Commitment contracts as a way to health

Much illness stems from poor health behaviours. But changing behaviours is difficult, particularly when immediate desires must be sacrificed to achieve future benefits,1 as when people try to quit smoking, eat less, or exercise more. To overcome these challenges, corporate ventures such as www.stickk.com and www.healthywage.com are banking, quite literally, on commitment contracts, offering the millions of people who struggle to lose weight or take their medicines more regularly the opportunity to deposit money that they will receive back only if they succeed. Grounded in behavioural economic theory,2 commitment contracts bring a risk of loss into the present, where the temptations also lie, and augment motivation to succeed. They potentially offer an efficient mechanism of behaviour change because people generally are more motivated to avoid losses than they are to achieve similarly sized gains.3

Although new to health promotion, the idea of making voluntary commitments that restrict future options has a rich history. Cortes scuttled his ships to enhance his soldiers’ commitments to overthrowing the Aztec empire. Odysseus lashed himself to his ship’s mast so he could hear the song of the Sirens but not be tempted to throw himself overboard. And for more than a century, people have saved money in Christmas club accounts that provide little or no interest and charge fees to prevent early withdrawals, despite the widespread availability of penalty-free savings accounts with higher interest rates. Indeed, recent evidence shows that some people use commitment contracts to help them save money,4 complete homework assignments on time,5 and limit their …