Childhood Obesity News: A Resource On The Growing Childhood Obesity Epidemic in the US

How Does AAI Work?

March 6, 2014 By Pat Hartman Leave a Comment

Venice - fitness

First of all, before asking how it works, what is AAI? Those initials stand for Animal-Assisted Intervention, one of the facets of green care or social farming, a new/old therapeutic modality based on the observation that many human problems can be alleviated by close contact with nature. We’re not talking about going out in the yard and waiting to be carried away by a tornado. That would solve some problems, for sure, but it’s a bit extreme. We’re talking about nice, gentle, friendly contact with nature, like when it’s shown that kids who are accompanied by dogs will voluntarily do more healthful physical activity.

This is not a blanket recommendation for every family with an obese child to go out and get a puppy, because a lot of other factors enter the equation. Many overweight and obese children already have dogs. It is possible that, if not for the activity-inspiring presence of a lively pet, some of these young people would be even more overweight.

And while playful dogs are a good addition to the tools available at a residential rehab center, not every household can afford to support a pet. A lot of families live in apartments or other situations where dogs are not allowed. Besides, some overweight kids, or their siblings, have allergies. Dog ownership is no panacea, and not just for the obvious reasons.

Wheels within wheels

Even the researchers who study Animal Assisted Intervention (AAI) do not clearly understand its mechanism. The eagerness of a dog to romp outside can provide motivation to get up and move, but it is not, in and of itself, sufficient motivation for a young person to want to escape obesity in the first place. There are complicated layers to the quality we call motivation. It comes in more than one variety. Running around with a puppy is not a motivation at the most basic level. Something else must trigger the desire to redesign the body for optimal health.

People regulate their activities from at least three different starting points, one of which is amotivation, characterized by the absence of intention to engage in an activity. A team from the University of Freiburg in Germany describes two other kinds:

Extrinsic motivation implies that a person engages in the behavior to satisfy an external requirement, to avoid negative feelings or to enhance one’s ego. Intrinsic motivation represents the most powerful type of motivation and refers to engaging in the activity for its own sake.

Where does intrinsic motivation come from? Regardless of its origin, the researchers propose that “a prerequisite for intrinsic motivation is that the behavior is congruent with actual affective preferences stemming from aroused implicit motives.” In other words, despite the benefits that comprise extrinsic motivation, it’s likely that a person will not be truly motivated on the basic level unless she or he finds the activity “inherently enjoyable, interesting, and challenging.”

Brazilian jiu-jitsu practitioner Kron Gracie recently talked with Joe Rogan about how good it is to live near the beach, because so many different forms of activity are available, and a person who does physical training every day gets very tired of seeing the walls of a gym. This challenge faces everyone who makes the effort to stay in shape. The intrinsic motivation, to achieve optimal health, needs to find appropriately matching extrinsic motivation, in the form of enjoyable, challenging, and interesting activities. Walking a dog, or playing with a dog, may be all of those, but it still does not equal intrinsic motivation.

Your responses and feedback are welcome!

Source: “Dogs motivate obese children for physical activity,” NIH.gov, 10/29/13
Source: “#460 – Kron Gracie,” Stitcher.com, 02/24/14
Image by Michael Dorausch

Filed Under: Uncategorized

Childhood Obesity and Dog-Assisted Intervention

March 5, 2014 By Pat Hartman Leave a Comment

Catch me if you can

What motivates kids to do the stuff that helps them lose weight and get healthy? That depends on the kid — but some seem to respond to dog-assisted intervention. Not much research has been done yet, but the idea has a lot going for it, such as empirical evidence, which is always a good feature for an idea to have. Yesterday, Childhood Obesity News looked at the wider horizons of what is called “green care,” a therapeutic movement with a lot of promise.

