January 17, 2018

Want to Improve Patient Health? Stop Promoting Health!

Michelle Segar, PhD, MPH is Director of  Sport, Health, and Activity Research and Policy (SHARP) Center and Researcher for the Institute for Research on Women and Gender, University of Michigan. Thanks to her for sharing the following post on the interest within the health care and wellness industries regarding the science behind why health promoters should stop promoting health if they want patients to adopt healthy lifestyles. 

Michelle SegarHealth promoters need a better hook than “health” if they want patients to actually achieve better health.

This suggestion may seem paradoxical and even downright heretical. But a quick reality check with those who have tried and failed repeatedly to stick to a health-motivated exercise or diet plan (maybe even yourself!) will reveal the truth: The vague promise of future “health” is rarely enough to sustain the behavior that gets us there.

Prescribing and promoting “health” as the reason for adopting a healthy lifestyle (eat more fruits and vegetables, move more, get enough sleep) seems like a logical thing to do, right? Interestingly, this is simply an assumption. It has no basis in science.

Based on research in behavioral economics as well as on my own published studies about how to motivate sustainable healthy lifestyles, the case that health organizations and professionals should stop promoting health right now is strong. Here’s just a few of the reasons why.

Logic Doesn’t Motivate. Emotions Do.

The logic behind promoting healthy living is easy to understand: “If my patients or employees make healthier choices, they will be healthier and use fewer health care dollars, so let’s promote healthy living.” And exercising and eating well for your health definitely sounds logical. The problem is that logic doesn’t motivate. Emotions do.

Most successful businesses (think Apple) know this. They conduct extensive market research and use their target customers’ needs, wants, and worries as the hooks in their marketing campaigns and social media initiatives. Successful businesses want to make a profit. And this means repeat customers, not one-time buyers.

We don’t find the same repeat customer mentality when it comes to promoting lifestyle changes. Health promotion counseling, programs, and services tend to feature the desired medical outcomes that health promoters hope for1, 2 instead of appealing to what individuals actually want and worry about every day. This has been a strategic error that has expensive consequences for everyone.

To be successful in achieving these outcomes (such as less stress and better health, weight maintenance), people have to sustain the lifestyle behaviors that they start. Yet the sad truth is that the majority of people who try to change health-related behaviors eventually drop out.3,4,5 Isn’t it curious that people who deeply want to make changes don’t generally sustain them?

The Vague Promise of Future “Health” Is Too Abstract to Be Compelling

University of Michigan research published in fall 2011 showed a surprising gap between what people say they value and what they actually do when it comes to exercising.6

University of Michigan Fall 2011 Research Figure 1University of Michigan Fall 2011 Research Figure 2Figure 1 shows how much study participants said they “valued” their reason or goal for exercising, and Figure 2 shows the average exercise participation by type of goal. The difference between these two graphs illuminates the important gapbetween what people say they value and their actual behavior.

When researchers followed these participants over one year to track their actual activity, participants with goals to improve their “daily quality of life” were more motivated and exercised about 20% more over one year compared to those with purely “health-related” goals.

It’s easy to say being healthy is “important”; but it’s another matter entirely to make health-related behaviors a daily must-do activity.

Behavioral economists have taught us that people have a present-focus bias: we choose things that will reward us now over selecting future rewards.8,9,10 Larger distant rewards such as “better health” are simply not as motivating as smaller, more immediate rewards such as increased energy, stress release, and lifted mood. In other words, if it makes us feel good, we want to do it again and again

 “Health” Is Just a Proxy for the Goal People Really Want: Living Daily Life Well

Health sounds like great goal, but health is only valuable to us because it helps us live our daily lives well.

Without health, we lack energy. And lack of vitality challenges our happiness, sense of well- being, and ability to fulfill the daily roles and responsibilities that make life meaningful. Health is really just a proxy for the experiences we desire and that make our life worth living.

Research on goal striving and behavioral self-regulation (how we manage and negotiate goals in our busy lives) clearly shows that if people are to continue to strive towards their goals, they need feedback that they are approximating them.11 Without evidence that they are making progress people quit.

Yes, biomarkers (such as improved blood pressure and lowered cholesterol levels) can show people that they are progressing toward their health and disease prevention goals. But research suggests that this type of feedback is not compelling enough to motivate the numerous decisionsthat most people have to make every day that are necessary for sustaining healthy lifestyles.

