Quote:

The advice, which will be published by the National Institute for Health and Clinical Excellence tomorrow, has been greeted with anger by critics who claimed such "bribes" were draining the public purse of money which could be better spent elsewhere. The study examined a series of schemes, including one in Kent which pays dieters up to £425 for losing weight and another in Scotland which gives pregnant women shopping vouchers worth up to £650 for quitting the habit. It also looked at programmes in Oxford, Manchester, London and Bangor in Wales, where schools have been given toys such as juggling balls, stickers and pencils to children who have eaten their fruit and vegetables. The report said that such rewards could be "an effective way of encouraging people to change their unhealthy ways." Fiona McEvoy, from the TaxPayers' Alliance, said state funds should not be used to pay people to change their lifestyles, She said: "Bribing people to lose weight or quit smoking is nothing but a quick fix which patronises the individuals in question and drains much-needed money away from the public purse. At a time when cancer drugs are being denied to sufferers due to lack of funds, many will be disgusted to learn that NICE are considering such a costly approach." Other schemes examined in the report include a pilot in Manchester which rewards overweight parents for walking their children to school. As part of a £30m project, supermarket points are given to unfit people who attend keep-fit classes, weight loss clubs or go for a run in the park. Overweight people gain credit points they can cash in for groceries just for turning up, with extra rewards depending on how much weight they lose. In Newcastle, Bristol, Torbay, Manchester and Bury St Edmunds, those aged 16 to 22 are given subsidised gym membership if they visit at least once a week. However, the report found limited evidence about whether the schemes make a difference. In the Scottish antismoking project, for instance, the study acknowledged that four fifths of the women in the £43,000 scheme were smoking again within three months of giving birth. The recommendations from NICE's independent citizens council do not constitute its official advice to the NHS. Its board will launch a public consultation on the matter before considering the paper, which would inform future guidance. However, the rationing body has already supported financial rewards for heroin addicts. Originally NICE recommended that addicts who attended treatment programmes should be given the chance to win prizes, such as televisions and MP3 players. The body dropped the idea following a public outcry but instead recommended that shopping vouchers worth up to £10 could be awarded to those who completed programmes, or showed they were clear of drugs. NICE has been widely criticised for refusing to pay for dozens of cancer drugs on the grounds of cost. Medicines rejected include the drugs Avastin for advanced bowel cancer and Nexavar for advanced liver cancer. Last year the institute fuelled controversy when it ruled marriage guidance counselling should be funded by the NHS, and supported the use of acupuncture for back pain, despite finding there was no good evidence it worked. The report follows a three-day meeting of NICE's citizens council, where members were asked to vote about the use of incentives. "More than 60 per cent said they were in favour of such schemes, as long as they were only used as a "last resort" and were not exchangeable for tobacco or alcohol. Sir Michael Rawlins, the chairman of NICE said: "We clearly face several public health challenges in today's society, some more obvious than others, and we must seek to improve these in ways that are likely to achieve the best outcomes to those affected. "The majority of the council has voted in favour of the use of incentives under certain circumstances, but this clearly remains a divisive issue". Public consultation on the report starts tomorrow. Dr Helen Waters, from the UK Faculty of Public Health said there was some evidence that reward schemes worked and usually cost the same as other ways of changing people's habits, such as weight loss clubs and smoking cessation groups. But she said there were risks about the message such payments sent – both to those who received them, and to the rest of the population. "There is some concern about the broader long-term messages – that reward schemes could be seen to be rewarding people for developing unhealthy habits," said Dr Waters.

Taxpayer should fund 'bribes' for obese and smokers - Telegraph

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Anecdata: at one point I got £20 a week for not skyving off school. It didn't have much of an effect.

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So I'd like to see all the evidence before passing judgement.

Economists have shown (afaik) that people do react to such incentives and do change their behaviour. In which case, it would be a perfectly apt use of public funds as you can calculate the 'gains' from not having to spend money later on on people sick because of smoking/unhealthy eating habits. It may be patronising but telling me to stop at a red light could similarly be construed as patronising.

OTOH, I am reading a book by Martha Beck (the 4 day win) about dieting (I am trying to lose some weight) and she says that such infantilisation/reward cycle will trigger unconscious rebellion so that, while a conscious/will-based approach may succeed in the short term, it will eventually lead to a backlash where people binge incontrollably and end up worse off...

She quotes a study (which I cannot find right now) where some men with a balanced lifestyle and good mental attitude were suddenly put on a strict diet - Slowly but surely, these men went bonkers, binging etc. Even after the study was finished, their relationship to food had been warped and they suffered the scars for a long long time...

Her point is that overweight people usually know that they should eat less and move more. The problem is that they cannot stick to the program. And that's not a question of willpower. It's a matter of them using food as an emotional palliative for a lot of things. Other people would bite their fingernails. Or smoke. Or drink. Or wash their hands compulsively. The point is that overeating has nothing to do with being hungry. Thus, the secret of losing weight (according to Beck) lie in controlling your stress/unhappiness and not using food as a destressor.

If she is right, then, putting added stress with cash reward will backfire in the long term.

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