Last year, scholars from Germany’s Freiburg University published the results of a study that scrutinized a precisely targeted realm of behavior: “the effect of a therapy dog on exercise performance in children with obesity.” The comparison wasn’t made between kids playing with dogs versus kids playing alone. No, just to keep things fair, the 12 subjects were divided into kid + dog pairings, and kid + kid pairings, then switched around so that every kid would have a chance with both another child and a canine playmate. And guess what? The dogs inspired exercise more than the other kids did. And that’s not all:

The results demonstrate that the presence of a therapy dog has the potential to increase physical activity in obese children…. The results of our study indicate the potentially beneficial effect of incorporating dogs into outpatient training for obese children.

Research in Australia, where more than half the children grow up with a family dog, showed that kids with dogs were 49% more likely to fulfill the recommended 420 minutes per week of physical activity. That team also looked at correlation with screen use and weight status, and found that dog ownership was not associated with either.

So one might presume that while dog-owning children are not necessarily slimmer, it’s likely they would be even heavier if not for the exercise associated with the dog. Of course, as in any psychologically oriented research, participants were asked to rate their own experiences. (Childhood Obesity News has considered some of the ramifications of self-reporting, which does not always reflect what seems to be objectively apparent.)

Between the two groups — the kids who were paired with other kids for exercise and the kids who were paired with animal companions — their self-reported feelings of well-being and satisfaction (or even of motivation) were not markedly different from each other, even though the animal-assisted kids engaged in more physical activity. The research team drew this conclusion:

Therefore, it stands to reason that a dog could trigger implicit motives which enhance motivation for activity…. [I]mplicit motives cannot be measured via self-reports but indirectly via non-declarative measures employing performance criteria…. The higher implicit motives could be measured indirectly via a better performance in the presence of a dog. However, no effects on self-report measures are to be expected.

Next time, Childhood Obesity News will look more into the “why” of this.

Your responses and feedback are welcome!

Source: “Dogs motivate obese children for physical activity,” NIH.gov, 10/29/13
Source: “Understanding the relationship between dog ownership and children’s physical activity and sedentary behaviour,” NIH.gov, 10/08/13
Image by Philippe Teuwen

Filed Under: Childhood Obesity Solutions

The Mystery of Resistance

March 3, 2014 By Pat Hartman Leave a Comment

Strawberry 6

Childhood Obesity News has been taking a closer look at what happened when two different groups of obese young people participated in trials of Dr. Pretlow’s W8Loss2Go smartphone application. Dr. Pretlow outlined the process in an earlier post, remarking that challenges arose in the recruitment of participants despite the fact that they were offered compensation in the form of free use of a snazzy new iPhone during the four-month study, plus $50 per month. These incentives were in addition to the central prize — what should have been an eagerly-seized-upon opportunity to bring their weight down into the healthy range.

The challenges didn’t end there. Despite filling out motivation questionnaires, in which participants seemed to indicate maximum enthusiasm and to justify the expectation of enthusiastic cooperation, there were obstacles. Childhood Obesity News talked about some of them last time, in light of the fact that most applicants rated their unhappiness with their overweight condition as 10 on a scale of 1 to 10.

But as it turned out, many of the participants resisted various aspects of the W8Loss2Go program — particularly the part about, you know, eating less. The need to eliminate major problem foods was met with anger, as was the necessity to cut the total amount of food eaten. The reluctance to eat less was so pronounced, it caused several kids to drop out of the study.

Surprise!

Surely, the need to reduce food amounts should come as no surprise to anyone over the age of, say, 5. But let’s move on to the exit questionnaires completed by the 27 Seattle participants who went the distance with the second study. This set of questions asked for ratings from 1 to 5, with 5 being the highest.

In answer to the question, “Why did you choose to participate in this study?” “The money” got an average rating of 3.07; “To use an iPhone for free” got 2.56, and “To lose weight” got 4.48, which is pretty darn close to 5, or the highest possible rating. Yet resistance was apparent during the trial of the application.

There was also a category of answers characterized as “other,” and the kids were asked to expand upon their choice of “other” as a reason. One person mentioned hoping for a boost in confidence and mood, and another the possibility of learning how to eat better even if weight loss wasn’t a result. More than one mentioned the novelty of the approach as appealing, and one liked the idea of convenience.

