Changing health behavior is hard work, whether it means losing 10 pounds, exercising 30 minutes a day or managing the day-to-day challenges of a chronic health condition such as diabetes or back pain. It’s a sad fact that more people fail to meet their goals than succeed.
Human resources leaders know this better than anyone, having seen the mixed results of employee health programs in recent years. The numbers have only compounded the problem: Many employers have developed an underlying bias that workers suffering from chronic health issues are unable to do what’s necessary to live healthier lives. They lack the motivation and willpower, the thinking goes, to change behavior.
These assumptions, fostered by pseudoscience and reinforced by pop culture, aren’t just contradicted by years of scientific research, they skew how employers view more advanced types of interventions for chronic health conditions. Changing behavior, experts say, requires approaches that are strikingly different from those found in most wellness programs and employee health plans.
Changing the perception of these programs, however, starts with understanding some common myths about health behavior — as well as science-based principles that HR and benefits leaders should focus on instead.
Willpower is the engine of change
Repeating habits is far a more useful determinant
One of the biggest misperceptions about health behavior is the belief that human willpower and self-control are the catalysts of great outcomes, and that some people have it, while others don’t.
“Behavior change requires repetition that’s not easily handled by willpower, simply because it requires us to persist,” says Wendy Wood, director of the Wood Habit Lab at the University of Southern California and author of Good Habits, Bad Habits, the Science of Making Positive Changes that Stick. “Habit memories form and change very slowly, and establishing one requires a lot of repetition.”
To make that possible, Wood says, it’s necessary to identify the obstacles to the desired change and get rid of them — “reducing friction,” as she says.
Consider the simple goal of making it to the gym more often. One 2017 study, by the market-research firm Distillery, found that people who had to travel 3.7 miles
on average to get to the gym went five times a month, while those who drove 5.1 miles went only once. Choosing a gym closer to home or work reduces the friction, boosting the likelihood of more frequent visits. Making a regular plan, say by always going on Tuesdays and Thursdays, is also beneficial, Wood says.
Scientific research also emphasizes the importance of habit. Studies over the last decade, such as this one published in the journal Science, have shown that our behavior is in part driven by automatic responses to environmental and social cues that require little cognitive engagement, says Mike Kelly, a professor in the department of public health and primary care at the University of Cambridge.
“Human behavior is the result of the interplay between habit, automatic responses to the immediate and wider environments, conscious choice and calculation,” Kelly says. “It’s also rooted in complex social environments and cultures.”
In practice, this means it’s possible to give self-control a boost by changing the environment. Angela Duckworth, a health researcher at the University of Pennsylvania and author of the bestselling book “Grit,” calls this “situational strategies for self-control.” Need help sticking with a diet? Then map a new route to work that doesn’t pass your favorite doughnut shop. Or choose a seat further from the bar to make it harder to order another round. Park closer to the stairs than to the elevator to get more exercise. Setting up your environment to help promote the behaviors you are aiming for helps to create lasting change.
Behavior change follows a set schedule
Time frames are different for everyone, and setbacks are part of the process
Many motivational wellness programs are based on set schedules and clearly defined goals, from six-week weightloss challenges to 10,000-steps-aday exercise regimens. But they often backfire, as employees push themselves to meet an immediate objective and don’t make the small yet important changes to their routines that lead to sustained weight loss or alleviate stress, and they don’t learn how to tackle new challenges or bumps in the road. They can quickly become discouraged and toggle back to old habits.
Science shows that quick wins are attractive but dangerous illusions.
Some behavior changes take longer to instill than others, and times can vary widely from person to person. In one often-cited health study, U.K.-based researcher Phillippa Lally measured how long it took participants to adopt new daily health practices, from drinking more water to doing 50 sit-ups. She found that participants needed to repeat the behavior an average of 66 days before it became a habit. Some people needed only a couple weeks; for others, it took longer than eight months.
Lally also found that a temporary lapse in learning the habit, or “falling off the wagon,” didn’t handicap ultimate success.
This challenges the common belief that a one-time slip can derail progress toward the changed behavior.
The principle is simple, if not wellheeded: Behavior change doesn’t follow a straight line. “It’s complicated and complex because it requires a person to disrupt a current habit while simultaneously fostering a new, possibly unfamiliar, set of actions,” says Megan Call, a professor of psychiatry at the University of Utah School of Medicine.
Because setbacks are part of the process, it’s important to teach people how to navigate when they get off track. “If we teach people how to manage setbacks and not get too discouraged or give up, they’re more likely to achieve important goals,” Call says.
Rather than asking participants to stick rigidly to a plan, modern health behavior programs are more likely to succeed when they build in flexibility and treat “failures” as an opportunity for self-knowledge. “If we help people learn to treat these setbacks as expected moments that require reflection, compassion and problem solving,” Call says, “we increase the chances of changing a new, helpful behavior into a habit.”
Information and tools will drive change
Coaching works better than explaining
The dismal success rates of stopsmoking campaigns and government nutrition programs make one thing clear: Simply informing someone about the dangers of unhealthy behaviors and the benefits of healthy ones has little or no effect on behavior.
What about tools designed to guide people to healthier actions, such as meal-by-meal diet plans or weekly workout schedules? By themselves, they aren’t much more effective than information campaigns. They need to be accompanied by continuing guidance on how best to use them.
Instead of lectures, people need to understand why losing weight or exercising more is meaningful for them. And fixed meal plans and workout programs don’t help when someone experiences inevitable setbacks that can cause them to drop out.
“There are new choices and variables all the time that impact health behaviors, like it’s snowing outside or they get an injury,” says Jennifer La Guardia, director of clinical product and behavior science at Omada Health. “We need to equip them to be ready to respond to any setback or challenge.”
Behavior change is a continuum
Changing health behavior isn’t simply about willpower, sticking to a schedule or following a plan. Nor is just about adopting healthier habits. It requires well-designed programs that teach a process of continuous change, understand what motivates each individual and equip participants to commit for the long haul.
Part of that means creating a variety of customized goals with set frequency and duration — from practicing eating smaller portions of food to adding in some yoga to relieve stress. People will experiment with these new behaviors, learn from what doesn’t work and incorporate what does into their daily lives. When life, or their health, changes again, they’re better equipped to adapt.
“If we go deeper to find out the pressures people face, the reasons they make their choices and the barriers that get in the way,” La Guardia says, “we can better understand what motivates them and are better able to support them in the changes they want to make.”