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  • January 2018
  • Article
  • American Journal of Health Promotion

The Effect of Cost Sharing on an Employee Weight Loss Program: A Randomized Trial

By: Leslie K. John, Andrea Troxel, William Yancy, Joelle Y. Friedman, Jingsan Zhu, Lin Yang, Robert Galvin, Karen Miller-Kovach, Scott Halpern, George Loewenstein and Kevin Volpp
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Abstract

Purpose: We tested the effects of employer subsidies on employee enrollment, attendance, and weight loss in a nationally-available weight management program.
Design: A randomized trial tested the impact of employer subsidy: 100%; 80% 50% and a hybrid 50% subsidy that could become a 100% subsidy by attaining attendance targets. Trial registration: NCT01756066.
Setting and Subjects: 23,023 employees of two U.S. companies.
Measures: The primary outcome was the percentage of employees who enrolled in the weight management program. We also tested whether the subsidies were associated with differential attendance and weight loss over 12 months, as might be predicted by the expectation that they attract employees with differing degrees of motivation.
Analysis and Results: Enrollment differed significantly by subsidy level (p<.0001). The 100% subsidy produced the highest enrollment (7.7%), significantly higher than each of the lower subsidies (vs. 80% subsidy: 6.2%, p=.002; vs. 50% subsidy: 3.9%, p<.0001; vs. hybrid: 3.7%, p<.0001). Enrollment in the 80% subsidy group was significantly higher than both lower subsidy groups (vs. 50% subsidy: 3.9%, p<.0001; vs. hybrid: 3.7%, p<.0001). Among enrollees, there were no differences among the four groups in attendance or weight loss.
Conclusion: This pragmatic trial, conducted in a real-world workplace setting, suggests that higher rates of employer subsidization help individuals to enroll in weight loss programs, without a decrement in program effectiveness. Future research could explore the cost effectiveness of such subsidies or alternative designs.

Keywords

Affordable Care Act (ACA); Subsidies; Weight Loss; Obesity; Incentives; Behavioral Economics; Motivation and Incentives; Behavior; Health Disorders; Health Care and Treatment; Compensation and Benefits; United States

Citation

John, Leslie K., Andrea Troxel, William Yancy, Joelle Y. Friedman, Jingsan Zhu, Lin Yang, Robert Galvin, Karen Miller-Kovach, Scott Halpern, George Loewenstein, and Kevin Volpp. "The Effect of Cost Sharing on an Employee Weight Loss Program: A Randomized Trial." American Journal of Health Promotion 32, no. 1 (January 2018): 170–176.
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About The Author

Leslie K. John

Negotiation, Organizations & Markets
→More Publications

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More from the Authors
  • Reaching for Rigor and Relevance: Better Marketing Research for a Better World By: Shilpa Madan, Gita Venkataramani Johar, Jonah Berger, Pierre Chandon, Rajesh Chandy, Rebecca Hamilton, Leslie John, Aparna Labroo, Peggy J. Liu, John G. Lynch, Nina Mazar, Nicole Mead, Vikas Mittal, Christine Moorman, Michael I. Norton, John Roberts, Dilip Soman, Madhu Viswanathan and Katherine White
  • A Randomized Trial of Behavioral Nudges Delivered through Text Messages to Increase Influenza Vaccination among Patients with an Upcoming Primary Care Visit By: Mitesh S. Patel, Katherine L. Milkman, Linnea Gandhi, Heather N. Graci, Dena Gromet, Hung Ho, Joseph S. Kay, Timothy W. Lee, Jake Rothschild, Modupe Akinola, John Beshears, Jonathan E. Bogard, Alison Buttenheim, Christopher Chabris, Gretchen B. Chapman, James J. Choi, Hengchen Dai, Craig R. Fox, Amir Goren, Matthew D. Hilchey, Jillian Hmurovic, Leslie John, Dean Karlan, Melanie Kim, David Laibson, Cait Lamberton, Brigitte C. Madrian, Michelle N. Meyer, Maria Modanu, Jimin Nam, Todd Rogers, Renante Rondina, Silvia Saccardo, Maheen Shermohammed, Dilip Soman, Jehan Sparks, Caleb Warren, Megan Weber, Ron Berman, Chalanda N. Evans, Seung Hyeong Lee, Christopher K. Snider, Eli Tsukayama, Christophe Van den Bulte, Kevin G. Volpp and Angela L. Duckworth
  • Calculators for Women: When Identity-Based Appeals Backfire By: Tami Kim, Kate Barasz, Michael I. Norton and Leslie K. John
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