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Publications
  • 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
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More from the Authors

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    When Less Is More: Consumers Prefer Brands that Donate More in Relative versus Absolute Terms

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    Sugar-sweetened Beverage Purchases and Intake at Event Arenas with and without a Portion Size Cap

    By: Sheri Volger, James Scott Parrott, Brian Elbel, Leslie K. John, Jason P. Block, Pamela Rothpletz-Puglia and Christina A. Roberto
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    Megastudies Improve the Impact of Applied Behavioural Science

    By: Katherine L. Milkman, Dena Gromet, Hung Ho, Joseph S. Kay, Timothy W. Lee, Pepi Pandiloski, Yeji Park, Aneesh Rai, Max Bazerman, John Beshears, Lauri Bonacorsi, Colin Camerer, Edward Chang, Gretchen Chapman, Robert Cialdini, Hengchen Dai, Lauren Eskreis-Winkler, Ayelet Fishbach, James J. Gross, Samantha Horn, Alexa Hubbard, Steven J. Jones, Dean Karlan, Tim Kautz, Erika Kirgios, Joowon Klusowski, Ariella Kristal, Rahul Ladhania, Jens Ludwig, George Loewenstein, Barbara Mellers, Sendhil Mullainathan, Silvia Saccardo, Jann Spiess, Gaurav Suri, Joachim H. Talloen, Jamie Taxer, Yaacov Trope, Lyle Ungar, Kevin G. Volpp, Ashley Whillans, Jonathan Zinman and Angela L. Duckworth
More from the Authors
  • When Less Is More: Consumers Prefer Brands that Donate More in Relative versus Absolute Terms By: Elizabeth A. Keenan, Anne V. Wilson and Leslie K. John
  • Sugar-sweetened Beverage Purchases and Intake at Event Arenas with and without a Portion Size Cap By: Sheri Volger, James Scott Parrott, Brian Elbel, Leslie K. John, Jason P. Block, Pamela Rothpletz-Puglia and Christina A. Roberto
  • Megastudies Improve the Impact of Applied Behavioural Science By: Katherine L. Milkman, Dena Gromet, Hung Ho, Joseph S. Kay, Timothy W. Lee, Pepi Pandiloski, Yeji Park, Aneesh Rai, Max Bazerman, John Beshears, Lauri Bonacorsi, Colin Camerer, Edward Chang, Gretchen Chapman, Robert Cialdini, Hengchen Dai, Lauren Eskreis-Winkler, Ayelet Fishbach, James J. Gross, Samantha Horn, Alexa Hubbard, Steven J. Jones, Dean Karlan, Tim Kautz, Erika Kirgios, Joowon Klusowski, Ariella Kristal, Rahul Ladhania, Jens Ludwig, George Loewenstein, Barbara Mellers, Sendhil Mullainathan, Silvia Saccardo, Jann Spiess, Gaurav Suri, Joachim H. Talloen, Jamie Taxer, Yaacov Trope, Lyle Ungar, Kevin G. Volpp, Ashley Whillans, Jonathan Zinman and Angela L. Duckworth
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