Economics is essentially the study of scarcity and deciding how we are going allocate different “scarce” resources (ie: money). Households and individuals (that don’t contain the surname Gates, Buffett, or Walton) have a limited supply of money and they must choose how best to allocate their limited supply, or what to spend it on. Therefore, much of economics is based on financial incentives. Individuals perform what is called cost-benefit analysis and look at what their financial cost is for a product and what their benefit is. If the benefit outweighs the cost, the transaction is made. Businesses will offer price incentives (sales) to decrease the consumer’s cost, while producing better products to increase the consumer’s benefit. Ok, I’ll leave it at that and try my best to incorporate weight loss into economics. Don’t x out of this screen yet, I think I was going to make a point somewhere. Here goes…

So in order to give yourself more incentive to lose weight, there needs to be something of importance (ie: money) that you risk if you are unable to lose weight. Try this: take out a contract on yourself. If you are unable to lose a certain amount of weight over a certain period of time, you lose the money (Give it to charity, friend, or family member). The fact is, people hate losing their own money, and Yale economist Barry Nalebuff brings light to this concept in his own personal weight loss endeavor Betting on Weight Loss. He entered a contract with his wife where she would actually pay him to lose weight each week. Some corporations have even incentivized their employees this way in order to decrease the company’s health care costs. Personally, I feel that having to pay out money if you don’t lose weight will be more effective than being paid if you do. The Legend Larry Bird once said, “I hate losing more than I like winning.” (He also hated normal length shorts- I miss the 80’s), but that’s neither here nor there.

So let’s say you are looking to lose 30lbs in 3 months. That is 10lbs per month. If you aren’t losing 2-3lbs per week, then you owe your friend $25 at the end of each week. As long as you reach your goals each week, you will save $300 at the end of 3 months. Oh, and you’ll also be 30lbs lighter! Losing weight is difficult, so let these simple economic incentives work to your benefit. Good luck!

Joseph Pepe, Jr. serves as the Director of Project Development for Planet Fitness. He oversees the Personal Training and Nutrition Department for 14 locations throughout CT. He is also the Managing Director for the Lose It! Weight Loss System (www.loseitweightloss.com). Joe received his B.A. in Economics from Wesleyan University. And since he’s our health and fitness guru, lets give him a plug as a athlete in his younger years as an All-NESCAC and Academic All-NESCAC Football Selection at Wesleyan. Go Cardinals!!

A New Motto for Weight Loss: Keep Disneyland Open By Alison Silvis

Look to Disneyland for the latest symptom of the obesity epidemic. The park’s “It’s a Small World” ride is simply too small to accommodate the extra 24 pounds the average American has packed on since 1960. Stalls and stops are so common that extra platforms have been built at problem hotspots along the ride. Now, the ride will be closing for ten months beginning in January for refurbishment with larger flume cars and deeper waterways.

As future health-care professionals, this is one more sign of the environment in which we will be practicing. Patients are getting heavier, more sedentary and in greater need of preventative care and support for behavior change. Evidence-based medicine should be the gold standard for such care. But we still cannot answer the simple question: how much weight gain is bad? And how much is good?

The November 7 issue of JAMA contains an article that adds to our understanding of the already-complex relationship between weight and health, but raises many questions about the supposed protective effect of being overweight. Knowing how to interpret articles and how to individualize research findings to a patient is our responsibility. But this is only one component of employing evidence-based medicine. It also means making sure patients understand the information, and then following up to see how they apply that information to their lives. This is easier said than done, of course, but that does not justify giving up.

The same issue of JAMA offered some hope in how to support long-term weight management behaviors, in the discussion of one physician’s efforts to manage the care of an obese patient with several health complications (“Clinical Crossroads: A 63-Year-Old Man with Multiple Cardiovascular Risk Factors and Poor Adherence to Treatment Plans”). The author, Dr. Bodenheimer, emphasized the importance of clinical care teams that work to merge a patient’s goals with clinicians’ goals. A patient’s participation in her care may be the single most important factor in adherence to medication, and presumably plays a fundamental role in determining adherence to behavior change.

In this sense, a clinician’s role may evolve into one of “self-management support,” providing information and resources to initiate and maintain healthy behavior outside of clinic visits. One promising model of this type of chronic care is at Health Partners Medical Group in Minnesota. There, patients receive previsit, visit, postvisit, and between-visit care from a variety of health professionals. Clearly, collaboration within the health professions and between clinicians and patients is essential to this model. Whether or not it improves patient outcomes is yet to be determined, but the current system is clearly failing.

We cannot afford to ignore the painful reality of the obesity epidemic. In Disneyland, when heavy patrons are disgruntled at being asked to step off the ride, they are offered a food voucher. In the world of evidence-based medicine, we need to challenge patients to confront the reality of their daily lifestyle choices, and then work with them to modify those that are unhealthy. We owe it to them