When Germany became the first country in the world to allow patients to obtain certified digital health applications by prescription, reimbursed by statutory health insurance, it made a bold bet: that people would value digital care enough to justify covering it alongside conventional medicine. A new study now puts that bet to the test for one of the country’s largest and most expensive health problems—obesity—and the answer is uncomfortable for app manufacturers. According to research published in Obesity Science & Practice, adults living with obesity are willing to pay meaningful amounts of their own money for structured weight-loss support, but only a fraction of what many prescribed obesity apps currently cost the system. Just as striking is the finding that whether the intervention arrives as a smartphone application or as a physician-led, in-person program barely matters to the people it is meant to help.
The study, conducted by researchers affiliated with the Leibniz Science Campus Bremen Digital Public Health, surveyed 424 adults in Germany with a body mass index of 30 kg/m² or higher, the clinical threshold for obesity. Using a contingent valuation survey—a health-economic technique that asks people directly how much they would pay for a service—they elicited monthly willingness-to-pay (WTP) figures under a hypothetical scenario in which neither of two obesity interventions would be covered by insurance. The first was a certified digital health application, known in Germany as a DiGA, modeled on approved apps such as Zanadio and Oviva, which combine dietary guidance, activity tracking, and behavioral coaching. The second was the disease management program for obesity, or DMP, introduced nationwide in 2024 following a decision by the Federal Joint Committee. The DMP is an offline, structured care pathway that coordinates general practitioners and specialists, includes structured training, individualized treatment goals, and continuous documentation within physician practices.
The methodology was designed to guard against some of the classic pitfalls of stated-preference research. Participants were recruited through the forsa.omninet panel, which is representative of German internet users aged 18 and older and recruited offline via random telephone sampling, reducing the self-selection problems common in online health surveys. To minimize value-cueing bias, respondents were randomly assigned to one of two payment scales, both spanning €0 to more than €100 per month but with different central values—one anchored near the price of mainstream weight-loss apps like WeightWatchers and Noom at roughly €10 per month, the other near €40, the midpoint between consumer apps and obesity-focused DiGAs, which cost self-paying users approximately €70 per month. Each participant stated the maximum amount they would definitely pay and the minimum they would definitely not pay, and their individual WTP was calculated as the average of the two. Respondents could also explain their answers in free text, a feature that proved important: after two independent reviewers categorized justifications suggesting biased or misinformed responses—such as beliefs that healthcare should simply be free or misconceptions that both interventions were digital—53 participants were excluded, leaving a final analytical sample of 371.
The headline numbers are sobering for the digital health industry. Mean WTP for the DiGA was €16.15 per month (95% confidence interval: €14.22–€18.09), while mean WTP for the DMP was €18.70 per month (95% CI: €16.52–€20.90). The DMP edge of €2.55, about 15.8%, was statistically significant in a Wilcoxon matched-pairs signed-rank test, but the authors characterize it as modest in substantive terms. Nearly half of all participants—47.4%—stated exactly the same monthly amount for both formats. Meanwhile, uptake willingness was nearly universal: 95.9% expressed a positive WTP for the digital app and 95.5% for the offline program. Set against manufacturer prices for obesity DiGAs of roughly €70 per month, the stated valuations fall short by a factor of more than four.
To understand what drives these valuations, the researchers employed a two-part regression model. The first part used a probit model to estimate the probability of expressing any positive WTP; the second applied a general linear model with a gamma distribution—chosen to accommodate the heavily skewed WTP data and validated with a modified Park test—to the subset of respondents who stated nonzero amounts. Marginal effects were derived using the delta method. For the DiGA, each additional year of age was associated with a €0.24 increase in monthly WTP (p = 0.02), and each unit increase on a digital affinity index added €6.91 (p = 0.01). Interestingly, older respondents were less likely overall to express any WTP, yet among those willing to pay, older age predicted higher amounts—a pattern the authors suggest may reflect younger users’ habituation to free apps versus older users’ greater trust in certified, regulated medical products.
For the offline DMP, the determinants looked entirely different. Female participants reported €6.20 higher monthly WTP than male participants (p = 0.02), and each unit of improvement in self-reported digital infrastructure added €2.63 (p = 0.04)—a counterintuitive result, since one would expect internet quality to matter for an app rather than a physician-led program. The authors speculate that the digital infrastructure variable may be capturing broader urbanization effects: better health awareness, more exposure to social comparison, shorter distances to care facilities. The sex difference, meanwhile, is consistent with prior research and may reflect the disproportionate psychosocial burden of obesity on women, including weight-related stigmatization in education and employment. Notably, general health status measured with the EQ-5D-5L, education, and equivalized net income showed no statistically significant association with WTP for either intervention, challenging assumptions that wealthier or sicker patients value weight-loss programs more.
