Wellness apps one approach in fight against obesity

Ironically, while our nation’s televisions have slimmed down over the decades, sedentary Americans have only gotten bigger in the past 30 years, often due to our couch potato habits like unhealthy overeating and watching too many How I Met Your Mother reruns.

“Sitting has become the new smoking,” explained Colin F. Watts, president of Weight Watchers Health Solutions, at the Care Continuum Alliance forum this past fall. Obesity has taken center stage as America’s most destructive endemic, and unhealthy eating habits have replaced tobacco use as the nation’s top threat to public health.

One-third of Americans are currently obese. Further, three-quarters of the inflation in the cost of health care in the United States can be attributed to chronic conditions, said Watts, and the vast majority of those chronic conditions are grounded in lifestyle choices.

“Without an aggressive attack on the lifestyle issues that drive the cost, we’re not going to find a solution,” Watts maintained. While technology has likely contributed to unhealthy behaviors, technology also offers a great opportunity to improve health. “The other wonderful thing about technology is that it’s bringing us some wonderful innovations,” he said.

Best wellness apps

Smartphones are the newest platform for delivering revolutionary technology. Here are Watts’s recommendations for best wellness apps available in today’s market:

• HealthyOut. This app is a combination of OpenTable and Yelp, but geared toward healthy dining. Consumers can enter in their dietary preferences — with requirements such as vegan, gluten free, or organic — and the app finds restaurants in their area that have menu items meeting their nutritional requirements.

“It’s a really cool use of technology to act as a filter to make it easier for us to make healthier choices,” explained Watts. The biggest obstacle Watts sees at Weight Watchers is participants struggling to eat healthy items when they go out.

• Zombierun.com. “There’s nothing like a horde of zombies to motivate you to run as fast as you possibly can,” said Watts of this unusual app that uses a game-styled environment to engage participants in running and wellness.

• Tracking devices. Recently the industry has seen an explosion in the use of tracking devices. Watts said that 43 million activity devices will be sold this year in the U.S. By 2018, 250 million devices will be sold in America. This is a growing trend and not a fad, believes Watts. He advises employers to look for technology that is accurate and inter-connected with other platforms in order to drive sustainable behavior change.

WeightWatchers

Capitalizing on apps to engage participants in weight loss goals, WeightWatchers invests between $7 million and $10 million each year in the mobile area. The company offers mobile apps for tracking nutrition and activity, as well as a barcode scanner app that delivers nutritional information while in the grocery store. However, the company also recognizes that participants need more than apps to help them reach their goals. 

“It comes down to creating a technology, but also a human support team,” said Watts. “Behavioral change is not only a functional journey, it’s a highly emotional journey. Along it, you’re going to need support, and more support than what an app can give you.” He added that consumers need “the face-to-face [component] to supplement and work in congruence with this technology.”

A 2013 clinical study in the American Journal of Medicine, using research from both WeightWatchers and Baylor College of Medicine, found that individuals who used the three core components of the WeightWatchers program — in-person meetings, mobile apps and online tools — had far greater success losing weight.

The experiment followed participants in two main groups: those that strove to lose weight on their own, and the other half that used the WeightWatchers program. Participants that used the program were 8 times more likely to have a clinically significant amount of weight loss. Further, people who regularly used all three components lost 19 pounds on average, compared to those using one or two tools, who only lost nine pounds on average. “It shows the power of building a system of supports,” said Watts.

Quirky tools for designing incentives

The CEO of StickK, an online wellness challenge platform, detailed how employers can form a “choice architecture” around wellness incentives to drive significant and long-term behavior change.

The StickK website encourages participants to set a goal (which is often related to well-being, such as quitting smoking, running a 10k or losing weight), and assigns a family member or friend as a “referee” to keep them honest.

“Then we ask that they put their money where their mouth is,” says Jordan Goldberg, StickK’s CEO. Participants can set a wager with someone, give money to a charity or up the ante by forcing the loser to money to donate money to a cause they don’t particularly care about said Goldberg. There might be extra motivation if a gun-control advocate didn’t reach their goal and had to fork over money to the National Rifle Association, for example. StickK can help facilitate that transaction.

“To make a behavior change, you have to have skin in the game,” Goldberg explained. The “anti-charity” motivation is a great example, he adds: “In a vacuum, a stick is more powerful than a carrot. The threat of losing $20 in your own pocket is more motivating than gaining money you never had.”

For employers, Goldberg recommends they incentivize employees by putting the value of the reward in context. An employee who earns $1,000 in cash for achieving a wellness goal sees the reward in the context of their salary: for someone making $50,000 a year, that’s only 2% of their yearly earnings. However, if the employer presents the reward as a $1,000 vacation, viewed in context of their vacation budget, that’s suddenly a more meaningful reward.

“And the perceived value is actually greater when you use noncash rewards,” explained  Goldberg. Those noncash rewards can be more powerful because they provide a reference point and remove the participant’s guilt in indulging in a reward by building an emotional connection with the incentive.

Enticing noncash rewards are experiences that employees normally wouldn’t buy for themselves, from catered dinner parties to sports tickets, as well as premier parking spots or lunch with a senior executive. Rewards for family outings, such as theme park tickets or private tutoring, are also great examples, as are services including gym memberships.

“There are lots of tools you need to be aware of as a choice architect when you’re designing an incentive program,” said Goldberg. Here are some other suggestions for developing meaningful rewards:

Lottery-based rewards. Research shows that many people would favor a 1-in-100 chance to win $200 over a guaranteed $2. This particular study also found that while 60% chose the lottery option to win cash, 80% would choose the lottery if the reward was a $200 gift card to a nice restaurant. That emotional connection to the reward plays a role in engaging participants.

The power of defaults. Goldberg suggests setting up wellness programs and initiatives with an opt-out clause whenever possible, because people will accept the default. This strategy has been used successfully in the retirement field to auto-enroll 401(k) participants into plans.  

Subliminal suggestion. Amsterdam airport officials strategically placed fake flies in the bowls of urinals to encourage men to aim better. The result: cleaner floors.

Progress illusion and loss aversion. A coffee company experimented with its loyalty incentive by handing out punch cards to customers. On the card, customers received one free coffee if they bought eight coffees. Then, the café gave customers a similar punch card requiring the purchase of 10 coffees, but the first two already punched. The customer still needed to drink eight more coffees to get their free cup, but people filled these cards 20% faster than the ones that weren’t pre-punched.

Goldberg explains that even if they have to commit to the same amount of work, if people feel they’re starting higher than zero, then they believe they have a head start and are more likely to engage. Instead of starting employees at zero as part of a wellness initiative to earn a massage, give them some free points so they don’t feel like they are starting from scratch.

“It’s all about framing,” Goldberg said. On StickK, the individual’s progress is framed differently for first-timers than for return users. For a goal of weight loss, the first-time user sees how much weight they’ve lost so far. But if a returning user who has had success in the past and returns to lose more weight, then StickK shows how many more pounds they need to lose to meet their goal. Participants have different sets of expectations, said Goldberg, and employers need to design incentives based on those disparate perspectives.