive programs are strategies designed to motivate individuals to adopt healthier behaviors and achieve weight loss goals through the use of rewards. These programs have gained traction as a potential tool to address rising rates of overweight and obesity. This article explores the various facets of weight loss incentive programs, including their types, effectiveness, and implementation strategies.
The Rationale Behind Weight Loss Incentives
A key barrier to healthy eating is lack of access or enough money to buy nutritious food. SNAP healthy incentives empower Americans to eat more fruits and vegetables, whole grains, and other healthful foods. Improving what we eat can significantly reduce diet-related chronic diseases and disparities.
Rising rates of overweight and obesity are of serious concern in Canada. Until recently, discussion of policy options to promote healthier lifestyles has ignored the topic of direct financial incentives. The idea of paying people to lose weight or adopt healthier behaviours is now attracting study and debate. Canadians of all ages are too sedentary, eat an unbalanced diet and continue to gain weight. The morbidity and mortality costs of overweight and obesity in Canada are reportedly as high as $30 billion annually (Society of Actuaries 2010). Until recently, discussion of policy options to promote healthier lifestyles among Canadians has ignored the topic of direct incentives. This idea is now attracting attention. Key stakeholders in healthcare, including governments, insurers and employers, are showing increasing interest in the use of financial incentives for health-related behavioural change. To control costs of lifestyle-related diseases, governments are interested in ways to motivate citizens to be healthier.
Advocates contend that direct rewards provide an incentive for people to resist the obesogenic lures of modern environments in ways that other measures - such as health education campaigns - have failed.
Types of Weight Loss Incentive Programs
Weight loss incentive programs can take various forms, including:
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Federally Funded Programs
SNAP Healthy Incentives
These incentives are designed to make nutritious food more accessible and affordable for SNAP recipients. A key barrier to healthy eating is lack of access or enough money to buy nutritious food. SNAP healthy incentives empower Americans to eat more fruits and vegetables, whole grains, and other healthful foods. Improving what we eat can significantly reduce diet-related chronic diseases and disparities.
Eligible Incentive Foods: Retailers can offer incentives for foods in the following food group categories: Fruits, Vegetables, including legumes (beans and peas), Whole grains, Dairy foods. Incentives can apply to specific products or any combination of products as long as they fall into one of the categories above and meet the specifications outlined in the chart below.
How SNAP Recipients Receive and Use Incentives: Each SNAP healthy incentive program is different. Generally, a SNAP customer earns incentives, such as a coupon, discount at the point of purchase, or extra funds for SNAP purchases, when they purchase eligible incentive foods with their SNAP EBT card. They can then redeem the incentives to purchase more eligible incentive foods or other SNAP eligible foods.
Examples of Federally Funded Programs:Electronic Healthy Incentives Pilot (eHIP): In June 2023, Colorado, Louisiana and Washington were selected to operate statewide eHIP projects. The grant cycle for these projects runs for four years.
Gus Schumacher Nutrition Incentive Program (GusNIP): GusNIP is a competitive grant program administered by the USDA's National Institute of Food and Agriculture. GusNIP grantees are authorized to provide fruit and vegetable incentives to SNAP recipients. The GusNIP Nutrition Incentive Hub offers a wealth of information about nutrition incentive projects and includes grantee spotlight stories.Healthy Fluid Milk Incentive (HFMI) projects: SNAP participants shopping at select grocery stores receive incentives for purchasing qualifying milk.
State or Local Government Funded Programs
Incentives can be funded by state, local, and tribal governments that partner with SNAP-authorized retailers.
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Privately Funded Programs
SNAP-authorized retailers can independently fund incentive programs or non/for-profit organizations can fund incentives in partnership with stores.
Farmers Market Incentive Programs
Farmers markets are authorized to provide incentives to SNAP recipients to make local foods more affordable and support farmers.
Employer-Sponsored Programs
Companies are also offering incentives for employees to adopt healthier lifestyles. A major US healthcare company, Indiana University Health (formerly Clarian Health) offers a bonus of up to $30 each pay period for employees who meet specified health targets. In Canada, a private company is partnering with organizations like the Canadian Obesity Network and Dietitians of Canada to offer the Best Life Rewarded program. Launched in late 2010, members earn points for healthier behaviours and redeem points for rewards, including fitness equipment, consultations with professionals such as kinesiologists and dietitians, and healthy-living magazines and books.