Resistance

But those answers do not provide clues to why some kids, especially the dropouts from the study, demonstrated such strong resistance to the necessity of reducing the amount of food consumed. There are low-calorie foods that can be eaten in generous servings. In the study, the child’s separation from problem foods is gradual, one problem food at a time.

Were they expecting some hitherto undiscovered magic that would render calorie count irrelevant? If obese young people are as unhappy as their motivation surveys indicated, where does all the resistance come from? “Obviously,” says Dr. Pretlow, “something else is going on” — and as readers of Childhood Obesity News know, that something is food addiction. Dr. Pretlow writes:

Withdrawal symptoms (grouchiness, depression), tolerance (needing to eat more and more), loss of a coping mechanism, and losing food’s pleasure as their main relief from emotional pain are likely factors. Moreover, as with other addictions, obese youth may be compelled to overeat just to feel normal.

Just as a heroin addict learns to accept the trade-off of chronic constipation, or a meth addict becomes comfortable with tremors, lousy skin, and cracked teeth, a mere detail like weighing 300 pounds may seem inconsequential compared to the compulsion of addiction. Food addiction is the reality that W8Loss2Go was designed to avoid or overcome, but as the classic 12-step paradigm has it, the program doesn’t work unless you work the program.

Your responses and feedback are welcome!

Image by Jesse Jacobson

Filed Under: Childhood Obesity Problems, W8 Loss 2 Go iPhone App

Animals, Obesity, and Green Care

March 3, 2014 By Pat Hartman Leave a Comment

Dog Walk

The use of companion animals is only one aspect of green care, also known as social farming. Either term is inclusive and covers not only animal-assisted therapy, but green exercise, ecotherapy, therapeutic horticulture, and wilderness therapy. It’s all about the healthful effects of contact with nature. The concept isn’t new, but it is making a comeback and is very big in Scandinavia, where Norway alone has 950 care farms.

A report from Bente Berget and Camilla Ihlebæk of the Norwegian University of Life Sciences says that client groups are extremely diverse:

These may include patients with defined psychiatric diagnoses, people with learning disabilities, those with a drug history, disaffected youth or elderly people, as well as persons suffering from the effects of work-related stress or obesity.

Information from Germany’s Freiburg University also confirms that Animal Assisted Intervention (AAI) is more effective with children, the elderly, and the developmentally impaired than with healthy adults.

Similar work in Sweden has shown that hanging out with a dog contributes to increased energy and physical activity, and reduces stress, pain, and the symptoms of mental illness. Additional research has shown that interaction with animals has the bodily effect of decreasing cortisol (a chemical related to stress) and increasing dopamine and serotonin (chemicals that make people happy).

People and pets

Back in 2006, the PPET Study looked at the effectiveness of joint exercise between an obese human and an obese pet. The subjects of the experiment, all overweight or obese, were divided into human/pet pairs and humans with no pets. Both groups were given dietary and physical activity counseling and were observed for an entire year. The dog-walkers showed a slightly higher increase in physical activity than the no-dogs group, but the important finding might be that people who walked their dogs did not do very much else — the dog-walking constituted two-thirds of their entire physical activity.

In Britain, a study of maternal obesity and dog-walking during pregnancy turned up a couple of interesting hints for possibly more successful interventions in the future. The Avon Longitudinal Study involved more than 11,000 dog-owning mothers of all weight classes. All were advised to have at least three hours of physical activity every week during their pregnancies.

The dog owners were 50% more likely to fulfill this recommendation, even though their activity was only brisk walking. Among all the other possible variables, dog ownership was the only factor positively associated with regular activity.

Disappointment and surprise

But in this study, neither dog ownership nor physical activity matched up with weight status. Most discouragingly, the uptick in activity was found among normal-weight and overweight prospective moms, but not noticeably in obese moms. In other words, although any activity is good for general health, the ones who needed a weight-loss benefit the most were not getting it. The researchers wondered about an association between dog ownership and obesity, but it appeared to be more correlation than causation:

[T]his was due to confounding by sociodemographic factors related to both dog ownership and risk factors for obesity…. [C]ertain family types are more likely to own dogs, and also tend to be overweight or obese prospective mothers, similar to findings for childhood obesity in the same cohort.

