This led us to wonder—is undermining responsible for the pattern of poor maintenance observed in weight loss and lifestyle interventions that have emphasized financial incentives?
On the one hand, the general pattern of poor maintenance observed across pay-for-performance weight loss and lifestyle intervention trials has been consistent with the undermining effect. On the other hand there are some noteworthy differences between the ways extrinsic rewards have typically been used in the context of experiments inves tigating the undermining effect versus how financial incentives
have typically been used in weight loss interventions.
Few studies of the undermining effect have tested the impact of extrinsic rewards for longer than a few hours or days; by contrast, weight loss interventions are typically interesting in assessing maintenance weeks or months later. Further, the typical laboratory experiment investigating the undermining effect has involved administration of a reward at a single time point, leading Deci et al. [30] to conclude from their meta-analysis that more studies are needed “that examine repeated administration of rewards over time” (p. 650). The pay-for-performance weight loss interventions conducted by Volpp and others have typically involved repeated payments for weight loss achieved incrementally over the course of multiple weeks. Furthermore, studies of undermining effects have typically involved rewarding participants for a behavior that is intrinsically motivated at baseline, that is, behaviors that are interesting or enjoyable (e.g., Soma puzzles). In the case of obesity interventions, participants’ baseline levels of intrinsic motivation for eating healthy foods and being physically active is likely modest. Collectively, these differences introduce reasonable skepticism about whether the undermining effect is relevant in the context of weight loss and lifestyle interventions and support the need for more
research on this topic