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 “Most people assume that people are rational, but we know that this
is not true. People are irrational but in predictable ways,” said
lead author Dr. Mitesh S. Patel of the Perelman School of Medicine
at the University of Pennsylvania in Philadelphia.
Patel’s group studied 281 overweight or obese adult employees who
enrolled online. Participants reported their height and weight, and
used a smartphone step-counter app to track their activity levels
for 13 weeks.
On average, U.S. adults take about 5,000 steps per day. For this
study, participants were given a goal of at least 7,000 steps per
day and then randomly divided into four groups. One group received
no incentives, another received $1.40 for each day they met the
goal, another lost $1.40 from a monthly incentive ($42) each time
the daily goal was not met, and the last group drew lottery numbers
for a chance to win $50 which they could only collect if they had
achieved 7,000 steps on the previous day.
All received daily feedback on their step count.
The loss-incentive group met their step goal on 45 percent of days,
compared to 36 percent of days in the lottery group and 35 percent
in the gain incentive group. Those in the comparison group with no
incentive only met their goal on average 30 percent of days, the
researchers reported in the Annals of Internal Medicine.
During the following weeks, when step count was still reported but
no incentive was offered, step counts decreased for all groups.
“According to a few seminal behavioral economics experiments, people
don't like losing something twice as much as they like gaining the
same thing, as a rule of thumb,” said Marc Mitchell of the
University of Toronto, who was not part of the new study.
A more tailored design might have yielded different results – like
if the researchers had measured how much each person was walking
before the study and asked them to increase their step count by
2,000, rather than setting the same goal for everyone, Mitchell told
Reuters Health by email.
“Just tracking activity using a smartphone or wearable device will
help, but for those who are overweight or obese or have a chronic
condition tracking alone is unlikely to boost activity,” which is
where a financial incentive comes in, Patel said.
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“About 80 percent of employers in the U.S. use financial incentives
of some kind in wellness programs,” he said.
Most simply lower insurance premiums if employees achieve health and
wellness goals, he noted.
Many are moving to more penalty based schemes given the short-term
financial benefit for the company, but this may not be a good way of
promoting quality health behavior change, Mitchell said.
“For most employer wellness programs around the country, you do
something, you get paid for it,” Patel told Reuters Health by phone.
“Sometimes relatively soon, sometimes off into the future.”
In this case, the gain and loss incentives were the same, only
framed differently depending on the group, he said.
This technique of framing the incentive comes from previous work in
behavioral economics, Patel said.
He added, “I think the evidence is clear, these financial incentives
could be better designed if they were based on insights from
behavioral economics.”
SOURCE: http://bit.ly/1QGxTgy Annals of Internal Medicine, online
February 15, 2016.
(This version of the story has been refiled to fix typos in
paragraphs one and two)
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