Another unexpected fact turned up that had nothing to do with walking a dog, briskly or otherwise. The desired three hours of weekly activity were also more readily achieved by rabbit owners.

Your responses and feedback are welcome!

Source: “Animal-Assisted Interventions; Effects on Human Mental Health — A Theoretical Framework,” Intechopen.com, 10/03/11
Source: “Dogs motivate obese children for physical activity,” NIH.gov, 10/29/13
Source: “The PPET study: people and pets exercising together,” NIH.gov, 10/14/06
Source: “Dog ownership during pregnancy, maternal activity, and obesity: a cross-sectional study,” plosone.org, 02/15/12
Image by Clara S.

Filed Under: Uncategorized

Childhood Obesity Study Brings Surprises

February 28, 2014 By Pat Hartman Leave a Comment

_DSC0008 Yesterday, Childhood Obesity News went into more detail about Dr. Pretlow’s reflections on the two (so far) groups of young people who tried out the W8Loss2Go smartphone app. They started by filling out applications and motivation questionnaires, but Dr. Pretlow’s team “found little correlation with the results of this questionnaire and the success with the app program.”

The obese youth who signed up were asked to rate some questions on a 1 to 10 scale. Two of the questions were “How much does being overweight bother you?” and “How committed are you to losing weight?” and most of the applicants answered both with 10 — the highest. And that is probably how they felt at the time.

But later on, once the study was underway, it appears that many of the kids “would not admit what they were actually eating, adamantly claiming they were eating only small amounts, in spite of the fact that they continued to gain weight.”

The perils of self-reporting

All studies are different in their particulars, but the ones that involve what are called self-report measures are susceptible to problems that impact the validity of whatever conclusions are drawn. The first problem with self-reporting is that it’s subjective, a condition that is the very antithesis of scientific objectivity.

Basically, what self-reporting means is that the researchers are taking the subjects’ word for it, and this can go wrong in a surprising number of ways, all of which were catalogued by Rob Hoskin, a PhD student in Sheffield University’s neuroscience department. We mention a few of them here, with the strong recommendation to refer to the source article for some eye-opening concepts.

A range of choices designated 1 to 10, for instance, provides for a more nuanced response than a simple yes-or-no vote. But unless a study is carefully designed, the rating scale tool can be as much a liability as an asset, because people tend to interpret the meanings of the increments differently.

More difficulties

People often experience a conflict between honesty and image management, which can come into play strongly when sensitive issues are involved. Sexual behavior and drug use are two examples that Hoskin gives, and no doubt eating habits are a similarly loaded topic. He warns that “it is unwise to assume, even when you are measuring something relatively benign, that participants will always be truthful.”

And of course, people sometimes lie even in an anonymous survey! So who knows what they might do when their name is attached.

Then there is a thing called “response bias,” where the participants very much wish to be honest, but all their training and experience has taught them what the answer “should” be. For example, how many parents would admit that there have been times when they wanted to put their kid in a duffel bag, tie the top securely, and drop the bag into the nearest body of deep water? How many parents would admit to having that impulse even once? Even in a totally anonymous questionnaire?

Adding another layer of complexity, subjects who wish to be totally honest may not have enough introspective ability to make sense of their own responses or behavior. Truer words were never spoken than, “Undoubtedly we are all to some extent unable to introspectively assess ourselves completely accurately.”

Your responses and feedback are welcome!

