Can Health Incentives Win Over Food Addictions?

food choices

The most desirable way to change your waist size is to understand that you have the power to control your appetite and increase physical activity. Why then can’t most Americans do this? Why doesn’t this work when we spend billions on weight loss every year?

It doesn’t work because some foods – saturated fat, salt and simple sugars – are addictive. That means that when you consume them, they cause a release of dopamine in the brain, which makes you feel pleasure. Overtime, that stimulation causes the brain’s post-orbital frontal cortex to grow, and to release more and more of that addictive substance. That need for dopamine release overwhelms your rational higher brain function, located in your parietal frontal cortex, as you try to tell yourself, “I have got to stop eating,” or “I’m not hungry anymore.” As you eat more, your rational self loses to your addictive cortex. This is why I say willpower is no match for addiction.

But – can you incentivize good health? And can these incentives overwhelm these addictive responses? I say yes.

Here is my position – and it may not reflect the official position of the Cleveland Clinic, where I am the Chief Wellness Officer, though I think it does: If you can grow your rational cortex bigger (size does matter for brain function), with more connections so these incentives are great enough to you, you can build your rational brain bigger so it can overwhelm the additive area of your brain. You can take control of your life if the incentive you have drives growth of your rational brain.

Emotional incentives can grow that part of your brain – whether it be the desire to see your kids’ kids graduate from high school, or being loved or being part of a group. A large enough financial incentive can also overwhelm the addiction incentive certain foods give your brain. You also need to couple these incentives with the belief that you can succeed – the ah-ha moment – and an environment and programs that make it easier to succeed.

The Cleveland Clinic has created an environment conducive to getting and staying healthy; and The Clinic has developed programs with social buddies and coaching to help foster and sustain its Workplace Wellness programs.

In addition to ah-ha moments, programs and coaching, The Clinic also has put a large financial incentive in place.

When we started this process at The Clinic, only 8% of people with chronic disease were attempting to get ideal management of that chronic disease (the industry average in health care is 12%; the best we were told by the consultants was 15%). After Cleveland Clinic made the environmental changes (vending machine makeovers and free fitness centers) and added programs (Weight Watchers and e-coaching, free to employees), around 23% of people participated. And after financial incentives became strong enough, now more than 60% participate – and this number is still growing.

As an example, if you participate in one of The Clinic’s programs and get on a pathway to your ideal five “normal” (blood pressure, blood sugar, LDL cholesterol, weight for height, and no tobacco products in your urine) and get your immunizations, you pay zero for your family’s insurance.

For a family of four, you’d get rebated over $2000 – now that’s a large incentive. More than 60% of our employees with chronic disease now have five normals or are on a pathway to five normals.

What does this mean if the data we are accumulating continues to follow this trend? Not only a flattening of the cost curve despite price increases for medicines etc., but our actual costs of medical care went down this year for our employee population.

If this continues, because people get healthy, and that’s what the literature would say, if you have five normals and you get your immunizations, your medical costs will be 50% of the typical medical costs over a lifetime compared to someone with even one abnormal – and, let me repeat, over a lifetime. You become more competitive – and you keep your jobs because your company is more competitive. If we can spread these wellness incentives to many other organizations in the USA, the country can decrease its budget deficit, and you and we can have a higher standard of living.

We as a community, by lowering our health-care costs, can thrive. As a country and as an organization, we don’t have enough time to study this extensively in a real double-blind gold standard of an experiment.

But the data we’ve accumulated show that incentives – large incentives – really do work. Join the fun of helping you control yourself. It really can make you younger and richer. Remember for your brain – as well as for incentives – size matters. And you deserve to have a really big parietal frontal cortex.

For more on incentivizing good health, listen to this podcast.

-Young Dr. Mike, The Enforcer