In contrast, when individuals make decisions to practice self-care behaviors as ways to feel good, increase well-being, and have more energy, they get feedback immediately that they have achieved their goal. An article in the Wall Street Journal reported that having a “focus on quality of life helps medical providers see the big picture – and makes for healthier, happier patients.”12 Even people who have lost their “health,” those living with a chronic illness, are more motivated by feeling and living better. This article quoted the late Noreen Clark, internationally renowned chronic disease management researcher, as saying that improving daily feeling and functioning is the real hook for motivating patients to manage their illnesses.

To Motivate the Consistent Decisions that Favor Health, Let’s Rebrand Health as Well-Being

I propose a simple strategy: Let’s rebrand “health” as “well-being.” In addition to the interdisciplinary science that supports this suggestion, I’ve been using this tactic in my private health coaching practice for twenty years and have seen how this simple change in framing revolutionizes people’s relationships with healthy behaviors by making them relevant and compelling to what matters most – to them, today.

Consider this: Many of the behaviors that improve health (getting more sleep, moving more, making better eating choices) also lead to feel-good experiences (reduced stress, feeling strong, lifted mood) that help us better succeed in our roles and responsibilities, all of which contribute to happier and more meaningful lives. So it is more strategic to rebrand these behaviors in ways that are more likely to hook patients: as direct routes to daily success, well-being, and meaning, which is what they truly are.

It’s counterintuitive, but true: To help patients achieve the consistent decisions and sustainable healthy behaviors that underlie disease management and prevention, we must stop promoting health within health care. Instead, we can embrace and promote an outcome that patients will both notice and want: well-being. And, in the process, we will make our clinic- and community-based interventions more patient-centered, long lasting, and value-based.13


1. American College of Sports Medicine. Exercise is medicine. 2008; http://www.exerciseismedicine.org/public.htm Accessed January 22, 2008.

2. American Cancer Society. Choose you. 2010; http://www.cancer.org/healthy/index Accessed November, 2010.

3. Dishman R. The problem of exercise adherence: Fighting sloth in nations with market economies. QUEST. 2001;53:279-294.

4. Berlant NE, Pruitt SD. Adherence to medical recommendations. In: Cohen LM, MCChargue DE, Collins FL, eds. The health psychology handbook. London: Sage; 2003:208-222.

5. Dunbar-Jacobe J, Mortimer-Stephens MK. Treatment adherence in chronic disease. Journal of Clinical Epidemiology. 2001;54:S57-S60.

6. Segar M, Eccles J, Richardson C. Rebranding exercise: closing the gap between values and behavior. International Journal of Behavioral Nutrition and Physical Activity. 2011;8:94:1-14.

7. DiMatteo MR. Variations in patients’ adherence to medical recommendations – A quantitative review of 50 years of research. Medical Care. Mar 2004;42(3):200-209.

8. Hariri AR, Brown SM, Williamson DE, Flory JD, de Wit H, Manuck SB. Preference for immediate over delayed rewards is associated with magnitude of ventral striatal activity. Journal of Neuroscience. Dec 2006;26(51):13213-13217.

9. Rath T, Harter J. Well-being: The Five Essential Elements. New York: Gallup Press; 2010.

10. Ariely D. Predictably Irrational: The hidden forces that shape our decisions. New York: Harper Perennial; 2009.

11. Carver C, Scheier M. On the self-regulation of behavior. Cambridge: Cambridge University Press; 1998.

12.  Landro L. The simple idea that is transforming health care: A focus on quality of life helps medical providers see the big picture—and makes for healthier, happier patients. The Wall Street Journal. 2012. http://online.wsj.com/article/SB10001424052702304450004577275911370551798.html Accessed August, 2012.

13. Segar, M. No Sweat: How the Simple Science of Motivation Can Bring You a Lifetime of Fitness. New York: Amacom; 2015.

Michelle Segar, PhD, MPH

Director, Sport, Health, and Activity Research and Policy Center, University of Michigan

Michelle Segar, PhD, MPH, is a motivation scientist and author of the critically acclaimed No Sweat: How the Simple Science of Motivation Can Bring You a Lifetime of Fitness. Segar is a sought-after keynote speaker and consultant to global health, wellness, and fitness organizations. Reaching the #1 Best Seller on Amazon’s Exercise & Fitness category, and featured in The New York Times, No Sweat was selected as the #1 book in Diet/Exercise in 2015 by the USA Best Book Awards. Segar holds a Ph.D. in psychology and master’s degrees in health behavior/health education (MPH) and kinesiology (MS). She ran with the Olympic Torch during the Olympic Games in Barcelona in 1992. For more information see MichelleSegar.com.

Copyright © 2016 Michelle Segar.  All rights reserved.

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