Perhaps the most consequential finding is what the near-identical valuations do—and do not—mean. In stated-preference literature, identical WTP across offerings of different scope is often dismissed as scope insensitivity, a red flag for careless survey responses. But the authors argue that interpretation does not fit here, because the two interventions were designed to deliver comparable expected clinical outcomes and differed mainly in delivery format. If nearly half of respondents value a prescribed app and a physician-coordinated program identically, the reasonable inference is that people are valuing the expected weight loss, not the technological packaging. This pattern may also reflect an embedding effect, in which respondents report their WTP for solving the overarching problem of obesity rather than for any specific intervention—an effect repeatedly documented in health valuation studies.
Placed in international context, the German figures look remarkably consistent. A systematic review of WTP for overweight and obesity interventions identified nine prior studies, four of which reported monthly values. Liu and colleagues found roughly $12 per month for pharmacological treatment and $10 for a low-calorie diet among employed women in Taiwan; Jerome and colleagues reported a median of $45 monthly for a lifestyle program; Lauer and colleagues found a median of €20 for childhood overweight prevention. When the new estimates were converted to euros per percentage point of expected weight loss, they yielded €5.31 for the DiGA and €6.15 for the DMP—closely matching the £6.51 (about $10.49) per percentage point reported by Doyle and colleagues for pharmacological interventions. The consistency across countries, populations, and intervention types strengthens the case that these magnitudes reflect something stable about how people value weight-loss support, rather than quirks of a single survey.
The study has limitations the authors acknowledge candidly. The sample skewed male, with about 60% male participants compared with roughly 40% in the general German population of adults with obesity, and higher-income individuals were under-represented, which may explain why income coefficients pointed in the expected direction without reaching significance. Conducting a digital survey about a digital product may itself have excluded people with low digital affinity who might value the offline program more. Survey incentives may have encouraged quick rather than deliberative answers, and the analysis was restricted to WTP without a full cost-benefit framework that would account for physician reimbursement costs attached to app prescriptions, documentation costs of the DMP, or downstream savings from avoided complications like type 2 diabetes.
The policy implications, however, are difficult to ignore. If one accepts the study’s cautious assumptions, prescribed obesity DiGAs currently reimbursed at around €70 per month appear to provide poor value for money from a welfarist cost-benefit perspective, since patient valuations sit far below the price. At the same time, the findings implicitly validate the German approach of basing coverage decisions on demonstrated clinical effectiveness rather than assumed enthusiasm for digital formats. As both the DiGA scheme and the new DMP for obesity mature, the authors call for research into whether willingness to pay evolves as patients gain real experience with these programs, and for full economic evaluations that capture all costs and benefits. For now, the message from more than 370 Germans living with obesity is clear: they want effective weight-loss care and will pay for it—but the screen, it turns out, is not the selling point.
Subject of Research: Willingness to pay for digital versus offline weight-loss interventions among adults with obesity in Germany
Subject of Research: Medicine
Article Title: Does Digital Make a Difference? Willingness-to-Pay for Digital Versus Offline Weight Loss in Germany
Article References: Helms, K., Lhachimi, S. K., Rogowski, W., & Lange, O. (2026). Does Digital Make a Difference? Willingness‐to‐Pay for Digital Versus Offline Weight Loss in Germany. Obesity Science & Practice, 12(3), Article e70151. https://doi.org/10.1002/osp4.70151
Image Credits: AI Generated
DOI: 10.1002/osp4.70151
Keywords: obesity, willingness to pay, digital health applications, DiGA, disease management program, contingent valuation, weight loss, Germany, health economics, reimbursement, digital affinity, cost-benefit analysis
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Ophelia Keating. (September 3, 2026). Germans Weigh the Value of Digital Versus Offline Weight Loss. Scienmag. https://scienmag.com/germans-weigh-the-value-of-digital-versus-offline-weight-loss/
Ophelia Keating. “Germans Weigh the Value of Digital Versus Offline Weight Loss.” Scienmag, 3 September 2026, https://scienmag.com/germans-weigh-the-value-of-digital-versus-offline-weight-loss/. Accessed 3 September 2026.
Ophelia Keating. “Germans Weigh the Value of Digital Versus Offline Weight Loss.” Scienmag. September 3, 2026. https://scienmag.com/germans-weigh-the-value-of-digital-versus-offline-weight-loss/
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