Source: “The dangers of self-report,” ScienceBrainWaves.com, 03/03/12
Source: “What Is an Anonymous Survey?” Wisegeek.com, 01/23/14
Image by Sergey Vladimirov

Filed Under: Childhood Obesity Problems, W8 Loss 2 Go iPhone App

Obesity and the Mysteries of Motivation

February 27, 2014 By Pat Hartman Leave a Comment

180 sucka

Today, Childhood Obesity News recalls Dr. Pretlow’s January 2 post, “Obese Youth and Motivation,” which was written once the Australian study related to the W8Loss2Go smartphone app had been concluded. It was difficult for his team to understand why some of the participants resisted using the app, based on several factors. First, according to the pre-study motivation questionnaire, they were not happy with the quality of life they were experiencing as overweight or obese young people.

Second, the participants discovered that W8Loss2Go is a new approach with several interesting features that don’t just duplicate the same old “eat less and exercise more” advice they had been hearing all their lives. Adults tend to expect more elasticity in the young. Kids are closer to the beginning of life than to the end, and have not spent decades letting bad habits become ingrained. It seems that the young should not be so set in their ways and should be more open to change — not just open to it, but embracing it.

Sadly, many times this does not turn out to be the case. In fact, as Dr. Pretlow noted, “Several youth in our studies reported that they have been overweight so long that they are accustomed to it.” This attitude goes against everything that adults fondly believe about the young.

Giving up

Dr. Pretlow also wrote, “They are fatalistic that they will always be that way and don’t know how to change.” But kids — we are showing you how to change! Open your eyes! As the venerable advice columnist Ann Landers so often exhorted her readers, “Wake up and smell the coffee!” An adult has an almost irresistible urge to say to the participants, “Hey, live up to your reputation and grab onto this new thing with both hands!” Yet in both W8Loss2Go studies, there was resistance.

When queried about his reluctance, a 17-year-old participant who weighed nearly 300 pounds indicated that he did not intend to worry about weight-related health issues until he was older. He produced the startling reply that his apathy in the face of obesity was a “teenager thing.” But since when do teenagers not care about looking good and being attractive?

A 400-pound 21-year-old told the researchers that he hadn’t previously cared, during his teen years, but eventually stumbled upon the very real possibility that his obesity could be fatal and decided that wasn’t how he wanted to die.

Deeper levels

Are the young people who say they don’t care just confused, deluded, or concealing some deeper issue? This is where things get tricky. As readers of Childhood Obesity News have learned, sometimes a history of abuse causes a young person to deliberately become obese in order to deflect unwanted and unwelcome sexual attention, and this can be true of both girls and boys. A child might feel that layers of fat provide a layer of cushioned armor that can protect her or him from the world’s perils. A youth who was bullied in younger years might grow to massive size to intimidate bullies by his sheer bulk. A youth who does not ever want to be inducted into the military might, consciously or subconsciously, decide to become obese to avoid that fate. When psychological depths are plumbed, anything might happen.

As we learned from Underground Wellness founder Sean Croxton, the interior climate is all-important. Sometimes when clients fail to make progress, he tries to get them to dig deeper:

I find that their why is not big enough, it’s superficial, doesn’t have anything to do with anything…. It’s just not big enough, so I spend a lot of time helping clients to find their why, I spend a little time as well helping people to find their values, what do they value in life.

Croxton works with adults to identify their core values and then shows them how excellent health aligns with these goals. There is no reason why the same techniques can’t be effective with kids and teens. Croxton explains why this is worth looking into:

Mindset is huge. If your mind is not right, then you should probably get it right or go get yourself a new goal…. If your mindset isn’t right, good luck, buddy. You know this is really not going to work.

Your responses and feedback are welcome!

Source: “The Dark Side of Fat Loss with Sean Croxton,” BulletproofExec.com
Image by niceness

Filed Under: Advice for Parents, Childhood Obesity Problems, W8 Loss 2 Go iPhone App

The Trouble with Studying Financial Motivation

February 26, 2014 By Pat Hartman Leave a Comment

Oooh Baby

Childhood Obesity News has been looking at the pros and cons of bribing and/or rewarding kids for their weight loss efforts and/or successes. One thing to always keep in mind regarding bribery is that this is how a lot of families get in trouble in the first place — when parents use the promise of a sweet treat to barter for desired behavior.

