I was troubled by this article in NewScientist (“Could paying people to lose weight help tackle obesity?” Grace Wade, NewScientist (29 June 2024, paywall)):
A growing body of evidence suggests that paying people to lose weight could be an effective treatment for obesity. While this seems to imply that the condition boils down to just lifestyle choices – an idea doctors have moved away from in recent years – it probably isn’t that simple.
Indeed, while it’s popular among the population and non-specialists to blame the obese, quite often they have little control over what their body does with consumed calories. From how the brain is trained in infanthood onwards to the content of their gut biome, there are many factors that affect body fat levels.
Can they be overridden? Not cured, I’m saying, but simply not fed? The body, from toes to brain, of an adult is accustomed to operating on its standard inputs, as mediated by the chemical that extract and transform food into something useful, and upsetting that balance can upset performance in their chosen fields.
And the use of a payment is a form of coercion, given the influence of wealth over most Westerners. Do we want to coerce folks into lowering their weights to healthier levels? Is this wise?
It’s not a rhetorical question. While an individualist might answer No, a communalist, someone who believes the best interests of society, which as a whole exists as a separate entity, must also be considered, might answer Yes.
And what are the numbers, anyways?
For example, a 2022 US study offered 660 people with obesity in socioeconomically disadvantaged neighbourhoods the chance to take part in a one-year weight-loss programme, made up of a personalised nutrition plan. About a third of the participants could also receive up to $750, depending on how much weight they lost. After six months, about 49 per cent of those with the prospect of getting paid had lost 5 per cent of their body weight, which is often considered the benchmark for a successful weight-loss intervention. The same was true for only 22 per cent of the participants who were just given the nutrition plan.
A similar UK study published in May involved researchers sending daily text messages with weight-management advice and educational resources to nearly 400 men with obesity, of whom 196 were told they would get £400 ($490) at the end of the one-year trial. The catch? The sum would dwindle if they didn’t hit certain weight-loss goals. Weight fell by around 5 per cent, on average, in the financial incentive group, compared with about 3 per cent in the text-only group.
It’s something to think about.
