Cash, Coaching May Boost Healthy Living

TUESDAY May 29, 2012 -- A new study finds that people with unhealthy lifestyles are more likely to eat better and watch less TV if they receive financial incentives, use technology to track their progress and get reminders from coaches.

It's not clear how much a program like this might cost overall, or exactly why it might work, but the study lead author said costs could drop if the coaches are virtual, not live, and she emphasized the larger message -- that a couple of simple changes in behavior can spur lasting changes.

"People are able to make healthy lifestyle changes, and they're able to make them a lot faster, sooner and larger than most of us would have believed possible," said Bonnie Spring, a professor of preventive medicine, psychology, psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. "And once they make them, 86 percent of people tried to keep it up."

The researchers launched the study to see what might inspire people to change bad habits that put them at risk of heart disease and cancer. "People usually have more than one unhealthy behavior," Spring said. "It's so hard to know where to begin, and folks tend to get overwhelmed because they don't know how to manage it."

The researchers recruited 204 people, with an average age of 33, who had four signs of poor health: high saturated-fat levels, low consumption of fruits and vegetables, high amounts of sedentary leisure time and low levels of exercise.

"We made the assumption that we couldn't get people to change all four at once," Spring said. "We wanted to see that if we could get them to change two, would we get freebies -- some others that would come along for the ride and improve?"

The study authors randomly assigned the subjects to treatments targeting two of the four problem areas. The target goals were eating five fruits and vegetables a day and limiting sedentary time to 90 minutes daily, or exercising for 60 minutes a day and keeping saturated fats to less than 8 percent of daily diet.

All had to use personal digital assistants to track their progress and communicate via email or phone with coaches. The participants could earn $175 for meeting goals.

The researchers found that average daily fruit and vegetable intake grew from 1.2 to 5.5 servings over three weeks, while sedentary leisure -- typically TV time -- fell from 219 to 89 minutes. Saturated fat, as a percentage of overall calories, fell from 12 percent to 9.4 percent.

However, even though most participants at a 20-week follow-up said they tried to continue their lifestyles, they had trouble. Their daily consumption of fruits and vegetables fell to an average of 2.9 per day, while their minutes of sedentary leisure grew to 126 minutes a day and their percentage of saturated fat calories rose to 9.9 percent.

Overall, targeting fruit and vegetable consumption and couch-potato lifestyles proved more effective than attempting to reduce saturated fats and increase physical activity, the researchers found. But that might have been because those goals were easier to achieve, one expert said.

So, did the coaching or the money make the difference? "We really don't know," Spring said. "What's important to realize is that if you talk to most physicians, they do not believe you can get people to make behavior changes like this."

As for cost, in the future it may be possible to create virtual coaches and use smartphone apps to replace the live coaches, which would considerably lower the cost, she said.

William Riley, a program director in the division of cardiovascular sciences at the U.S. National Heart, Lung, and Blood Institute, who wrote a commentary accompanying the study, said the cost may be low long-term if the strategies improve people's health.

"If just one person using this intervention had just one less outpatient office visit as a result of improved health, that would offset the cost of the $175 incentive provided in this study," Riley said. "Think what the cost savings would be if this monetary incentive prevented one or more participants from developing diabetes or having a heart attack."

The study appears in the May 28 issue of Archives of Internal Medicine.

More information

For more about obesity, visit the U.S. National Library of Medicine.

Posted: May 2012


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