Tina Nanos' life was bogged down by her weight for years.

"I thought about it. I was overweight for a very large portion of my life," said Nanos, who lives in Wallingford with her husband and two children, 13 and 5.

But when her weight "skyrocketed" after having her second son, so much so that sitting in an airplane seat and even walking were uncomfortable, she still didn't change.

Then her employer and health insurer, UnitedHealthcare, offered her a cash incentive. She shed 101 pounds in two years and saved $1,200 on her annual premium.

"Basically, they wanted to inspire employees to empower themselves and live healthier lives. … Learning a little bit about the program, I saw the first year, 'Oh boy, I'm not going to be able to get my points and save on my premiums because I'm overweight,'" Nanos said.

Nanos changed her lifestyle. She exercises daily on an elliptical machine, she serves smaller portions at mealtime and she even bought smaller dinner plates. Nanos met the benchmarks annually, and she feels better.

"I started to see the weight fall off. I became inspired, empowered," Nanos said.

UnitedHealth Group's rewards program is one of many offered by insurers. They are particularly attractive to large employers hoping to reduce medical expenses, improve productivity and reduce absenteeism. The percentage of large employers that offer monetary incentives has increased each of the past three years, from 33 percent to 48 percent, according to a 2012 Mercer National Survey of Employer-Sponsored Health Plans released in November. The Mercer survey included responses from more than 2,800 employers of various sizes.

The incentive programs come at a crucial time.

An increasing number of Americans are overweight or live sedentary lifestyles; there's an upheaval in health care, as new rules related to the Affordable Care Act take effect; and many employers are shifting a bigger share of medical care costs to workers. Facing ever higher insurance premiums, a discount on an the employee-paid contribution to health insurance offers welcome relief for some workers.

UnitedHealth spokesman Benjamin Goldstein said an average family in Connecticut pays an annual medical premium of $3,801, which could be reduced to $2,601 if the family received the maximum $1,200 annual discount on premiums.

Savings in these types of health incentive plans are linked to having a checklist of good health practices including a yearly physical, blood metrics and an improved body-mass index, which is determined by age, gender and height.

The approach has its critics. Advocates for people with cancer and other chronic conditions argue that if financial incentives are tied to improving health, people who are incapable of meeting those goals will simply pay more for health insurance.

Old Idea, New Twist

Employer-sponsored programs to get workers to live healthy lifestyles date back decades. What's relatively new is the monetary aspect, whether its gift cards, raffles, contributions to a health savings account or discounts on health insurance premiums — all of which have become increasingly popular.

Most health insurers offer their customers, which is to say employers, some framework for improving their employees' overall health while managing diseases including diabetes. They encourage employees to eat better, quit smoking, exercise, get regular checkups and more.

Despite the encouragement, participation was about 10 percent without an incentives, said Paul Coppola, Aetna's head of Wellness Program Strategy & Development.

"When you start to put an incentive around it, and you marry that with an organizational commitment, we can see that go over 25 percent even upward of 50 percent," Coppola said. "And we've had employers in organizations that are really committed to the success. … In those cases, we can even see participation in the 70s, 80s and 90 percent."

Bloomfield-based Cigna Corp. said its customers have seen twice or three times greater participation in health management or wellness programs when a financial incentive is used, company spokesman Mark Slitt said. The number of employers that use Cigna's Incentive Points program — offering financial incentives for a health assessment, biometric screenings and health coaching — increased by 52 percent last year over the previous year.

Anthem Blue Cross and Blue Shield in Connecticut, the state's largest health insurer by membership, has had a similar experience.