For most of her adult life, Alfena Rascoe battled obesity.
At 238 pounds, the Laurel resident said, the extra weight slowed her down, affecting her stamina at work as a child psychiatric specialist. It also led to high blood pressure, putting her at risk of heart disease and stroke.
"I've done Atkins [diet], protein powder, the lemonade diet," says the 47-year-old. "Everything you can think of, I've tried it. They all work, but my issue is being able to maintain it."
So in March 2013, after a new blood pressure medication caused swollen ankles and shortness of breath, she decided to give dieting one more try.
Rascoe joined DietBet, a website that turns losing weight into a money-making — or money-losing — game.
The site is part of a new weight loss trend in which businesses offer financial incentives for dropping the pounds.
For many DietBet players, money is the initial draw, said Jamie Rosen, founder and CEO of DietBet and its parent company, WayBetter. Since the site launched in 2012, it has paid more than $8 million to DietBet participants betting on themselves to lose weight.
"There's something about having money on the line that flips a switch in our minds and gets us to really care about the outcome," Rosen said. "It doesn't have to be a lot of money. Betting just $25 on yourself achieves this effect."
But once the game gets underway, Rosen and players said, it's the competition and the support players receive from one another that keeps them going.
"We try to put the emphasis on the experience, the weight loss and where it should be in terms of getting healthy and not on the money," he said. "The money is really just a way of holding yourself accountable."
How it works
Different sites structure their competitions in various ways. Like DietBet, HealthyWage offers straightforward financial incentives.
Over at stickk.com, they've shaken it up a bit by offering "anti charities" as an added incentive. If you don't make your goal, not only do you lose money, but it goes toward a charity you don't want to support. For instance, gun lovers might pick the Educational Fund to Stop Gun Violence as their anti charity, while gun-control proponents might end up sending a donation to the NRA Foundation if their goals aren't met. Participants can also choose to fund charities they like with their winnings.
DietBet offers players two games: the Kickstarter, where players try to lose 4 percent of their weight in four weeks, and the Transformer, where players try to lose 10 percent of their weight in six months.
Anyone from friends to strangers and even fitness celebrities can create games. Players place bets, ranging from $10 to $100. Whoever reaches their goal splits the pot, minus DietBet's fee.
"Think of it like a fun run," Rosen said of the Kickstarter games. "Everyone who reaches the finish line at the end is a winner. It's not about being the first to cross the finish line."
If the game has a high percentage of winners, DietBet forfeits its cut to ensure players at least get their money back.
For the Transformer game, participants must have lost at least 6 percent by the fifth month to be eligible for the final pot.
Two days before DietBet games begin, players submit their starting weights. The weigh-in process requires two photos: one full-length image of the player on a scale wearing "airport security attire," meaning no shoes, bags or belts, and another of the scale's reading and the weigh-in word, which changes with each player.
To prevent cheating, a team of referees works around the clock, reviewing photos and final weights, Rosen said. The site also has algorithms to detect unusual activity or weight loss. In these cases, some players may be required to submit video weigh-ins for future games or be banned from the site.
At the end, players have 48 hours to weigh out. They are only required to submit photos if they win.
Rascoe bet just $25 and $30 for her first two Kickstarter games.
"I didn't put that much pressure on myself because I didn't want to fail," she said.
For the first few days, Rascoe said, she struggled. Before DietBet, she never exercised, and she ate fast food three times a day. But as soon as she reached out to her fellow gamers online, she said, she realized she was not alone.
"Everybody was struggling," she said. "If I had a bad day, or I wanted to eat a candy bar or burger, I shared it."
The support she received encouraged her to keep trying, implementing healthy behaviors whenever she could. Rascoe began walking 60 minutes a day, six days a week. She also cut back on fast food. By the end of the four-week games, she lost 6 percent of her weight, surpassing her goal and winning $43.71 and $43.56, respectively.
Life Time Athletic, a fitness center in Columbia, sponsors a 90-Day Challenge in which winners can receive up to $10,000 for reaching their weight loss goals. Like DietBet, Life Time offers participants two challenges: the Weight Loss Challenge, where participants win based on total pounds lost, and the Transformation Challenge, where participants win based on change in body fat percentage.
Emily Calkins of Elkridge, a Life Time Athletic member, called herself the "poster child for all of the popular diets."
"Tried them all with varying degrees of success," she said.
A few years ago, she joined the 90-Day Weight Loss Challenge to lose weight and keep her Type 2 diabetes under control.
For $25, a trainer provided Calkins with an initial fitness consultation and helped her identify weight loss and nutrition goals for the challenge.
For the first four challenges, she lost between 12 and 16 pounds each time.
"After the first few, I knew in my heart that I didn't do everything I could have to lose more," Calkins said. "I was OK with that at the time because I still was feeling successful."
But in February 2014, she decided to commit "100 percent," she said.
Each week, she participated in Try It Tuesdays — fitness classes, nutrition seminars and weigh-ins designed specifically for challenge participants. She also had daily access to a trainer through email or by phone.
By May, Calkins had lost 38 pounds, winning the women's challenge. While she did not win the national $10,000 prize, she did win $300 in club money, which can be redeemed for Life Time classes, services or products. She also won her own locker for a year.
"I will be really sad when I have to turn my key back in when the year is up," she said.
Why it works
Research, and results, show getting paid to lose pounds can work.
A 2013 Mayo Clinic study found 62 percent of people offered $20 a month to win a yearlong weight loss challenge completed the competition, dropping an average of nine pounds. In the non-financial-incentive group, only 26 percent of the people completed the challenge, losing an average of two pounds.
Last May, the 124 people who participated in Life Time's 90-Day Weight Loss Challenge lost a combined 644 pounds.
"It speaks to everybody's desire to take on a challenge, start fresh and achieve a goal," said Derek Favreau, head of the personal training department at Life Time Athletic. "It speaks to that feeling inside us that we need to have a starting point. For some people, [money] gives them a greater sense of 'There's something at stake here.' "
In the DietBet Kickstarter game, about 40 percent of those playing win, Rosen said. Overall, more than 90 percent of players lose weight.
"Some sort of incentive is valuable," said Dr. Lawrence Cheskin, director of the Johns Hopkins Bloomberg School of Public Health's Weight Management Center. "Any process that engages you and monitors you so there's accountability is probably going to improve your chances of success."
But to achieve long-term weight loss, he said, people need to look at triggers for their weight gain and not just rely on short-term incentives.
For Rascoe, the support she has gained through DietBet keeps her on track. She plays weight-loss games almost monthly, runs up to five miles a day and eats healthier than ever, she said. Rascoe has dropped to 140 pounds — 98 pounds lighter than her initial DietBet starting weight. And she has won more than $3,000, which she puts back into the site or spends on fitness equipment like heart rate monitors or running shoes.
"It worked for me because I needed someone who could identify with me and the struggles that I had," she said. "I didn't realize there were people uncomfortable with their weight like I was."
Fellow gamers who started off as strangers are "just like family now," she said.