Slim Down or Pay Up

Obese people incentivized through healthcare costs to engage in healthy behavior

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) It’s a topic that is sure to spark debate – is making obese adults pay more for health insurance unless they commit to a healthier lifestyle coercive and discriminatory or is it fair and good for society? And given the choice, will people make healthy changes or will they hand over the cash?

As obesity rates have risen, the cost for healthcare problems associated with being seriously overweight has gone up as well.

This has prompted some employers and insurance companies to create wellness programs (often using online tools) that reward healthy behaviors with financial incentives in an attempt to lower healthcare costs.

In a new study examining one such program, researchers found a high level of employee participation and acceptance of the program.

"Park in the back of the lot to get in some extra walking."

This study, led by Donna M. Zulman, MD, MS, of Stanford University and the VA (Veterans Affairs) Palo Alto Health Care System, looked at a large Midwestern US insurance company launching a program in 2010.

The authors estimates that obesity can account directly for 6 percent of adult medical expenditures in the US, not counting indirect costs associated with increased risk of conditions like diabetes, cardiovascular disease and certain cancers.

Participants were given a free pedometer that stores data online and were required to walk an average of 5,000 steps daily during each three month quarter over the year.

If they did so, they were eligible for enhanced benefits that resulted in savings of around 20 percent of their out-of-pocket healthcare expenses. The authors estimated that for some families, this amounted to savings of $2,000 over the year.

At the start of the program, 12,102 obese employees (with a body mass index over 30) were considered eligible to participate. Of this group, 6,548 opted to participate in the internet-mediated walking program.

At the end of the year, researchers found that participants logged an average of 6,523 steps per day, well above the 5,000 step goal. This increased to an average of 7,500 steps per day among those who uploaded counts for 75 percent of the days out of the entire year.

In an online survey of participants (with a 12 percent response rate), 51 percent reported appreciating the program for improving their health and decreasing their healthcare costs, while 31 percent reported not liking the program, with many making comments about feeling coerced into participating due to the financial incentives.

Another 17 percent of survey responders reported that they were not pleased about the program initially, but that after participating they came to appreciate the benefits.

While this study shows a high level of participation and a largely positive response upon completion, it does not evaluate the physical health benefits to participants or the effect on healthcare costs for employers, participants or insurers. Further research will need to explore these outcomes.

Fitness and training expert Jim Crowell, owner and head trainer at Integrated Fitness in Pittsburgh, told dailyRx news that this increase in physical activity will likely have a positive effect on health.

However, Crowell warned that any feelings of being "forced" into a program will likely cause resistance and limit positive results.

"I have worked with a myriad of different people and different demographics but one thing typically reigns true....they will resist being 'forced' into things," said Crowell. "They want to feel empowered, they want to feel good about their workouts, and they want to see progress."

"Many people have mental barriers that they need to work on in order to eat healthier and live healthier in the long run and I have had far greater success implementing a great community of people who feel empowered and supported," explained Crowell. 

Crowell suggested that companies create programs that couple incentives with life coaching and community to see more drastic results in the fight against obesity. 

The study was published by Translational Behavioral Medicine on May 8. One of the study’s authors is an advisor to the internet walking program used and a consultant to the healthcare network involved in the study. However, she is not paid for either role and has no financial interest in the companies.

Reviewed by: 
Review Date: 
May 8, 2013
Last Updated:
October 17, 2013