A Systematic Review of Financial Incentives for Dietary Behavior Change

Abstract

In light of the obesity epidemic, there is growing interest in the use of financial incentives for dietary behavior change. Previous reviews of the literature have focused on randomized, controlled trials and found mixed results. The purpose of this systematic review is to update and expand upon previous reviews by considering a broader range of study designs, including RCTs, quasi-experimental, observational, and simulation studies testing the use of financial incentives to change dietary behavior and to inform both dietetic practice and research. The review was guided by theoretical consideration of the type of incentive used based upon the principles of operant conditioning. There was further examination of whether studies were carried out with an institutional focus and whether incentives took the form of assets or savings. Studies published between 2006 and 2012 were selected for review, and data were extracted regarding study population, intervention design, outcome measures, study duration and follow-up, and key findings. Twelve studies meeting selection criteria were reviewed, with eleven finding a positive association between incentives and dietary behavior change in the short-term. All studies pointed to more specific information on the type, timing, and magnitude of incentives needed to motivate individuals to change behavior, the types of incentives and disincentives most likely to affect the behavior of various socioeconomic groups, and promising approaches for potential policy and practice innovations. Limitations of studies are noted, including the lack of theoretical guidance in the selection of incentive structures and the absence of basic experimental data. Future research should consider these factors even as policymakers and practitioners continue to experiment with this potentially useful approach to addressing obesity.

Money as Health: A Study of Health Status Disparities among African Americans of Flint, Michigan

“…However, on the basis of Skinner's behaviorism, money can be used as a form of inducement or motivation in order to elicit positive responses in a person-for example exercising at a gym to get reward points. These points have monetary value and may then be used for the purchase of various goods and services [4]. The argument here is that the idea of money as health is not without limitations or exclusions.…”

Perceived Self-Efficacy and Financial Incentives

“…19 Despite widespread implementation of FI-based workplace wellness policies, the effects of FI on exercise or healthy diet initiation and maintenance and behavior change in adults remain unclear due to mixed findings. While most report FI to be effective, these results tend to be short lived, 18, 22 and there is little evidence indicating FI lead to sustained weight loss maintenance. 20 FI remain to be a potentially useful tool in aiding behavior modification, but further investigation is warranted.…”

“…3 FI has also been linked to positive effects on healthy food purchases, consumption, and dietary behavior modification in short-term interventions. 19, 22 Modest FI in workplace weight loss interventions have been shown to motivate overweight employees to lose weight 23 , improve health outcomes (weight loss) in the short-term, and incite some lifestyle and behavior modification. 18 Additionally, FI have been linked to increased engagement and adherence to healthful behavioral change, perhaps even after the incentive is withdrawn, 3,21 which may further lead to improved SE.…”

Evaluating factors influencing the delivery and outcomes of an incentive-based behaviour change strategy targeting child obesity: protocol for a qualitative process and impact evaluation

“…As such, promising research in adults has found that incentives can positively influence health-related behaviour change in the short term 16–18. For example, several systematic reviews have demonstrated positive outcomes as a result of financial incentives in terms of healthy eating19–21 and positive effects on exercise behaviour 2223 Many of the studies included in the reviews have acknowledged the need for more research to determine specific information on the type, timing and magnitude of incentives needed to motivate individuals to change their behaviour, as well as disincentives 19.…”

“…For example, several systematic reviews have demonstrated positive outcomes as a result of financial incentives in terms of healthy eating19–21 and positive effects on exercise behaviour 2223 Many of the studies included in the reviews have acknowledged the need for more research to determine specific information on the type, timing and magnitude of incentives needed to motivate individuals to change their behaviour, as well as disincentives 19. There are also mixed findings on whether incentives are more useful for simple one-off behaviours (eg, attendance at a vaccination) rather than complex health behaviours such as dietary behaviour change, and if specific groups may benefit more from incentive schemes 17.…”