Do financial incentives and environmental strategies impact our behavior?

UPenn PRC researchers studied how financial incentives and environmental strategies impact behavior change when losing weight. After the study was completed, they interviewed high- and low-success participants to learn more about how the trial did or did not work.  By examining participant perceptions, they gained insights into factors related to the effectiveness – or lack of effectiveness – of these interventions.

Read the latest publication from the Healthy Weigh Study in volume 14/issue 3 of BMJ Open.

Trial participants who successfully lost weight differed from those who did not lose weight in several ways.

Successful Participants:

– Had robust prior attempts at dietary and exercise modification.

– Actively engaged when they encountered obstacles.

– Received substantial social support.

– Routinized dietary and exercise changes.

– Often considered weight loss as its own reward, even without incentives.

Interestingly, neither group could clearly articulate the details of the incentive intervention or identify payments as incentives or study payments.

With or without a specific incentive or environmental intervention – it appears that successful weight loss is linked to actively trying, having social support, and being intrinsically motivated.


Glanz K, Kather C, Chung A, et al. Qualitative study of perceptions of factors contributing to success or failure among participants in a US weight loss trial of financial incentives and environmental change strategies. BMJ Open 2024;14:e078111.

Main Results Paper: 

Glanz K, Shaw PA, Kwong PL, Choi J, Chung A, Zhu J, Huang Q, Hoffer K, Volpp KG.  Effect of financial incentives and environmental strategies on weight loss in The Healthy Weigh Study: A Randomized Controlled Trial. JAMA Network Open, 2021;doi:10.1001/jamanetworkopen.2021.24132

Protocol Paper:

Glanz K, Shaw P, Hoffer K, Chung A, Zhu J, Wu R, Huang Q, Choi J, Volpp K.  The Healthy Weigh Study of Lottery-based Incentives and Environmental Strategies for Weight Loss: Design and Baseline Characteristics.  Contemporary Clinical Trials, 2019; 76: 24-30.


The Nutrition Environment Measures Survey (NEMS) – A Systematic Review

A Tool for Understanding the Food Environment

The Nutrition Environment Measures Survey (NEMS) is a set of tools that researchers use to assess the availability of healthy food options in stores and restaurants. NEMS tools have been used in research for over 15 years and have been adapted for diverse settings and populations.

A recent systematic review published in the American Journal of Preventative Medicine (AJPM) examined how NEMS tools have been used in published research. The review found that 190 articles from 18 countries had used NEMS tools. Most studies (69.5%) used a modified version of NEMS tools, and there were 23 intervention studies that used measures from NEMS tools or adaptations as outcomes, moderators, or process assessments.


Adapting to the times

The review also found that 41% (n=78) of the articles evaluated inter-rater reliability, and 17% (n=33) evaluated test–retest reliability. This suggests that NEMS tools are generally reliable and valid measures of the food environment.

The review concluded that NEMS measures have played an important role in the growth of research on food environments. NEMS tools have helped researchers to explore the relationships among healthy food availability, demographic variables, eating behaviors, health outcomes, and intervention-driven changes in food environments.

The review also noted that the food environment is constantly changing, so NEMS measures should continue to evolve. Researchers should document the data quality of modifications and use in new settings.


NEMS tools are a valuable tool for understanding the food environment. They have been used in a wide variety of research settings and have helped to advance our understanding of the relationships between the food environment and health. As the food environment continues to change, NEMS tools should continue to evolve to meet the needs of researchers.

Glanz K, Fultz AK, Sallis JF, Clawson M, McLaughlin KC, Green S, Saelens BE. Use of the Nutrition Environment Measures Survey: A Systematic Review. Am J Prev Med., 65:1, 131-142, July 2023. EPub March 2023. doi: 10.1016/j.amepre.2023.02.008. PMID: 36990939.

Healthy Weigh Study Results

What strategy works better for weight loss in overweight employees?

  • Financial incentives
  • Environment change strategies
  • A combination of the two,
  • On-your-own weight-loss efforts


Drs. Karen Glanz and Kevin Volpp, along with the team at the UPenn PRC, found that participants in all groups lost weight. Incidentally, the financial incentives group lost slightly more weight, but none of the strategies netted significantly greater weight losses than the others. The results from their Healthy Weigh Study are currently published in the September 2021 edition of JAMA Network Open.


In 2015, the University of Pennsylvania Prevention Research Center (UPenn PRC) conducted a study to test strategies to achieve weight loss and maintain weight loss in urban worksites in Philadelphia.

First, researchers collected data on participants who earned daily financial rewards, in addition to those guided on positive changes to their environment.

Second, they compared each strategy, separately and together, to see which one helped the participants achieve weight-loss.

Third, the team compared that data to those who tried to lose weight on their own.

Ultimately, the goal of the study was to manage obesity by improving nutrition and physical activity, in order to reduce the risk of cardiovascular disease and other chronic health conditions.





