Would having to give a large sum of money to charity each time you light a cigarette help you stop smoking? Or would knowing that each week you fail to shed any fat will result in you donating funds to George Bush's presidential library and museum be enough to make you lose weight? For some people, self-imposed spurs like these are proving effective where all else has failed in helping them kick their unhealthy habits.
The idea of using financial incentives or penalties to help change your lifestyle is behind a whole raft of new health websites and initiatives. When you sign up to stickK.com, for example, you pick a price, a goal and a referee whom you can trust not to lie for you, no matter how much you plead with them. Meet your targets and you get to keep your cash; fail and the money is donated to charity or even an "anti-charity" - an organisation you wouldn't want to benefit.
Sheila Gilmour, from Edinburgh, has always had a weight problem. She had tried various diets to no avail until she joined Weight Watchers, which helped her lose weight, but she struggled to keep it off in the longer term. Her son heard about stickK.com and suggested she try it.
"I've put on 22lb during the last two months so I've placed a bet that I'll lose 1lb per week for 22 weeks. Each time I fail, I've got a contract that will mean I have to give £200 to charity. This is a lot of money over 22 weeks," she says. While Gilmour admits that she doesn't have significant money worries, she says that the amount she has bet is a "powerful motivator" for her to excercise and eat the right food.
"The bet is essentially a voluntary tax. It takes the vices we have and it makes them more expensive," says Dean Karlan, professor of economics at Yale University, whose own success in losing weight by placing a hefty bet with a friend inspired him to set up StickK. "It is a very simple way of making tempting options more costly so that we do not choose them."
StickK.com reports that more than 70% of people who put money at stake achieve their goals. Gilmour, for one, is happy with her progress so far. "It's only been four weeks, but I've met my goals - just," she says. Her son is her referee and keeps a watchful eye over the scales. If, at the end of the 22 weeks, Gilmour has reached her goal, she will be given the option to set up a continuing incentive to keep her weight within a certain margin of it.
Other websites, such as fatbet.net and makemoneylosingweight.com, are designed for communities of dieters who want to challenge one another. A group of friends or colleagues sign up, everyone puts a set amount into a pot and makes a commitment to lose a certain amount of weight. After a pre-arranged period of time, whoever is closest to his or her target weight takes the pot. The websites provide a forum for publicly tracking weight.
The incentives don't always have to be monetary. One current bet between two men - Iain and Paul - on fatbet.net, entitled the Battle of Trafalgar, uses good, old-fashioned shame instead. "The doggedly lardish of us will have to run around Trafalgar Square in their underpants on a Saturday afternoon waving pizza slices in the air and shouting 'I love being fat'. Possibly while wearing flippers. And a pickelhaube," they write. So far, it looks as if Iain will be doing the stripping.
Using cash incentives to help people change their unhealthy behaviours is fast gaining popularity with UK health policy makers, but rewards rather than penalties have been favoured. It's a different approach to the websites, which focus on loss aversion.
Schemes vary from an Essex-based initiative to help pregnant women stop smoking by offering them £20 in food vouchers for one week of cessation; £40 after four weeks; and another £40 at one year, to the first NHS-funded trial of a weight loss incentive scheme, Pounds for Pounds (nhsweightlosstrial.com), which is based in Kent. Participants set their personal weight-loss targets of between 15lb and 50lb to earn rewards from between £70 to £425.
Theresa Marteau, a health psychologist at King's College London, is part of a new team at the Centre for the Study of Incentives in Health, investigating the mass benefits of these schemes. "They clearly work for some people, but then so do most things," she says. "For example, grapefruit diets and crystal wafting. The question is whether they have effects that are greater than those expected by chance." Research so far has shown mixed results and the people who bother to sign up to these websites, she says, may well be more motivated to change their behaviour in the first place.
"Positive financial incentives," says Marteau, "capitalise on the tendency that most of us have to pursue small immediate rewards rather than larger but more distant ones." The theory is that by establishing new behaviours using the power of rewards, these new behaviours will then become habits. One downside of that, she says, is that people may adopt unsustainable or unhealthy ways of achieving their goals. "People may indulge in unhealthy practices to win or avoid loss, such as taking laxatives or diuretics in weight-loss programmes. There are also now blogs on how to cheat carbon monoxide testing for smoking," she says.
Gilmour, meanwhile, is surprised by how powerful the cash motivator has been in helping her change long-standing habits. "It's early days, but I'm optimistic," she says.