Individual Investment Programs
Some private fitness centres allow people to invest their own money in weight-loss incentives, for example, by putting in $200 and receiving a portion back as they achieve incremental weight-loss goals.
International Examples
The United Kingdom has established a “nudge unit,” formally known as the Behavioural Insights Unit, within its Cabinet Office to “develop and apply lessons from behavioural economics and behavioural science to public policy making” (Cabinet Office 2010). The UK National Health Service partnered with a weight loss incentive firm, Weight Wins, to trial the Pounds for Pounds program, where participants who achieve and maintain weight-loss targets under medical supervision receive payments up to £425. In Germany, health insurers permit individuals to accumulate points for healthy behaviour, such as participating in nutrition classes, fitness programs or tests of endurance, strength and coordination (Schmidt et al. 2009). Points are redeemable for rewards such as bicycle helmets, sports watches or Wii Fit consoles. People can qualify for cash payments if they meet body mass index, blood pressure and cholesterol targets. The largest national health insurer in South Africa, Discovery Health, offers a health promotion program in which members are eligible for discounted gym memberships and accumulate points for engaging in fitness activities. This tier-based incentive program - with bronze, silver, gold and diamond status categories - entitles the member to discounts on products and services from nationally participating businesses (see www.discovery.co.za for details).
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How to Start a SNAP Incentive Program
The basic steps for starting a SNAP healthy incentive program are:
- Identify funding: Unless you are a federal grantee, you must identify state, local or private funding.
- Select SNAP-authorized retailers: Determine which stores will offer incentives.
- Choose your model: Decide how households will earn and redeem incentives.
- Request a waiver: The funding entity or store must get FNS approval to offer healthy incentives. Federal incentive grantees and farmers markets do not need a waiver.
- Train staff and program operators.
- Market and promote: Make sure all SNAP households have an equal opportunity to participate. SNAP incentive projects must get FNS approval to waive the SNAP equal treatment provision before offering healthy incentives. The SNAP equal treatment provision requires SNAP recipients to be treated the same as other customers. The provision prohibits both negative treatment (such as discriminatory practices) and preferential treatment (such as incentive programs).
SNAP Incentive Waiver Request
The waiver can be requested by the retailer or funding entity. Incentive projects operating at multiple store locations only need one waiver for all locations. A single store may offer incentives funded by multiple sources, but if any portion is funded by a state or local government or private entity, they must first obtain a waiver from FNS. Farmers markets that independently fund incentives for their own market do not need to request a waiver. Incentive projects that are part of one of the federally funded projects listed above, such as GusNIP or HFMI, do not need to request a waiver.
Effectiveness of Weight Loss Incentive Programs
Studies of shorter duration - one to eight months - show that economic incentives result in significantly better outcomes in goals such as weight loss (Volpp et al. 2008; John et al. 2011), physical activity (Finkelstein et al. 2008; Charness and Gneezy 2009) and healthier food and activity choices in families with children (Sepúlveda et al. 2010). Follow-up studies reveal, however, that people who receive short-term incentives typically fare no better a year or more later in sustaining weight loss than those who did not receive payments (Paul-Ebhohimhen and Avenell 2007; John et al.
Available evidence indicates that financial incentives help promote short-term change, but there is a dearth of evidence on longer-term programs and outcomes. Targeted incentives for specific risk groups have shown more success.
Research Findings
Healthy Incentives Pilot (HIP): HIP participants (respondents aged 16 and older) consumed almost 1/4 cup (26%) more fruits and vegetables per day than did non-participants. HIP households spent more SNAP benefits on fruits and vegetables than non-HIP households in participating supermarkets and superstores - $12.05 versus $10.86 on average each month - an increase of $1.19 or 11%. HIP households reported higher total spending on fruits and vegetables than non-HIP households.Food Insecurity Nutrition Incentives (FINI): FINI increased fruit and vegetable purchases by 12-16% in three of the treatment groups. The overall redemption rate for FINI incentives was about 82%. For many retailers, redemption rates and issuance were slow at implementation and improved over time.Gus Schumacher Nutrition Incentive Program (GusNIP): The findings from year two show that participants redeemed more than $20 million dollars in nutrition incentives and produce prescriptions distributed by GusNIP and the program generated an economic impact of about $41 million dollars. In addition, participants reported greater fruit and vegetable intake and improvements in hunger reduction.Farmers Market Incentive Provider Study: This study showed that SNAP redemptions and incentive use tended to grow the longer the incentive program was in operation.Discovery Health Program: A study analyzing five years of data from the program revealed that “engagement in fitness-related activity increases with continued membership [in] an incentives and rewards-based health promotion program” (Patel et al. 2011). Additionally, members with higher levels of physical activity had fewer health insurance claims and lower hospital admission rates for cardiovascular, endocrine and metabolic diseases and cancers (Patel et al.