JAMA Healthy Weigh_visual


Glanz K, Shaw P, Kwong P, Choi J, Chung A, Zhu J, Huang Q, Hoffer K, Volpp K. Effect of Financial Incentives and Environmental Strategies on Weight Loss in The Healthy Weigh Study: A Randomized Clinical Trial. JAMA Network Open 2021;4(9): e2124132. doi:10.1001/jamanetworkopen.2021.24132

How many ways do you protect yourself from harmful UV rays?

Skin cancer prevention practices aim to reduce exposure to harmful ultraviolet (UV) rays that causes skin cancer. There are several behaviors that can protect the skin from the harmful radiation – using sunscreen, wearing hats and shirts, and seeking shade.

The Study

Researchers at Penn conducted an experiment with white men and women between the ages of 18 – 49 years old, to see if specific health communication messages would change their intentions to protect themselves from the sun.

Researchers asked participants to watch videos, and then to report whether they would be more or less likely to use the protection method featured. They also viewed messages that contained more than one protective behavior.

The Findings

The results of the experiment showed that messages which emphasized only one sun protection behavior with general sun safety messaging were more promising than those that focused on multiple behaviors.  In some cases, men and women responded differently. More women in the study felt strongly that they would miss out on activities if they applied sunscreen, but they felt positive about protecting their head and face from the sun by covering up. On the other hand, men more often felt they would miss out on activities if they sought shade.

Investigators did not see specific messages rising to the top in this study, and suggest that focusing on a single sun protection behavior initially would be more effective.  This is seen as a first step, as longer communication campaigns may be needed to achieve lasting changes. One viewing of a message about protection is not enough to change a person’s behavior when it comes to sun protection methods.

Read the full paper here.

Bleakley A, Jordan A, Strasser A, Lazovich D, Glanz K. Testing General Versus Specific Behavioral Focus in Messaging for the Promotion of Sun Protection BehaviorsAnnals of Behavioral Medicine, 2019 Oct 4

How far will you go to prevent skin cancer? Penn researchers look at the options

A study was published in the American Journal of Preventive Medicine, where Penn researchers evaluate the beliefs in sun protection behaviors versus the risk of skin cancer.

It is known that practicing multiple behaviors against harmful UV rays, yet few adults report practicing more than one recommended behavior. This study examines how far a person is willing to go to prevent damage from UV rays, and which prevention measure is used most frequently.

Read the paper here


Bleakley A, Lazovich D, Jordan AB, Glanz K. Compensation Behaviors and Skin Cancer Prevention, American Journal of Preventive Medicine, Volume 55, Issue 6, December 2018, Pages 848-855


Read more about the Skin Cancer Communication Project here.

Advances in Alzheimer’s imaging are changing the experience of Alzheimer’s disease

Stites, S.D., Milne, R., Karlawish, J.
Alzheimer’s and Dementia: Diagnosis, Assessment and Disease Monitoring

Volume 10, 1 January 2018, Pages 285-300

  • PRC Investigator, Dr. Jason Karlawish joined S.D. Stites and R. Milne to study how a bio marker-based diagnosis can help a patient during each stage of Alzheimer’s Disease. The stigma or shame that can come with the disease can affect how a patient feels about themselves. Dr. Karlawish and his colleagues explored how changes in the way a patient is diagnosed can help address these stigmas.

Read more about the Healthy Brain Research Network here.

A national survey of young women’s beliefs about quitting indoor tanning: implications for health communication messages

Indoor tanning is a risk factor for skin cancer, particularly among young, white women. Our researchers found that persuasive health messages that encourage young women to quit indoor tanning should focus on their beliefs that it helps their appearance and mood, rather than the health risks.

20% of our nation’s young, white women indoor tan, knowing the risk of skin cancer. In November and December of 2015, a national online  survey was conducted with 279 non-Hispanic white women, ages 18-25 in the United States, who indoor tan.

This survey investigated the young women’s beliefs and attitudes as well as social influences that kept them from quitting.

“Young women were most concerned about skin damage and that quitting tanning might affect their mood,” says Amy Bleakley PhD, MPH, lead author of the study. “It was interesting that quitting tanning to prevent skin cancer did not motivate their intention to quit. Health messages that focus on appearance and mood instead of skin cancer may be more effective in encouraging young women to quit indoor tanning.”

Researchers suggest that health messages from doctors, parents and other loved ones aimed at discouraging indoor tanning should highlight the belief that quitting indoor tanning will reduce skin damage. In addition, messages should counter the belief that quitting will make them less happy. Finally, messages should highlight key people who would approve of them quitting indoor tanning.

Read the article here.


Amy Bleakley, Amy Jordan, Morgan E Ellithorpe, DeAnn Lazovich, Sara Grossman, Karen Glanz

Translational Behavioral Medicine, ibx007,
Published: March 15, 2018


Wearable Devices as Facilitators, Not Drivers, of Health Behavior Change

Despite the latest trend in technology and weight loss, new research by PRC researchers reveals that wearable tracking devices are not extremely effective in changing users’ behaviors. Although these devices have potential, researchers say there are significant challenges.
Read the article here.


Patel M, Asch D, Volpp K. Wearable Devices as Facilitators, Not Drivers, of Health Behavior Change.  JAMA. 2015;313(5):459-460. doi:10.1001/jama.2014.14781.