Should we pay people to lose weight?

By Amanda Johnson 24/09/2009

I was interested to read reports recently in the media proposing a smart card (an electronic subsidy system) to help those on a low income eat healthily and lose weight. It would apparently be aimed at reducing food insecurity and encouraging consumption of healthy foods in low- and middle-income families with children to reduce New Zealand’s high rate of obesity.

Obesity and overweight are certainly a significant problem in New Zealand, with one adult in three overweight and a further one in four obese. Among children, body size is also an issue, with one in five children overweight and a further one in twelve obese

The idea of financial incentives to reduce obesity is not new. An article in the UK newspaper The Daily Mail last year reported that Government plans to tackle obesity included the idea that ’the Health Service and employers could give vouchers to the overweight to spend on healthy food in supermarkets.’ They also suggested that those who manage to lose weight could be given cash prizes!

But what really motivates us to lose weight? You’d think the adverse health risks would be a strong motivating factor — many people in New Zealand are living with obesity-related health problems such as Type 2 diabetes, hypertension, dyslipidaemia and osteoarthritis, but still, even in the face of such problems, it is extremely difficult for many to find the motivation to lose weight while living in an environment where there is an abundance of highly palatable energy-dense foods and a complete lack of necessity for physical exertion.

But would a financial incentive encourage people to shed the extra kilos?

An intervention study in the Journal of the American Medical Association in December last year looked at financial incentives for weight loss; the authors found that economic incentives produced significant weight loss during the 16 weeks of intervention, although this was not fully sustained. They recommend longer-term use of incentives should be evaluated.

Research published earlier this year in the USA suggests, based on limited evidence, small taxes or subsidies are not likely to produce significant changes in BMI or obesity prevalence, but non-trivial pricing interventions may have some measurable effects on Americans’ weight outcomes, particularly for children and adolescents, low-income populations, and those most at risk for overweight.

Any strategy that helps and supports those people who want to lose weight is worthy of consideration. When you are on a low income it’s much easier to buy the stodgy high energy-density foods, which provide more calories per dollar, and fill you (and your family) up. Fruit and vegetables, which may be expensive, are often not high on the list of necessities — so any initiative that makes fruits and vegetables more affordable for people on a low income should be supported.

Financial incentives may help, but information and education in relation to healthy shopping, cooking and eating on a tight budget, along with ongoing support, is also likely to be an important part of the equation. It will be interesting to see the results of further research in this area and it will be interesting to see what sort of policies are implemented by our Government to tackle our burgeoning obesity problem.

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