Ananthapavan J, Peterson A, Sacks G. Paying people to lose weight: the effectiveness of financial incentives provided by health insurers for the prevention and management of overweight and obesity – a systematic review. Obes Rev. 2018; 19:605-613

Ashcroft RE. Personal financial incentives in health promotion: where do they fit in an ethic of autonomy?. Health Expect. 2011; 14:191-200

Department of Health and Social Care. New specialised support to help those living with obesity to lose weight. 2021. (accessed 20 May 2021)

Grannell A, Fallon F, Pournaras D, le Roux CW. Exploring patient beliefs and perceptions regarding obesity as a disease, obesity causation and treatment. Ir J Med Sci. 2021; 190:163-168

Hagoel L, Rennert G, Feder-Bubis P. Laypersons' views of material incentives for enhancing colorectal cancer screening. Health Expect. 2013; 18:1194-1203

Harcombe Z, Baker JS, Davies B. Evidence from prospective cohort studies does not support current dietary fat guidelines: a systematic review and meta-analysis. Br J Sports Med. 2017; 51:1742-1748

Do we need to pay people to lose weight?. 2021. (accessed 20 May 2021)

Judah G, Darzi A, Vlaev I Financial disincentives? A three-armed randomised controlled trial of the effect of financial Incentives in Diabetic Eye Assessment by Screening (IDEAS) trial. Br J Ophthalmol. 2018; 102:1014-1020

Lee C, Kwak S, Kim J. Controlling COVID-19 Outbreaks with Financial Incentives. Int. J. Environ. Res. Public Health. 2021; 18

Ludwig DS, Ebbeling CB. The Carbohydrate-Insulin Model of Obesity Beyond “Calories In, Calories Out”. JAMA Intern Med. 2018; 178:(8)1098-1103

Malhotra A, DiNicolantonio JJ, Capewell S. It is time to stop counting calories, and time instead to promote dietary changes that substantially and rapidly reduce cardiovascular morbidity and mortality. Open Heart. 2015; 2

Molema CCM, Wendel-Vos GCW, Puijk L A systematic review of financial incentives given in the healthcare setting; do they effectively improve physical activity levels?. BMC Sports Sci, Med Rehabilitation. 2016; 8

Moller AC, McFadden HG, Hedeker D, Spring B. Financial motivation undermines maintenance in an intensive diet and activity intervention. J Obes. 2012; 2012

Paloyo AR, Reichert AR, Reinermann H, Tauchmann H. The causal link between financial incentives and weight loss: an evidence-based survey of the literature. J Econ Surv. 2014; 28:(3)401-420

Patel MS, Asch DA, Troxel AB Premium-based financial incentives did not promote workplace weight loss in a 2013-15 study. Health Aff. 2016; 35:(1)71-79

Tambor M, Pavlova M, Golinowska S, Arsenijevic J, Groot W. Financial incentives for a healthy life style and disease prevention among older people: a systematic literature review. BMC Health Serv Res. 2016; 16 Suppl 5

Yancy WS, Shaw PA, Wesby L Financial incentive strategies for maintenance of weight loss: results from an internet-based randomized controlled trial. Nutr Diabetes. 2018; 8

Weight loss and financial incentives: a flawed scheme?

02 June 2021
4 min read
Volume 32 · Issue 6


The use of financial incentives in healthcare is controversial. George Winter looks at the evidence behind these schemes

Financial incentives shape our daily routines – for example, if we do not work, we do not get paid – but to what extent should they shape our health choices and/or those of others? Asserting our autonomy entails behaving according to our individual preferences and values, free of both influence and coercion, and when Ashcroft (2011) sought to reconcile financial incentives with the concept of autonomy, he concluded that ‘they [financial incentives] may be in general or in specific instances paternalistic, coercive, involve bribery, or undermine the agency of the person.’ It seems reasonable to suppose that financial incentives may risk undermining the moral integrity of decision-making.

But what does the evidence show? When Korean mathematicians Lee et al (2021) devised an epidemic model to investigate the theoretical role of financial incentives to see how they might usefully address the COVID-19 pandemic, they found that ‘the larger the incentive budget is, the faster the epidemic will end’, but also included this subtle qualifier: ‘it is assumed that there is no moral hazard for rewards …’. In the real world, however, such an assumption might evince unwarranted optimism. For example, citing studies of negative outcomes of financial incentives – including reduced patient motivation and adverse effects on the trust that is intrinsic to a doctor-patient relationship – Hagoel et al (2013) reported that laypersons in an Israeli population they questioned ‘found administering incentives in exchange for colorectal cancer screening inappropriate on rational and moral grounds’; in a literature review by Tambor et al (2016), they found that ‘qualitative studies indicate limited trust of older people in the use of explicit financial incentives for health promotion and prevention’; a UK study by Judah et al (2018) concluded: ‘Financial incentives, particularly lottery-based incentives, attract fewer patients to diabetic eye screening than standard invites in this population’; and the title of a study by Moller et al (2012) – ‘Financial Motivation Undermines Maintenance in an Intensive Diet and Activity Intervention’ – summarises their findings.

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