How much money would it take to get you to lose some serious weight? $100? $500?
Many employers are betting they can find your price. At least a third of U.S. companies offer financial incentives, or are planning to introduce them, to get their employees to lose weight or get healthier in other ways.
"There's been an explosion of interest in this," said Dr. Kevin Volpp, director of the University of Pennsylvania's Center for Health Incentives.
But does this kind of effort really put a permanent dent in American's seemingly intractable obesity problem? Not likely.
"It's probably a waste of time," said Kelly Brownell, director of Yale University's Rudd Center for Food Policy and Obesity.
Brownell's assessment is harsher than most. But the science seems to back him up.
Only about 15 to 20 U.S. studies have tried to evaluate the effect of financial incentives on weight loss. Most of those studies were small and didn't look at whether such measures worked beyond a few months. None could make conclusions about how much money it takes to make a lasting difference for most people.
Perhaps the largest effort to date was an observational study by Cornell University. It looked at seven employer programs and the results were depressing: The average weight loss in most was little more than a pound.
The Pepin plan
Several years ago Tampa's Pepin Distributing tried a pay-for-pounds employee weight-loss program. It failed in part because it was difficult to administer and awkward to enforce, said Pepin's Natalie Mealey.
What has helped 110 Pepin employees lose thousands of pounds since January 2009 is a program operated by Medi Weight Loss Clinics that Pepin pays for.
"Some of them have lost 20 or 30 pounds; at least two have lost over 100 pounds," says Mealey, who heads the program. It costs Pepin an average of $2,000 per employee to participate, and dieters must sign a contract and pay the company back if they don't meet their weight-loss goals.
No active employees have reneged on the deal, although Mealey says there are about five on a "watch list"; two employees who left the company without meeting their goal weights paid the company back between $1,100 and $1,300 dollars.
Breaking bad habits
One study published last year in the New England Journal of Medicine, co-authored by Volpp, found that cash rewards of a few hundred dollars nearly tripled quit-smoking rates.
One problem: "Food is more difficult than tobacco," said Steven Kelder, an epidemiology professor at the University of Texas School of Public Health. While cigarettes can be addictive, people don't need to smoke to live.
Health officials lament that more than two-thirds of American adults are overweight and one-third obese. A Conference Board report found that obese workers cost U.S. private employers an estimated $45 billion or more annually in health care costs and lost labor.
So the impetus for action is clear. Some companies reward employees just for having a health evaluation or simply enrolling in a class — whether they complete it or not. Others, like Pepin, require measurable achievement.
Some companies offer money, some vacation trips. Some refund the cost of Weight Watchers classes. Others reduce health insurance premiums.
Hunches and human resources budgets — not research — often drive decisions about financial incentive details.
By the numbers
Psychologists say people are more motivated by the risk of losing their own money than by a chance they'll win somebody else's. Applying that idea to weight loss, some studies have set up refundable bond systems: Volunteers sign a contract agreeing to lose a certain amount of weight by a certain date or they forfeit their deposited money.
One of the seven companies in the Cornell study offered a refundable bond option to employees. Its average weight loss was nearly 4 pounds, which sounds modest, but it's almost twice as much as the average weight loss at companies that paid quarterly rewards.
A 2008 University of Pennsylvania study found that after 16 weeks people who put their own money on the line lost about a pound more, on average, than people who got cash from others.
Some employers worry that if they go too far, it may seem coercive and even grounds for a lawsuit. Many believe the wisest approach is to use financial incentives as just one facet of a broader effort.
Kevin Acocella illustrates their point. The 35-year-old IBM marketing manager was 5 feet 9 and a chunky 185 pounds when he enrolled two years ago in the company's Web-based fitness program.
IBM offers $150 a year for taking part. But Acocella failed twice. The money got his attention, but couldn't overcome his location. "In New York City it was, 'What restaurant can we go to, or what bar can we go to?' "
This year, Acocella moved to the IBM office in San Jose, Calif. "Here it's, 'What activity can you do, and what can you go see, and how can we figure out a way to not take a car there,' " he said.
Acocella had lost 9 pounds in the three months he has been there. He recently signed up for the IBM reward program again, but this time it's incidental to his new active lifestyle.
"The real issue was getting myself in a program I could actually do and could keep up with. I don't think those things swing on a dollar," he said.
Times staff writer Irene Maher contributed to this report.