Abstract
BackgroundHealth insurers worldwide implement financial incentive schemes to encourage health-related behaviours, including to facilitate weight loss. The maintenance of weight loss is a public health challenge, and as non-communicable diseases become more prevalent with increasing age, mid-older adults could benefit from programs which motivate weight loss maintenance. However, little is understood about their perceptions of using financial incentives to maintain weight loss.MethodsWe used mixed methods to explore the attitudes and views of participants who had completed an Australian weight loss and lifestyle modification program offered to overweight and obese health insurance members with weight-related chronic diseases, about the acceptability and usefulness of different types of financial incentives to support weight loss maintenance. An online survey was completed by 130 respondents (mean age = 64 years); and a further 28 participants (mean age = 65 years) attended six focus groups.ResultsBoth independent samples of participants supported a formalised maintenance program. Online survey respondents reported that non-cash (85.2%) and cash (77%) incentives would be potentially motivating; but only 40.5% reported that deposit contracts would motivate weight loss maintenance. Results of in-depth discussions found overall low support for any type of financial incentive, but particularly deposit contracts and lotteries. Some participants expressed that improved health was of more value than a monetary incentive and that they felt personally responsible for their own health, which was at odds with the idea of financial incentives. Others suggested ongoing program and peer support as potentially useful for weight loss maintenance.ConclusionsIf financial incentives are considered for mid-older Australian adults in the health insurance setting, program planners will need to balance the discordance between participant beliefs about the individual responsibility for health and their desire for external supports to motivate and sustain weight loss maintenance.
Highlights
Health insurers worldwide implement financial incentive schemes to encourage health-related behaviours, including to facilitate weight loss
Successful telephone contact was made with 57 members and a suitable focus group time arranged with 33 members
Our online survey results indicate that the majority (93.9%) of Healthy Weight for Life (HWFL) participants supported a booster or maintenance program, a finding confirmed by our focus group discussions
Summary
Health insurers worldwide implement financial incentive schemes to encourage health-related behaviours, including to facilitate weight loss. McGill et al BMC Public Health (2018) 18:244 related behaviours such as smoking, healthy eating, alcohol consumption and physical activity [11, 12] They have been shown to have a positive effect on weight loss in adults, with the first six months of a weight loss program being most effective [13]. Research suggests that weight loss is rarely sustained after the incentive is removed [14, 15] and that no significant changes in weight loss or weight loss maintenance have been reported at 12 and 18 months follow up [16] It is unclear whether financial incentives are effective at eliciting long-term behaviour change and health outcomes [17]. As most of the current research has been in the general adult population, the effectiveness of financial incentives among older adults in changing health behaviours is unclear [22]
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