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Researchers find financial incentives lead obese people to exercise more

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Researchers at Stanford and the University of Michigan recently found that an insurance policy that offered lower rates for obese customers who participated in a walking program was successful in getting these patients to exercise more.

The study was conducted with customers of the Blue Care Network, which has previously used similar policies to try to incentivize healthier lifestyles among its customers.

When obese participants had to choose between exercising and paying 20-percent higher health insurance costs, 97 percent of the participants who committed to a regular, Internet-tracked walking program followed through with it and walked an average of 5,000 steps a day or more.

“This was a great way to study how these programs do in the real world with financial incentives that would usually be allowed,” said

Donna Zulman ’00, a medical instructor and the paper’s lead author. “These were people who were deciding to enroll in something offered by their insurance companies in a real world setting, and we just stepped in to understand how things were working.”

In order to qualify for participation, patients had to have a Body Mass Index of at least 30, the cutoff for obesity. To receive the financial incentive, participants agreed to walk 5,000 steps per day and wear a pedometer that tracked their step count.

Approximately 15,000 patients qualified based on their weight, and 12,000 agreed to participate. Half participated in the walking program, and the other half participated in another wellness program, such as Weight Watchers.

According to Zulman, the researchers’ main goal was to examine the effectiveness of incentivized health programs, although they were also interested in tracking participants’ perceptions of the policy.

“We were primarily interested in whether people would agree to participate in a program for physical activity, and if they agreed, whether they would actually participate and meet the goals of the program,” Zulman said.

The research team found that adherence rates were surprisingly high, with University of Michigan Assistant Professor Caroline Richardson, a senior author of the paper, noting that “almost the entire cohort” stuck with the program for the whole year.

Though Zulman said that most participants were willing to take part, the study and similar programs have proved controversial, allegedly inducing altered eating and exercise habits by applying financial pressure.

“Historically, we have said that it is unethical to force people to change their health behaviors,” Richardson said. “While these people weren’t actually forced and could have chosen not to participate in the walking program, the cost was so high if they didn’t that it felt to them like they were being coerced.”

According to Richardson, many of the participants who initially felt coerced still continued through the study and appreciated the health improvements they saw over time. Richardson said that the results were surprising compared to other studies of pedometer-based walking programs the researchers have done.

“In those [other] trials we haven’t given people a big discount on their health insurance, so our enrollment and adherence rates have been relatively low,” she said. “But in this program, because of the big financial incentive, everybody did it. And they stuck with it for a full year, which was really unexpected.”

Zulman said that study’s results prove that similar programs may be effective in encouraging greater patient health.

“Overall, what we found was that the program was acceptable to many people, and that most patients were able to meet their physical activity goal,” she said. “We feel that this is an opportunity to encourage physical activity among individuals who have health risks associated with obesity.”