Commitment devices: using initiatives to change behavior.

Unhealthy behaviors are responsible for a large proportion of health care costs and poor health outcomes. 1 Surveys of large employers regularly identify unhealthy behaviors as the most important challenge to affordable benefits coverage. For this reason, employers increasingly leverage incentives to encourage changes in employees' health-related behaviors. According to one survey, 86% of large employers provide incentives for healthy behavior change. 2 In this Viewpoint, we discuss the potential and limitations of an approach that be-havioral science research has shown can be used to influence health behaviors but that is distinct from incentives: the use of commitment devices (Table). 3 Many people intend to improve their health behaviors in the future (eg, to exercise more, adhere to medication regimens, eat well, quit smoking), but when the future arrives, they fail to follow through. 4 People are not unaware of the challenges associated with achieving their goals: many take steps to precommit their " future selves " to follow-through. For example, those eager to exercise more may buy gym memberships with annual contracts so future visits will require no out-of-pocket expenses, or they will schedule exercise with workout partners so failing to show up will mean disappointing friends; alcoholics may take disulfiram in the morning so drinking alcohol in the evening will make them ill. These are examples of commitment devices—many of which have no financial cost, but all of which deliberately limit future choices. Commitment devices attempt to enforce people's voluntarily imposed restrictions until they have accomplished their goals, or their voluntarily imposed penalties for failing to accomplish their goals. A common form of commitment device, also sometimes called a deposit contract or commitment contract , involves people voluntarily depositing money into accounts that they can access again only if they accomplish a goal. Commitment devices like this have been shown to help people lose weight, improve their diets, exercise more, and quit smoking. One randomized experiment , for example, found that access to a commitment device increased the rate at which smokers succeeded in quitting after 6 months by 40%. 5 Commitment devices have 2 basic features. First, people voluntarily elect to use them. This means people must be self-aware enough about the gap between their current goals and their likely future behaviors to recognize the value of taking steps to limit their future choices and actions. Many people are unaware of this gap and therefore fail to …