subject: Will Incentives Solve Obesity Epidemic? [print this page] Will Incentives Solve Obesity Epidemic? Will Incentives Solve Obesity Epidemic?
Earlier this week,the National Institute For Clinical Excellence (NICE) published a report produced by its Citizens Council on using incentives to promote individual health behaviour change.' Over 60 per cent of the Council voted in favour. Personally I think they're barking up the wrong tree.
The publication of the report followed a three day meeting held earlier in the year and attended by representatives from the London School of Economics, the Harvard School of Public Health and the Kings Fund plus public health workers from the UK with direct experience of incentive schemes.
Limited Evidence That Incentive Schemes Work
The report made clear that evidence for incentive schemes is limited. Most of the evidence that does exist comes from America where circumstances are very different and even there suggests that incentive schemes "work best when designed to influence one-off changes in behaviour, for example, encouraging attendance at an immunisation clinic and if the reward is immediate."
The success or otherwise of several UK schemes was also analysed. A Pounds for pounds scheme in Kent, for example, offered participants up to 425 depending on how much weight they lost versus agreed targets. In this scheme only 25% had lost more than 5% of their body weight after 12 months (a minimum of 10% is deemed significant for health benefits).
A Short-Term Fix?
The fact is that financial type incentives might work for some people and might work in the short-term, but that is totally missing the point. With weight loss, for example, plenty of people lose weight. The problem is that 95% put it all back on again. As a society we need to help people make long-term lifestyle changes so that they can lose weight and keep it off for good.
Moreover some GPs already use incentives (or is that disincentives?) to try and encourage people to lose weight, such as refusing fertility treatment until a patient's BMI (body mass index) is below a certain level. Even with this incentive, some women who are absolutely desperate to have a baby, still find that they can't shift those all-important pounds.
We Need Longer-Term Solutions
The two keys to weight loss are mindset change and nutrition.
Much more emphasis needs to be placed on offering severely overweight individuals emotional support - help with building self-esteem and self-efficacy, guidance in determining what would motivate them personally to lose weight and therapeutic interventions to overcome any psychological barriers they may have.
We then need to overlay that with clear and simple nutritional advice, laws which ban food manufacturers and advertisers misleading consumers with dubious health claims and a huge focus on education in nutritional health and cooking for young and old alike.
The NHS should be focussing on other priorities and not allowing short-term fixes to distract them from potential longer-term solutions.
