VOLUME 16 NUMBER 1 | JANUARY 2008 | www.obesityjournal.org
Behavior and Psychology
nature publishing group
Insurance Coverage and Incentives for Weight
Loss Among Adults With Metabolic Syndrome
David Arterburn1,2, Emily O. Westbrook1, Cheryl J. Wiese1, Evette J. Ludman1, David C. Grossman1,
Paul A. Fishman1, Eric A. Finkelstein3,4, Robert W. Jeffery5 and Adam Drewnowski2
Objective: To describe how insured adults with metabolic syndrome respond to various options for insurance
coverage and financial incentives for weight management.
Methods and Procedures: Insured adults meeting the criteria for the metabolic syndrome were randomly identified
through automated medical records and invited to participate in a telephone-based survey of the acceptability of
various weight management programs—with different financial incentives and insurance coverage options—in a
health maintenance organization. Multivariable logistic regression models were used to test the relationship between
participant characteristics and the odds of being motivated by incentives.
Results: One hundred and fifty-three adults with the metabolic syndrome completed the survey (i.e., 79% of telephone
contacts). A hypothetical increase in insurance coverage from 10 to 100% led to a threefold increase among women
and a sevenfold increase among men in the proportion reporting they were “very interested” in enrolling in a weight
management program within the next 30 days. Most participants (76% of women and 57% of men) supported a health
plan–sponsored financial incentive program tied to weight loss, and 41% believed such a program would motivate
them to lose weight. The mean financial incentive proposed for a 15-pound weight loss was $591 (median: $125).
Discussion: Although weight loss is an effective treatment for metabolic syndrome, standard health insurance rarely
covers intensive behavioral treatment. The results of this study suggest that providing full insurance coverage and
financial incentives for weight management increases the interest in participating in obesity treatment programs.
Further research should determine how full coverage and incentives affect participation rates, long-term body weight
changes, and costs.
Obesity (2008) 16, 70–76. doi:10.1038/oby.2007.18
Much of the evidence supporting behavioral interventions
for weight loss comes from randomized controlled trials that
have waived the costs of the interventions for participants (1).
Under these circumstances, intensive behavioral interven-
tions can prevent the onset of type 2 diabetes and can improve
blood pressure and levels of serum lipids and fasting blood
glucose (2–6). Outside of the artificial setting of randomized
trials, the uptake of such evidence-based interventions is lim-
ited, and most obese people seeking to change weight-related
behaviors face substantial monetary and time constraints (7).
For example, individuals with lower socioeconomic status, and
those without adequate health insurance coverage, may lack
the financial means to use weight loss programs. Furthermore,
major changes in diet and activity behaviors often require indi-
viduals to make significant time investments (7).
Of US adults under the age of 65, 85% have some form of
health insurance coverage (8). Therefore, one way to reduce
the economic barriers to behavioral weight loss treatment
is to expand insurance coverage to include evidence-based
weight loss programs (self-help and commercial). Evidence
from smoking-cessation studies has shown that full coverage
of cessation programs improves both access and quit rates (9).
Enhanced insurance coverage would remove one major bar-
rier to enrollment in weight loss programs; however, oppor-
tunity costs (i.e., convenience and time demands) of changes
in diet and physical activity, and the willingness of the indi-
vidual to accept constraints on personal lifestyle choices, may
strongly influence long-term participation in such programs
(7). One possible strategy to overcome the opportunity costs
and psychological discomfort of sustained weight manage-
ment is to provide financial incentives—such as gifts, rebates,
coupons, or cash—to individuals who adopt a desired behav-
ior or achieve a particular outcome (7). Many large employers
offer incentive programs; however, few have been rigorously
evaluated (10). The most successful programs have tied the
1Group Health Center for Health Studies, Seattle, Washington, USA; 2University of Washington, Seattle, Washington, USA; 3RTI International, Research Triangle Park,
North Carolina, USA; 4Duke University, Durham, North Carolina, USA; 5University of Minnesota, Minneapolis, Minnesota, USA. Correspondence: David Arterburn
Received 27 December 2006; accepted 19 May 2007. doi:10.1038/oby.2007.18
VOLUME 16 NUMBER 1 | JANUARY 2008 | www.obesityjournal.org
Behavior and Psychology
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