Paying people to make healthy lifestyle changes does work

Posted: June 05, 2012

What does it take to get people to change unhealthy behavior?

Some cynics would say nothing works, but researchers at Northwestern University’s Feinberg School of Medicine got good results with Palm Pilots (OK, the study started five years ago), remote coaching, and money.

A team led by Bonnie Spring, a health psychologist and professor of preventive medicine, worked with 204 people with bad eating and exercise habits. The study, published in last week’s Archives of Internal Medicine, targeted specific behavior — eating too much saturated fat and too few fruits and vegetables, plus watching TV too much and exercising too little — that are associated with health problems and shorter lives. People were asked to change two behaviors at a time.

Not surprisingly, the hardest set — eat less bad stuff and exercise more — got the worst results, while the easiest — eat more fruits and vegetables and cut down on the after-work screen time — was the one people did most successfully. Still, all groups improved and sustained the changes to some degree during five months of follow-up.

"The most important part of the study," Spring said, "is showing that people can make these changes and we can maintain them pretty well."

The eat more/watch less group increased fruit and vegetable servings from 1.2 to 5.5 during the first three weeks, then fell back to 2.9 servings. Sedentary leisure time went from 219 minutes per day to 89 and then to 126. Calories from saturated fat went from 12 percent to 9.4 percent and to 9.9 percent. Eating more fruits and vegetables did not lead people to reduce fats. Not watching TV, which is often paired with snacks, was the key factor.

Study participants recorded what they were doing and a coach monitored them. They were paid $175 if they met initial goals and $30 to $80 for continuing to input data during the follow-up.

Paying people to do healthy things is controversial, Spring said. It just seems wrong, especially to people who already behave properly, to pay bad actors to do what they should have been doing anyway. "My own view about this is we’re going to be paying anyway," she said. Her point is that behavior that leads to heart disease and other chronic illnesses results in higher insurance costs for everyone.

— Stacey Burling

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