Why Changing Health Behaviors is So Hard

The health care issue rages on within our political halls - but the real problem is raging on in American's bodies.  Preventable, behavior-based health issues are creating enormous costs for individuals and for our current employer-sponsored insurance system. 

Companies are working hard to develop programs and ideas that will help reduce the costs associated with poor health.   The almost ubiquitous application of "wellness" programs with incentives is testament to the value companies see in reducing the cost of health care.

But impacting behaviors associated with health issues has always been a very tough row to hoe.  One of the basic reasons, I believe, is the distance between adopting new behaviors - and the rewards associated with those new behaviors. 

Temporal Discounting

I've posted before on temporal discounting - its means we place a higher value on an immediate award than one provided sometime in the future.  In incentive terms, the closer the award is to the behavior you're rewarding the greater the perceived value.  The further into the future the reward is the less value the award "seems" to have.  I put quotes around the word seems because the value really doesn't change but we as humans perceive it that way.

If you think about health behaviors there is a huge gulf between when I start my healthy behavior and the payout for that change.  Graphically it might look like this...

In addition, adopting healthy behaviors not only has a long, long, payout - but there is an immediate drop off in a behavior that was reinforced either by drugs (say, nicotine) or through pleasure (food).  So something I used to do that was pleasurable is no longer there, and the behavior that is better for me has no immediate reinforcement - the payoff is in the future.

Those are some tough, tough hills to overcome and one of the reasons I believe traditional incentive programs for wellness have had only moderate success. 

Back To The Future

If the time lag between behavior change and reward is one of the problems how do you fix it?  Without a DeLorean and a flux capacitor I don't think we can bring the future to today.

Oh... but you can.  Not necessarily the "rewarded future" - but the "unrewarded future."

What I'm referring to is the process by which Dr. H on "The Biggest Loser" brings the long-term payout for bad behavior into the present.  As part of the process participants go through on the show they are put through a battery of tests to assess their health - and are then presented with the outcomes.  One of the tests shows them their "biological" age.

Watch the video from last season below (email feed subscribers may have to click through to the post on the web - and I apologize for the commercial before the clip - big media companies don't get social media) and see the effect presenting the participants with their "biological" age has. 

It cements it - it makes the outcomes of their behavior today a present day problem - not a problem to worry about tomorrow.

If we are ever going to impact wellness we have to make either the negative consequences (or the positive ones) present day issues.  Telling people they should do it to ensure they live another 10 years is too far in the future and too abstract to grasp.  Show them the present.  Connect with today and you will have a better chance of changing behavior.

Comments

[twitter.com/femelmed]

paul, as you knew, i'd have to comment on this one. a complementary perspective to your idea is the science of procrastination and how that plays into our deciding to make a change. how it goes for most of us: sure, i could go to the gym and avoid that heart attack, but i'm not likely to have one 'til i'm in my 50s, even 60s. i'll plop on the couch today and go tomorrow. what's the harm?

i also think we need to acknowledge it's a tough road because of other complicating factors -- access to healthy, inexpensive food, places to run and play, and marketing-free playgrounds, among many other things. we don't exist in a vacuum, but wellness programs often operate in one.

and last, i've seen the "biggest loser" reaction from employees who have had shocking wake-up calls after completing a company-requested health risk assessment. yet, because of the unavoidable coupling with the workplace and despite HIPAA protections, these assessments are almost always viewed with skepticism and fear. another tough, tough hill to overcome.

good post. good conversation.

thanks,
f

[Paul Hebert]

Thanks Fran...

I agree with about 90% of what you're saying... but...

Procrastination is based on the reward/time line issue - since I don't get the reward now - not motivating - I'll put it off.

I don't agree that we have a problem in this country with access to healthy inexpensive food - we just have greater access to unhealthy food. And unless you're in South Central LA - there are plenty of places to run - heck walk!

I can see the issue with skepticism and fear issue - but simply telling me I have a problem is one thing - the idea of putting the time line in place ie: biological age - really hits home. Now it has a number - not just a concept.

Thanks for the comments!

[David Janus]

I'm not sure one should be so quick to dismiss Fran's point about access (or lack of access) to healthy food choices. It's well documented that for millions of people the food choices that are most easily available to them are dominated by unhealthy options.

But I think the larger point is that we live in a culture where overeating is encouraged. I recently read David Kessler's book "The End of Overeating." In that book he makes a pretty compelling case that food choices, while ultimately an individual's responsibility, are influenced quite strongly by culture and environment.

Wellness programs, incentives, telling people their "biological age," etc. are all positive and helpful steps in the right direction, but it is going to be tough to turn around the problem of obesity in the U.S. without deeper and broader cultural and social changes.

[Paul Hebert]

I am on board with the culture thing - we've been doing it since the wild west - everything is bigger in the US - including our food.

But I'd submit we've made the turn on smoking - hardly acceptable behavior in today's culture - and I am seeing some of the same movement as it relates to obesity.

Unfortunately, there are some non-behavioral causes which can keep the cultural pressure from becoming too overpowering.

[Frank Roche]

Nice work, Paul. These are not the days for delayed gratification.

[www.facebook.com/profile.php?id=632019852]

I'm not a food scientist (although I've hired them), so this won't be written very well...

...but there's an argument that our bodies are being manipulated by cheap & modified foods. We are unable to regulate our behaviors because we've become addicted to food. The only way to break free and change this cycle is to fully detox from the very food that is cheap & accessible: corn, refined grains, sugar, starch, caffeine.

I have heard that food companies know which chemical concoctions will create dependencies. Some speculate that there's a reason why McDonalds wants to sell you a burger, fries and a coke: our bodies become dependent on the highs/lows of insulin that results from eating those foods. It's the same reason why Starbucks adds whips and creams to its caffeinated beverages.

So we can blame free will and whatnot, but until we ban soda in school and make fresh food & produce readily accessible, I don't like picking on the fat kids.

(Not that you're picking on fat kids, but FATISM is huge. Alltop has a section on it. http://fatosphere.alltop.com/)

[Paul Hebert]

I can't disagree with any of that Laurie - whether the outcome was accidental of if Micky D's employs scientists to drive up the addictive qualities of their food - I'm sure there is a grain of true in the analysis and that we are addicted.

My only point in the post was that changing behavior is very difficult for health behaviors - like other "addictions" because the long wait for reward lowers the value and anything we can do to move the reward closer to the change in behavior will go a long way toward success.