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Study Shows That Cash Incentive Can Get People off the Couch
By Denise Mann
WebMD Health News
Reviewed by Louise Chang, MD
May 29, 2012 -- Knowing you need to make healthy lifestyle changes like exercising more and eating less fat is, as most anyone knows, a lot different from actually doing it.
Now new research shows that cold, hard cash may help more people make -- and maintain -- such changes.
According to the study, adults were more likely to eat better and spend less time channel surfing on the couch when they kept a digital record of their diet and activity -- and received $175 for meeting their health goals during the three weeks of the study.
The findings appear in the Archives of Internal Medicine.
The new study included 204 adults aged 21 to 60. All ate a diet high in saturated fat and low in fruits and vegetables when the study began. They also got little exercise each day and had high amounts of inactive leisure time.
Participants were placed into four groups, asking them to:
- Eat more fruits and vegetables and exercise more.
- Decrease the amount of unhealthy fat in their diet and spend less time on the couch.
- Eat less fat and exercise more.
- Eat more fruit and vegetables and decrease couch time.
A Little Cash, a Lot of Changes
Study participants uploaded information on their progress into a hand-held device, which was then sent to a coach. Those who met their goals after three weeks got $175.
Once the three-week study was completed, participants then got $30 to $80 for sending data to their coach for five months. They were no longer asked to meet health and fitness goals, just to report on their daily activities and eating patterns.
Yet the changes stuck.
- The servings of fruits and veggies increased from 1.2 per day on average when the study started to 5.5 at the end of three weeks. They leveled off to 2.9 at the five-month follow-up.
- Time spent on the couch decreased from an average of 219.2 minutes per day before the study to 89.3 minutes at the end of three weeks and then to 125.7 at the end of the follow-up period.
- The average number of calories from artery-clogging saturated fat fell from 12% of daily calories to 9.4% at the end of the three-week study, and rose slightly to 9.9 % at the five-month follow-up.
About 86% of participants who were interviewed at the end of the entire study said they tried to maintain healthy changes once they had made them.
"The implication is that we paid these people enough money to make large changes," says researcher Bonnie Spring, PhD. She is a professor of preventive medicine at the Northwestern University Feinberg School of Medicine in Chicago. "I think, in part, the money caused them to surprise themselves, and when we took away the financial incentive, they still tried to keep it up."
The healthy habits with the greatest staying power were eating more fruits and vegetables and decreasing inactive time, the study shows. "The cutting down of TV watching predicted the drop in fat calories," says Spring. "There is a hand-to-mouth pattern like eating popcorn at the movies."
There's an App for That
You don't need to take part in an organized study to reap these benefits, Spring says. "Just because someone else isn't offering you an incentive doesn't mean you can't arrange one," she says.
Reward yourself for making healthy changes or losing weight.
Also, Spring says, it wasn't the coach or coaching as much as it was the keeping track and perception of support. "This can be accomplished by writing down what you eat and/or your physical activity."
William Riley, PhD, wrote an accompanying editorial. He is a clinical psychologist and program director for the National Heart, Lung, and Blood Institute, in Bethesda, Md.
There are certain habits that are more easily changed than others, he says. "Increasing fruit and vegetables and reducing sedentary activity are relatively easier than some of the other targets."
The money helped, too. "The role of an incentive was useful and changed behavior quickly," Riley says.
It is also relatively simple for individuals to monitor and track their own behaviors. "There are many apps on smart phones that can track diet and exercise," he tells WebMD. "Self-monitoring even without an established program can monitor how many fruits or vegetables a person eats or the amount of time they spend sitting in one place, and provide feedback."
Gradual Changes More Likely to Stick
This is a "welcome study," says Scott Kahan, MD, MPH. He is the director of the National Center for Weight and Wellness in Washington, D.C. "This and other studies that use technology and incentives to change health behavior have been pretty positive, but after longer follow-up, the differences tend to go away."
The real issue is how to make these changes stick for the long-term.
Remember that Rome wasn't built in a day, says Michael Aziz, MD. He is an internist at Lenox Hill Hospital in New York and author of The Perfect 10 Diet.
"Changes should be gradual," he says. "If you push everything at same time, people get overwhelmed."
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