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Penny a PoundShould the government pay you to lose weight?

By Jake HalpernPosted Tuesday, Dec. 4, 2007, at 7:53 AM ET

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Why would women quit smoking for less than $100 dollars a month, when what's really at stake is the health of their babies? The answer, Higgins says, is about timing. People who are trapped in an unhealthy relationship with something that makes them feel good—whether it is cocaine, cigarettes, gambling, or eating—often focus on immediate gratification and short-term payoffs to the exclusion of everything else. One famous study asked heroin addicts and nonaddicts to tell a story by completing the following sentence: "I woke up this morning and I thought about the future and I thought ..." On average, nonaddicts described a future that was 4.7 years away, whereas the addicts described a future that was just nine days away. The key to changing behavior triggered by this type of short-term mindset may not be to push a longer-term view but to provide an alternative payoff scheme that is also immediate. And this is exactly what Finkelstein and Higgins managed to do.

One of the main criticisms of programs like theirs is that participants may relapse once the money runs out. Undoubtedly, in some cases this is quite true, but there are two points to consider. Somewhere along the line, the long-term benefits kick in. When successful dieters and ex-smokers begin to feel better as they skip up a flight of stairs or chase after their kids, this reward may sub in for the payouts they're no longer getting. In addition, the reward system can be structured to offer long-term benefits. Mayor Buonanno, for example, offered his townspeople a big payoff if they hit a five-month goal. Employers or insurers could do the same thing—quarterly or yearly payoffs for employees who maintain a healthy body weight.

One of the main obstacles to such efforts is that employers and insurers are often reluctant to make long-term investments in employees. The average tenure of an American employee is just four years. The disincentives this creates for companies raises the question of whether state or local governments should follow Mayor Buonanno's lead. Indeed, this is a mayor who may have a great deal to teach us. His other social initiatives include a plan to supply the good people of Varallo with Viagra. "Ensuring the wellbeing of one's fellow citizens also means making sure they have the possibility of a serene sex life," the mayor has declared. Ahh, to be Italian.