Not only does this practice build dangerous mental and emotional links to high-calorie foods, but it may even render good behavior more difficult to achieve. A vast body of literature ties behavioral problems to the “sugar high.” But that’s a topic for another place and time.

A while back, concerned citizens of the United Kingdom expressed alarm because the National Institute for Health and Clinical Excellence had determined that there was some support for programs that paid people for smoking cessation, weight loss, and other health-enhancing efforts. Critics of the idea thought it a flat-out waste of public money.

Not long afterward, a group of four researchers announced a meta-study that would answer some questions about the efficacy of financial incentives, namely: whether effective financial reward would depend on the length of the intervention period and of the follow-up period; exactly what kind of incentive works best; and how these factors would vary according to the subjects’ socioeconomic position, gender, age, and other variables.

In the fall of 2013, the team published a paper “documenting the complexity of financial incentive interventions” when it came to behavioral change. They had looked into a number of different programs, past and present, and drawn some general inferences that were not so much conclusions as pointers to areas needing further exploration. Among the findings:

In practice, many financial incentive interventions designed to change health behaviours include a number of different incentive components…. Given the complexity of financial incentive interventions, the framework highlights the naivety of current research that tends to focus on simple questions of whether or not financial incentive interventions ‘work’ to successfully change healthy behaviours.

We do not believe that this complexity has been widely recognised previously and the framework helps both to highlight this and to provide a vocabulary to begin to explore it further.

In short, they don’t seem to have established much except how to ask better questions — which, after all, is no small matter.

Your responses and feedback are welcome!

Source: “Disgust over NHS bribes to lose weight and cut smoking,” Express.co.uk, 09/27/10
Source: “Carrots, sticks and health behaviours: a framework for documenting the complexity of financial incentive interventions to change health behaviours,” tandfonline.com, 10/21/13
Image by Emilio Labrador

Filed Under: Childhood Obesity Solutions, Public Policy

More on Obesity and Financial Motivation

February 25, 2014 By Pat Hartman Leave a Comment

Love and trust

Yesterday, Childhood Obesity News considered the responses gleaned by CNN reporter Todd Benjamin from an article about the concept of bribing children to lose weight. Benjamin heard back from former kids who had been paid for good grades and former kids who had not; and parents who had paid their kids for grades, and parents who had not. Only a couple of personal experiences were connected with obesity, though the underlying principles, whether they embrace or reject bribery, are pretty much the same. One respondent wrote:

i was an overweight kid.. (not too long ago) and i was advised to lose weight, and i managed to lose it without any financial incentive at all. my parents strictly controlled my diet.

A person who signed in as “nomi” had strong feelings:

As someone who works with people who suffer from eating disorders, I cannot ignore that bribing children with money to lose weight is blatantly planting the seed for an eating disorder…. The reward for weight loss must be related to the weight loss!… The outward reward will be experienced as their peers will most probably begin to treat them with more respect as they begin to respect themselves.

A teenager from Europe, where they weigh in kilograms and pay in euros, wrote, “if i lose 1kg and get five euros, i would go buy chocolate to gain back my 1kg so therefore my weight would always be the same.”

One reader felt that bribery is okay if it will keep the child from dying young, while another cynically replied that the world is overpopulated anyway. A wary adult cautioned that a normal-weight kid might be entrepreneurially inspired to pile on fat in order to be paid for losing it. Another grownup, possibly an experienced parent, asked sensible questions and foresaw other ways to play the angles:

How long do you think the weight will stay off? Will they have to pay it back if they gain it back?… How much will you pay me to study? To take a shower? To wash dishes? To go to college? Etc.

In a more general sense, other readers felt that the bribe/reward is a manipulative ploy used only by parents who fail. If considered at all, it should be a tactic of last resort. Getting into deep psychology, what a child wants more than anything else is parental attention. Very young children are transparent about the fact that face time with Mom or Dad is the best reward. It’s all about “Look at me!” As kids get older, they hide their vulnerable longing for parental attention, and as teenagers they even hide it from themselves.