Factors Influencing Effectiveness
- Program Duration: There is a dearth of evidence on programs that offer longer-term incentives. Paying someone to lose 30 pounds in 16 weeks likely will not help that person keep off the weight over the next year. But offering rewards over longer periods may provide a more compelling incentive to maintain healthier behaviours.
- Targeted Incentives: Because targeted financial incentive programs offered to specific risk groups have shown more success (Sutherland et al. 2008; Marteau et al. 2009), it may be advantageous to offer incentives for weight loss or maintenance of healthy body weight to high-risk groups in contact with the healthcare system. For example, excessive weight gain during pregnancy is unhealthy for the mother and the baby (Davis and Olson 2009), so financial incentives could be offered to women to meet recommended weight-gain guidelines during pregnancy.
Behavioral Insights and Reward Strategies
Rewards work as positive reinforcement; when you reward yourself for a behavior, you’re more likely to do it in the future. Science shows that rewards work best when they’re immediate, meaning you get them right after performing the new behavior, and intermittent, meaning you don’t get them every single time you do that behavior. Weight loss milestones, like losing 5 pounds, are a good time to reward yourself.
Types of Rewards
Food-Related Rewards: It doesn’t make a huge difference what your treat is. But the behavior that results from that treat might have a larger impact. For example, does drinking lead you to eat more? While there’s nothing wrong with a little wine or a little white bread, if having wine leads you to eat more bread than you normally would, then you should be aware of that. If you’re planning on having some wine as your weekly treat, don’t keep bread nearby (or whatever food you think you might reach for).
Non-Food Rewards:
- Take a nap.
- Clean out your garage or a junk drawer.
- Play mini-golf.
The Importance of Avoiding Deprivation
If you’re constantly thinking about cake while dieting and you deprive yourself of it until you reach a certain marker, you are more likely to eventually go overboard. If you make it a more regular occurrence, you’ll be able to enjoy smaller amounts while still being satisfied. The regularity of “treat foods” is important because it removes the guilt associated with these foods. Food should never make you feel guilty. No matter what you’re eating, that food gives you important energy and helps your body function.
Scheduled Treats
When your treats are scheduled ahead of time, it can help remove the guilt, in addition to fitting less-healthy food into the bigger picture of your weight loss journey. Think about your week of meals: if you’re eating well 95% of the time, one treat meal is only 5% of your week.
Managing Setbacks
Eating healthy is hard! A meal or two that don’t quite fit into your plan won’t reverse the progress you’ve made. You might get a little bloated, but you probably won’t gain much weight. Don’t get discouraged because you feel like you’ve fallen off the wagon. If you were on track before, you can do it again! Don’t let an unplanned treat or two make you think that all your efforts are hopeless. The only thing that truly reverses diet progress is letting a mistake defeat you and resorting back to your old ways.
The Role of Rest
Proper rest is one of the most important (and most overlooked) elements when it comes to good health. If you’re tired or stressed, you’re more likely to overeat. Sleep-deprived brains are more likely to reach for “rewarding” foods (i.e. treat foods), making it even more dangerous. The easiest solution? Create a regular sleep pattern. Put away your electronics at least 20 minutes before bed and try to fall asleep at the same time every night. This regularity makes it easier to fall asleep faster and makes you feel well-rested.
Criticisms and Considerations
Yet, it is an overbroad conclusion to say that “[c]ompelling evidence exists to demonstrate that financial reward strategies are not effective” (Spahn et al. 2010) in influencing nutrition and health behavioural changes.
Many weight-loss/healthy-lifestyle incentive programs that have had weak long-term success involved participants who self-selected to participate, for example, by responding to media ads (Spahn et al. 2010).
The Importance of Sustainability
One of the reasons Noom helps people maintain their weight loss is that our personalized programs are sustainable. Noomers aren’t swearing off bread or birthday cake. Instead, the Noom Weight program encourages you to continue enjoying your favorites in moderation.
The longer you keep up your good habits, the easier and more natural they become.
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