ImageDubai recently launched an initiative to pay chunky citizens real gold to lose weight, as part of the United Arab Emirates’ efforts to curb the obesity epidemic.  I would guess they will have some success in the short term, but I would be curious to see if contestants keep the weight off.

Various monetary incentives are becoming a larger and larger part of the wellness culture.  Wellness professionals would love employees to be motivated by a desire to not become sick.  However, for most people the possibility of maybe getting sick somewhere in the future causes their motivation to also move to “sometime in the future”. The prospect of an immediate reward is much more motivating.

I am not against incentives.  They can be used successfully. However, before going down that road it is important to understand the plusses and minuses of using incentives.

Plus side

  • Incentives have been shown to be powerful tools for short term, easy to accomplish behavior (flu shot, complete a health assessment).
  • Incentives often increase participation.  Participation can be a first step toward lasting behavior change.

But their usefulness may be limited in regard to more complex, deep-seated behaviors.


  • Paying incentives may become economically unsustainable over long periods of time.
  • Incentives are not shown to work for long-term maintenance of behavior change.
  • Incentives can encourage the potential for unintended negative consequences (cheating, short cuts and unethical behavior).
  • Incentives may be construed as an entitlement and potentially reduce motivation and appreciation for the wellness program.

Incentives should be one element, among many, in driving engagement, participation and sustained behavior change.  It should not be the primary mechanism to drive outcomes. 

If not incentives, then what?

  • Create a supportive culture.  Provide opportunities to give and receive social support (promote team challenges, buddy systems).
  • Provide an environment where the healthy choice is the easy choice (such as, healthy vending and cafeteria food, walking paths or exercise classes at the workplace).
  • Provide comprehensive communications: tell them, tell them, and tell them again.
  • Implement relevant programs.  Use a needs and interest survey to find out what is of interest to your employees.
  • Use recognition as a reward.
  • Make the wellness program part of the culture.  It should be part of recruitment, onboarding, safety, community affairs, productivity, etc.

The true cost of making something as deeply personal as health choices about money, is a culture where it’s more difficult for people to want to do something good for themselves (just tell me what I need to do to get the money).  According to positive psychology research, one of the key elements for true happiness or well being, is pursuing items for their own sake, not merely to get anything else.

Valorie Bender, CWPM


NY Daily News (last updated July 22, 2013). Dubai paying citizens gold to lose weight in fight against obesity.  Retrieved July 22, 2013, from

Terry, P.E. PhD, Serxner, S.A., PhD, MPH, Moller, A. PhD, Spring, B.A. PhD. The Motivation Issue.  The Art of Health Promotion, March/April, 2013.

Witherspoon, Reese, How to Create an Environment Where Intrinsic Motivation Can Flourish. Last updated July 17, 2013. Health Enhancement Systems. Retrieved July 22, 2012 from

Seligman, Martin E. (2011).  Flourish A Visionary New Understanding of Happiness and Well Being. New York, N.Y.: Free Press.


There are many different methods to reward healthy behavior change.  One method gaining in popularity is linking incentives to benefit programs.   David Hunnicutt, President of Wellness Council of America (WELCOA) states “Perhaps the best approach in increasing wellness participation levels is formally linking your benefit program to your wellness plan design.”

There is sometimes hesitation on the part of organizations to take that route as they are concerned with employee reaction.  The times are a changing. According to the Wall Street Journal/Harris Interactive Poll, 53% of U.S. adults think it is fair to ask those with unhealthy lifestyles to pay more for their health insurance (up from 37% only three years ago).  According to a  Washington Post article, 56% of employers plan to hold employees more responsible for the cost of health benefits.

There are important HIPAA factors to keep in mind when designing benefit based incentives. HIPAA stipulates: If an incentive is contingent upon the satisfaction of a health standard, the following guidelines must be observed.

  1. It must be re-assessed at least once per year.
  2. It must be designed to promote health and wellness.
  3. It may not exceed 20% of the total cost of coverage offered (raised to 30% effective Jan. 2014)
  4. It must be available to all “similarly situated individuals”, appeals and “responsible alternatives” must be offered.
  5. The availability of the appeal must be disclosed in all plan materials.

Other factors to consider:

  • How will the incentives be awarded and administered, what technology is needed?
  • Will it be a reduced payroll contribution, a better health plan, a deductible credit, or a Health Savings Account deposit?
  • How will appeals be handled?
  • Will supporting programs be offered to help employees reach the incentive goals?

While this approach may seem daunting the rewards can be significant.

In one case study involving a manufacturing company with a little less than 2,000 employees,  one year savings were over $200,000.  This was done by choosing four areas – blood pressure,  body mass index, cholesterol and tobacco use.  If an employee fell within the acceptable parameter for each item the employee contribution to their medical plan was less; if they did not meet the criteria, they paid more. All four areas improved for that employee population.

Valorie Bender