Should Your Employer Punish You for Being Unhealthy?

Employees facing threat of financial loss exercise more than those rewarded, UPENN researchers say


Could being rewarded by an employer for healthy behavior actually lead to failure?

A new study from the University of Pennsylvania (UPENN) has found that financial rewards for healthy behavior might not cut it-but financial punishments might do the trick when it comes to keeping employees healthy.

Lead study author Dr. Mitesh Patel, assistant professor at UPENN's Perelman School of Medicine, and team gave 281 overweight adults a goal of walking 7000 steps a day for 13 weeks, and tracked the steps using the Moves smartphone app. The average American walks 5000 steps a day, and about half of Americans do not meet daily physical activity requirements, the study authors said.

The average body mass index (BMI) of the participants was 33, and the minimum was 27. BMI is a measurement determined by calculating a person's weight divided by their height squared, and the measurement can be an indicator of overweight or obesity, according to the Center for Disease Control and Prevention (CDC). A woman who is 5'4" and weighs 145 pounds, for example, has a BMI of 25, which is considered overweight. The same person is considered obese at a BMI of 30, or 174 pounds.

One group of 70 study subjects were given $1.40 for each day they accomplished the 7000 step goal , while another 70 were given 42 dollars at the beginning of each month and lost $1.40 each day they did not achieve the goal. A group of 71 participants were given the chance to enter a lottery to win prizes if the goal was accomplished, and the remaining 69 participants were in the control group, which did not receive any reward. After the experiment, the participants were followed for an additional 13 weeks.

"The gain incentive, in which an employee received a fixed amount each day he or she met goal, was no more effective than control," the study authors wrote. "In comparison, a loss incentive...resulted in a 50% relative increase in the mean proportion of time participants achieved physical activity goals."

In other words, the threat of losing money could be an effective incentive when it comes to encouraging healthy behaviors. At the end of the study, while the control group accomplished their goal 30 percent of the time, the financial loss group achieved the 7000 steps at a rate of 45 percent. The financial gain and lottery groups clocked in at 35 and 36 percent, respectively.

According to Dr. Patel and team, their research is evidence that whether or not incentive-based models encourage employees to become healthier at work, the "design of the incentive" is also important.

"Employers are increasingly using workplace wellness programs to target health outcomes," the study authors said. "Although the popularity of these programs is growing, the optimal design of financial incentives to change health behavior is uncertain."

According to Dr. Patel and team, more than 80 percent of large companies use incentive programs to better their employees' health. However, the authors say that "evidence suggests that most workplace physical activity interventions are not effective."

The study authors say that their research is evidence that incentive-based employee health programs must be designed with psychology and "behavior economics" in mind.

This study was published February 16 in the journalAnnals of Internal Medicine.

The National Institute on Aging , Department of Veteran Affairs and Robert Wood Johnson Foundation financed this study.

Disclosures: Dr. Asch received grant support from the National Institutes of Health and he is a principal and part owner of the behavioral economics consulting firm VAL Health. Ms. Hilbert reports grant support from the National Institute of Aging. Dr. Volpp reports grant support from the National Institutes of Health during the conduct of the study. Further, he reports consulting income from CVS Health and VAL Health (principal and part owner) and grants (or grants pending) from CVS Health, Humana, Merck, Weight Watchers, Discovery (South Africa), and Hawaii Medical Services Association; and stock in VAL Health.