All kids crave parental attention, and a little goes a long way if it’s the good kind. If they can’t get the good kind, kids are notorious for courting negative attention, operating from a subconsciously held principle that even punishment is better than being ignored. This unfortunate human tendency leads to some hideous family dynamics of a kind that social workers and health care professionals dread.

If obesity is the only thing about a kid that ever catches the parents’ attention, the road ahead does not look smooth. If incipient obesity is approached with bribes or rewards, some of Benjamin’s readers felt that the problems likely to come up later in life were not worth the cost. They didn’t want their kids tying their self-worth to monetary gain, or winding up in therapy to deal with a swollen sense of entitlement. A reader who signed in as “lrc” touched on the importance of developing personal integrity:

Bribing kids turns them into brats with no appreciation for the subtler (yet ultimately more gratifying) rewards that come from taking care of your body, being kind to others, or striving for your personal best. So what’s more important? The immediate goals of making your child do what you want them to, or teaching them to have integrity and decency throughout their life?

Your responses and feedback are welcome!

Source: “Economics 101: Bribe your kids?,” blogs.cnn, 06/03/08
Image by Mike Baird

Filed Under: Advice for Parents

Obesity and Financial Motivation

February 24, 2014 By Pat Hartman Leave a Comment

BBQ steak dinner

The company that conducted a study of obese Mayo Clinic employees used to be called Gympact before the name was shortened to simply Pact. Their program is available online, where it is used by at least one adult Childhood Obesity News visitor, who endorses it. An overview of it, written by David Ahn, MD, appeared online:

GymPact asks users to make a two-fold commitment: for each week, they must in advance 1) set a target number of gym visits for the upcoming week and 2) agree to a fine ($5-$50) for every number of visits they fall short of that goal. Then, at the end of the week, those that succeed in carrying out their pact are rewarded the money paid out by the users who did not meet their goals.

GymPact beautifully executes a very simple concept of using negative reinforcement…. Both its business model and utility for end-users are fairly transparent: motivate users to work out by giving a fine to them if they do not reach their goal.

Dr. Ahn admits that one of his initial concerns was the human propensity to cut ourselves a lot of slack, to the point of frankly cheating the system. If nobody admitted to skipping gym sessions, there would be no fund of collected fines when payout time came around. This fear was not realized, and he suggests that the reward “is so small that it provides very little incentive to cheat, though it is still enough to provide satisfaction for the honest users.”

To recap, we have seen that the lure of a big money prize can be effective in persuading adults to substantially change their behavior — that is, if you define effectiveness as something that works in the short term. Also, thanks to research done by various scientific bodies, it seems fair to say that small monetary prizes only work if they continue forever, but even bribery isn’t reliable once a person has gotten used to it.

What about children?

Todd Benjamin, CNN’s International Finance Editor, wrote about a European study:

Scientists in Switzerland gathered data on more than 100 families. The families had at least one obese adult and one obese child. They had to follow one of four programs including motivational letters and different diets.

The final option was cold hard cash, bribing the kid — five euros for every kilogram they lost, and five euros each time they improved their body mass index score.

In the words of Professor Claus Luley: “We found that giving the money works in children. They were certainly eager to get their hands on the money.”

Benjamin asked his online readers to respond to the report, and many did, though their experiences were mainly with chores and homework rather than dietary issues. An idea mentioned more than once is that a bribe and a reward are two different things. A bribe is agreed upon ahead of time and is in essence a contract.

A reward, on the other hand, is not promised in advance, and not framed as “pay” or a thing to which the child is entitled. Neither expected nor guaranteed, it is a spontaneous and genuine expression of pride and encouragement.

One parent said that when his child gets a good report card, the family goes out to eat and the event is characterized as a celebration, not as a reward. Another respondent felt that, in fairness, if rewards are given they should be for the effort expended, not solely for stellar “winning” results. Others were against the notion of either bribing or rewarding children for anything they should already be doing in the first place, like helping around the house, making good grades, or maintaining their own good health. A father who signed in as “Jeff” wrote:

Bringing up kids involves teaching them values. We hope that they will study because of the thirst to learn, not to make a quick buck…. Family members should feel responsible to each other for more than a superficial commercial motive. I will not educate my kids to do anything in the family for monetary reward.

