Money talks when it comes to losing weight, according to a recent Mayo Clinic study that followed 100 participants for one year and revealed that those who were paid to lose weight not only shed more pounds than those who weren't, but also stuck with the program for a longer period of time.

"There's a trend toward using financial incentives, and the problem is most financial incentives are, in our opinion, not structured very well or very thoughtfully," says Jimmy Flemming, co-founder of HealthyWage, a weight loss wellness company that requires employees to bet their own money they'll lose weight. "And employees are effectively punished for being too fat or for smoking, or rewarded for being thin enough, for not smoking, usually by being able to get a discount on a health insurance premium or a lower monthly rate. And our philosophy is less about cost-shifting and punishing or rewarding people, and more about trying to use financial incentives to actually achieve behavior change."

HealthyWage offers three basic competition formats: The Matchup, in which teams of five compete together to lose the most weight (up to 16.59%); the 10% Challenge, where participants can double their money if they lose 10% of their body weight in six months; and the BMI Challenge, which rewards achieving a healthy body mass index. For health and safety reasons, HealthyWage places limits on shed poundage in a given timeframe. For the $10,000 prize Matchup competition, rules cap loss at 16.59% of starting weight over a 12-week period.

The corporate office of Domino's Pizza has used HealthyWage's services not once, but twice. Global benefits manager Jennifer Balliett says she "can't think of anything better ... that wouldn't cost a lot of money" for the company.

"Originally, we were looking just for some interesting ways to help folks take control of the things that they want to do with their health," Balliett says. "So we came across the HealthyWage program, and we liked that it was team-oriented, that it was longer-term than just a one-month weight-loss thing, and we liked the accountability, where you had verified weigh-ins. And certainly the large motivational prize - that really got people excited."

One of things that makes the program achieve a high success rate, Balliett says, is that it's "the people who were willing to commit, to make some change in their lives" who were going to join, since part of their own paycheck was involved.

And she knows of what she speaks: "We've had some great successes within the teams," she says. "Personally I was on a team the first time around and I lost 25 lbs. on my own. More than half the folks the first time around lost more than 6% of their body weight."



Footing the bill discouraged

HealthyWage was founded in early 2009, and its objectives and ideology were partially based on research published in the Journal of the American Medical Association the previous December. Employers could well find they pay less (Flemming hastens to point out that his program costs less than Weight Watchers) for better results by using employees' own money.

Employers are actually discouraged from footing the bill themselves. Says Flemming: "We instead encourage the company to offer a partial subsidy, so they make it a little less expensive, or to offer a subsidy for, say, the first 200 people to sign up."

The cost, he says, entirely "depends on how much the employer wants to subsidize. We can do it for free. If the employer wants the employee to pay the entire fee, then the employer bears no cost. And more than two-thirds of employers do it that way. Alternatively, employers can pay as much as they want, and we have custom programs where employers pay a fee for us to run a program that is tailored to their specific needs."



Gender disparity

The two defining psychological features of a HealthyWage campaign - a personal stake and the competitive structure - have helped it overcome one of the pesky recurring problems of wellness/weight initiatives: gender disparity. Simply put, men aren't as interested in, and don't respond as well to, typical weight-loss offerings; they account for less than 15% of commercial weight-loss programs by some reports. HealthyWage has seen male success rates of 63%, which Flemming calls "shocking, insane," in terms of achieving weight loss goals.

"One of the big challenges that our clients have had is: How do we get men to participate? And how do we get them to stick with it?" Flemming says. "A lot of typical wellness offerings are much more readily adopted by female employees. And Weight Watchers is a great example. If you think of what might appeal to women vs. men, going and sitting around in a group and talking about your emotions is something that tends to appeal much more to women than to men, whereas getting in a group to compete appeals to men more than to women. So this is a great way to appeal to [everyone]."

Fifteen percent of women in HealthyWage campaigns meet their goals. In a program where employers aren't looking to spend anything at all in overhead, "you're lucky to get 10%, so [it's] still a significant success for women, even if there's significantly more success for men," says Flemming.

Jon Whicker, a finance manager and father of two from Utah, has lost 125 lbs. and gained $2,200 through the HealthyWage programs, and he's not done - he wants to get rid of another 50.

"Having some skin in the game encourages you not to give up, that is for sure," says Whicker, who weighed 400 lbs. at his heaviest. "I could see teams giving up if they really hadn't put any money out there. For me, just the competition keeps me motivated."

That "skin in the game," HealthyWage officials say, is significantly more of a motivator than the traditional incentives that employers offer with weight-loss programs. The wagered risk (and competitive nature) of betting on your own diet and exercise is seeing marked success, they report. HealthyWage officials say they offer 49% and 29% success rates, respectively, for 5%+ and 10%+ weight loss.

Flemming says all of these programs "are well-suited to the workplace because that's what they've been optimized for." The company counts "just about 500 corporate and government clients, including not-quite-50 of the Fortune 500," as users of its service.

In the end, though, HealthyWage might be successful most of all because it leads you to compete with yourself, says Whicker. Participants want to lead their team, to get their money back (and more) and to use the program to hit a new personal best. Success can prove addictive.

"Going through this process, I've come to understand a lot better how people can struggle with [body image], because you get this image in your head about how you look, and it doesn't matter what the scale or anything else says, until the image in your head works for you, you're going to continue to push," says Whicker.



Mayo Clinic study results

Study participants - 100 Mayo Clinic employees or their dependents, ages 18 to 63 with a body mass index of 30 to 39.9 - were placed into one of four groups: Two groups received financial incentives and two did not. Participants in the incentive groups who met their goals received $20 per month, while those who failed to meet their targets paid $20 each month into a bonus pool. People in both incentive groups who completed the study were eligible to win the pool by lottery.

All participants were given a goal of losing 4 lbs. per month, up to a predetermined goal weight. They were weighed monthly for one year.

Study completion rates for the incentive groups were higher compared to the nonincentive groups: 62% vs. 26%. Participants in the incentive groups also lost more weight; in the incentive groups, participants’ mean weight loss was 9 lbs., compared to 2 lbs. in the nonincentive groups.

Researchers found that even participants in the incentive group who paid penalties were more likely to continue their participation in the study than those in the nonincentive groups.

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