Most wellness programs assume that the first step to changing habits is education. Whether in the form of a wellness website, nurse line, wellness fair, lunch and learn, newsletter or paycheck stuffer, the assumption is always the same: If people only knew what good health habits were and why they should practice them, they would surely make the right choices. If you, too, think that education is an effective behavior change tool, think again.
In the 1950s, cigarettes were endorsed by Santa Claus, actually recommended by doctors (as a treatment for asthma no less!) and even as late as the early nineties, some hospitals allowed nurses to smoke at their stations. During those times, Joe Public could be forgiven for being confused about the health risks of smoking.
Yet now, unless you're a recluse or actively avoid the media, it's impossible to avoid being "educated" about the health risks of smoking. Thus, it's reasonable to assume that 95% or more of Americans would answer "Is smoking bad for your health?" with a resounding "yes." Still, 60 million Americans smoke. Have they just missed the message or is something else going on?
In fact, smokers are quite aware of the risks of smoking. They are not uneducated at all. What explains their continued habit, apart from their chemical dependence on nicotine, is their social dependence on being a smoker (amongst smoking friends) and the fact that we all frame information in a way that allows us to live with our so-called cognitive dissonance. For many smokers this sounds like, "Yes, I know smoking is dangerous, but ..." and the sentence ends with:
* I'm still young and will quit when I'm 30 before the risks get too big.
* Life's too short and, anyway, at least I don't [fill in another vice].
* I love the taste and it helps me relax.
* My Uncle Ted smoked 60 cigarettes a day and lived to age 90.
We are all incredibly gifted at the art of rationalizing and processing information in a way that allows us to reconcile how we behave with what we know. Even though it may not make much sense to other people, the rationalizing trick allows us to live with our bad habits even though we know better.
On eating
Rationalizing aside, when it comes to good nutrition, there is a better case to be made that the average American really is unaware of what it really means to eat healthily. In fact, a case could even be made that food companies have consciously obscured the truth about which foods are healthy and which are not (high fructose corn syrup being renamed as corn sugar, for example), much like tobacco companies did for years. There is no FDA requirement that health claims for food need to be proved with double blind tests. High-fiber (but sugary) cereals get to claim that they are heart healthy, and low-fat products get to boast that they are good for losing weight. Unfortunately, the science of nutrition turns out to be quite different from our common sense.
Many of us think: "I need to lose a few pounds; better hit the gym." While exercise is very healthy, the reality is that 90% or more of weight loss is explained by changes in our diet, and not by whether or not we exercise.
Gary Taubes, author of "Why We Get Fat and What to Do About It," presents a compelling case that it's not the fat in food that makes us fat either, again contrary to the central message of the low-fat food industry. The reality is that fat storage (on our butts or elsewhere) is regulated by hormone responses to blood sugar levels. What mostly makes us fat is eating sugars and easily digestible starches that spike our blood sugar, rather than fats themselves, which have a lower glycemic load. Of course, eating a lot of fat will also lead to weight gain - this is not a license to eat sticks of butter!
This perhaps explains why efforts at improving food labels have not solved the obesity epidemic. People read the label, look at the fat content - mostly unaware of, or unable to remember, whether it's saturated or unsaturated fat that's unhealthy - and if the fat content looks low, people assume the food must not be fattening. Food companies take out the fat but replace it with sugar, to maintain taste - what they call "palatability." The result: low-fat foods often make us fatter than the full-fat versions of the same products, because it's sugar that's doing the damage to our waistlines.
Experiments with calorie-count labeling and food labels have, in many cases, shown that the labels create what is known as a "health halo," leading people to assume that because the calorie count is small, the impact on weight gain is low. One hundred calories of sugar is more fattening than 200 calories of broccoli since the "calories in, calories out" model simply does not take into account the impact of blood sugar on weight gain.
A health halo is the good, or healthy, light cast onto a food by one healthy ingredient in that food. A pernicious example is the recent emergence of vitamin waters, vitamin-enriched milk, vitamin-enhanced cereals and other products that have been enhanced with one or more ingredients that are supposed to improve our health (antioxidants anyone?). The real concern with these products is that the "vitamin added" label casts a halo of good health over the product that hides the fact that what we are drinking is full of sugar.
Products of our environment
Finally, another reason wellness education alone is so ineffective is because of how we make most of our decisions. We don't spend as much time thinking about what we eat; rather, we tend to take our cues from the people around us and the availability of food in our vicinity.
Research on the power of social influence suggests that health habits, including food choices, are highly "contagious" through our social networks. This means that even if we know that we should be eating a salad, if everyone else at our table orders the chocolate molten lava cake, we're going to have a very hard time resisting. When our primal brains and tastes kick in, our prefrontal cortex or reasoning brains have a hard time competing. Our desires, and the actions of others, win over our logic and knowledge almost every time.
If education is not quite enough to make us change habits, what is? We'll tackle that question in future articles. -A.S.
Contributing Editor Andrew Sykes is chairman of Health at Work. He is a qualified actuary, a licensed health insurance broker, an HIAA managed health professional and an accomplished speaker on the topic of consumer-directed health care and wellness. He can be reached at