Your responses and feedback are welcome!

Source: “Physician’s Review,” imedicalapps.com, 01/01/14
Source: “Economics 101: Bribe your kids?” CNN.com, 06/03/08
Image by Lars Plougmann

Filed Under: Childhood Obesity Problems, Childhood Obesity Solutions

Obesity, Money, and the Mayo Clinic

February 21, 2014 By Pat Hartman Leave a Comment

arriving-at-a-party_1504

At first glance, it seems as if media product such as a weight-loss TV show, or a large-scale international public-relations event like Dubai’s “Your Weight in Gold” competition, might tell us something about the relationship between weight loss and the prospect of financial reward. But because of all the complicating factors and conditions, they turn out not to be useful exemplars.

What happens under different circumstances? Marilynn Marchione wrote for Huffington Post about a study whose subjects were 100 obese Mayo Clinic employees. Think about it for a second. We’re talking about one of the world’s foremost medical facilities, and nobody even seems surprised that there were so many obese Mayo Clinic employees from which to choose. But doesn’t that fact, in and of itself, speak volumes about the obesity epidemic’s pervasiveness?

Digression

The institution has examined its own situation before, in 2012, and the headline reads, “Obesity outweighs smoking in employer health cost.” That’s right:

Mayo Clinic researchers tracked health care costs of more than 30,000 Mayo Clinic employees and retirees from 2001 through 2007. Obese employees cost the health care organization $1,850 more each year than their nonobese peers, compared to the excess $1,275 spent annually on health care costs of employees who smoked.

Employees who are more than 100 pounds overweight (termed ‘morbidly obese’) cost their employer, on average, $5,500 more than their nonobese peers.

Back to the present

The recent new research has the distinction of being the most lengthy study of the effect of financial incentives on weight loss that had yet been undertaken. For half the participants, the program was “weight-loss counseling, monthly weigh-ins and a three-month gym membership.” The other half were entitled to the same benefits, plus a rather detailed schedule of possible financial rewards and penalties. Pragmatically, the money part had to be self-sustaining, with the slackers’ penalties paying for the rewards of the diligent.

Theoretically, the most a person could win for the year would be $360, plus whatever surplus had built up in the pot. The most a person could lose over the course of the year would be $240. The end result was that those in the financially remunerative half of the study lost four times as much weight as those who were only in it for the counseling and use of the gym. Marchione writes:

The cash was a big motivator for one study participant — Audrey Traun, 29, a lab training specialist who dropped 40 pounds, from 215 pounds to 175.

‘I was impressed. I didn’t think I was quite capable of that,’ said Traun, who lives in Kellogg, Minn. As the study went on, though, the cash became less important, and ‘it was actually more motivating to see my progress — pounds lost and how my clothes were fitting,’ she said.

Unfortunately, Ms. Traun’s experience may have been the exception. One study leader, Dr. Steve Driver, told the reporter that incentives do not function in the same way as training wheels for a novice bicycle rider. (Another type of doctor might have said that incentives do not resemble booster rockets that fall away when the space capsule achieves escape velocity, because it never does.)

Also quoted is a financial expert from King’s College, London, Eleni Mantzari, who said that once the financial motivation has ceased, people often return to their former unhealthful habits. Even worse, it appears that even when the incentives are still being offered, somehow the willingness to participate wears off. Although many conscientious employers and insurers offer rewards to people who quit smoking, start exercising, and so on, apparently these programs don’t live up to their potential.

Your responses and feedback are welcome!

Source: “Weight Loss Bribes: Cash Can Entice Dieters To Drop Pounds,” HuffingtonPost.com, 03/07/13
Source: “Mayo Clinic study: Obesity outweighs smoking in employer health cost,” MayoClinicHealthSystem.org, 05/01/12
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