The Obesity Solution: A vision for health AND prosperity in the 21st

Century

James O. Hill, Ph.D. John C. Peters, Ph.D. Executive Director Chief Strategy Officer

Anschutz Health and Wellness Center

Do We Have a Plan to Reduce Obesity?

• Currently have lots of tactics

• Tobacco model?

• Policy as driver for change?

Major Government Intervention

Institutionalizing Effective Action

Mass C

om

mu

nicatio

nNutr. Rev. 59:40, 2001.

Emotion

Values

The ontogeny of social change for tobacco, seat belts, recycling

Eco

no

mics

A Crisis Building Science Base Strong Advocacy

Formulating a Plan Coalition Building Community Spark Plugs Local Environment/Policy Change

What’s Happening?

• NYC - sodas• San Francisco – Happy Meal ban• LA – Zoning fast food restaurants• Tax sodas/fat• Remove vending machines• Almost exclusive focus on food• Food industry does not deserve a seat at

the table – can’t be trusted…Kelly Brownell

What is the future state being offered?

To lower obesity we will have to “radically change the way we live”…..Expert in “Weight of the Nation”

• Produce and sell less food• Produce and sell fewer

televisions and computers• Produce and sell fewer cars • Produce and sell fewer labor

saving devices

Where’s the Data?

• Sodas and obesity• Marketing and obesity• Fast food and obesity• Vending and obesity• Physical activity/inactivity and obesity• We’ll never get the data – too complex• Problem is too great to wait for the data

Do We Need an Alternative Plan?Can we offer a different future state?

• Solutions to reduce obesity in the U.S. must be consistent with American values

• Economic success and competitiveness is central to these values…land of opportunity

• Personal liberty – freedom of choice, fairness

Can health and prosperity co-exist?

What is the premise?

• Historically, obesity has been seen as a disease of the wealthy…or, of prosperity.

• Presently, in the USA we see disproportionate obesity and consequences among the poor…how can this be?

What is prosperity?

• Prosperity is the state of flourishing, thriving, good fortune and/or successful social status…the good fortune and status definition seems to dominate our cultural psyche.

• Prosperity often encompasses wealth but also includes others factors which are independent of wealth to varying degrees, such as happiness and health.

BMI and GDP

It doesn’t take much to be prosperous in relative terms…

• In the poorest societies around the world people spend great physical effort simply to survive…to obtain food, shelter, safety, etc.

• Their environment and circumstances do not permit the behaviors that lead to obesity.

• Once a minimum level of per capita income is reached it is possible to obtain relative excesses of food and inactivity.

• So, in the USA low income groups are prosperous by one measure…but, other elements of prosperity may be missing.

Prosperity and obesity

• Despite the apparent paradox in the USA, it is still true that obesity is a disease of prosperity (at least financial).

• Most people today are relatively more prosperous (financially) than their ancestors or people in developing nations

• In the 21st Century…– Unintended consequence of a lifestyle that becomes

possible because of individual means or economic norms for the nation

– In the USA food and inactivity are cheap (both in monetary and convenience terms)

But, aren’t the rich healthy?

• The rich are not healthy…they just have more money to pay for things that go wrong

• Poor people today suffer the same maladies but have less money to pay to fix them

• This speaks to our primary focus on fixing problems once they occur…vs. preventing them from occurring in the first place

• Both rich and poor in today’s world do not live a healthy lifestyle as the norm

• We could spend much of our effort on trying to provide the same level of “fix it” services to the poor as the rich…this may be fair, but it won’t fix the underlying problem?

• The current paradigm is creating generations of unfit and less productive people…regardless of what social class they belong to

Happiness and GDP

Money helps, but it’s not everything…

How can we move toward health and prosperity for

everyone?

Problem Statement

• We know what behaviors are needed to prevent and treat obesity (and chronic disease)

• We don’t know how to get individuals or society to do them in any persistent way

• We have limited knowledge of what and how to change the environment to make a persistent difference

• We have only begun to think of this as a “systems” problem

Motivation…the missing piece

• How do we change our society to live more healthfully as a matter of course…in a way that is good for individuals, society, and the economy…and consistent with American values?

Many barriers…

• The current rewards system strongly encourages biologically preferred behavior…i.e., “bad” behavior

• The rewards for desired behaviors are mostly time discounted, i.e., not immediate

• The historical perception of obesity is that it is a personal issue…it’s a mindset

What is missing in our approach today?

We need a better reason for people to be healthy that matters to them as individuals and to the nation as a whole…what’s in it for ME and what’s in it for US?

Let’s change the paradigm

• Current paradigm is that health (and well being) is essentially a system output…we do the things in our lives for other reasons and health is what results from the choices we make

• A novel approach is to reframe the mindset such that health is seen as an input to the system…it is the fuel that allows us, individually, and collectively to do the things we want to do…

• It is the fuel for achieving prosperity

Health is currently a system output…

OccupationIncomeStatusFamilyRelationshipsNutritionPhysical activityStressLeisureFinances

Your Health

Inputs Outputs

What if we considered health as a system input?

OccupationIncomeStatusFamilyRelationshipsNutritionPhysical activityStressLeisureFinances

Your Health

Inputs Outputs

Well-being as an input?

“For policymakers, the existence of these mechanisms raises the possibility that a happier society may be one that intrinsically generates higher incomes for its citizens. Traditional thinking has focused upon the opposite.

“Although, in this paper, human well-being is considered instrumental or as a means—rather than an end in itself—it needs to be emphasized that this is not with a view to putting money center-stage at the expense of happiness. To the contrary, the results indicate that happiness and income are connected by a two-way relationship, and that human well-being can itself be a source of economic dynamism.” Forbes, 1/07/2013

We need to think about the problem in a new way

• Work with the biology…rewards part of daily life

• Align individual and collective purpose

• Align purpose and context…work, school, business

• Not opt in…everyone is part of it…new behavioral expectations become “part of the woodwork”

Elements of behavior change

• Changing behavior requires motivation and support across at least three domains:– Personal (Why should I do anything?

What is the purpose that is important to ME?)

– Social (Why should WE do anything? What is the purpose that is important to US?

– Structural (What rules, policies, procedures, systems, rewards, environment will support the purpose?)

Personal Social

Structural

What is motivation for the nation?

• What is a more powerful motivator for society? – Slowly rising health costs? – Loss of economic viability and global

competitiveness? – Declining standards of living?

• We need a systemic motivator that is tied to American values and is consistent with our goals as a nation

• And, that has experiential value “in the present”

Social motivation hierarchy

Transcendence

Well Society

National defense, affordable housing,

safe neighborhoods

Collective purpose,

American Values, National Pride

Economic health, jobs, global competitiveness, education

Drive motivation for behavior change by linking desired behaviors to meeting basic needs

Physiological

Safety and Security

Belongingness and Love

Esteem

Self-actualization

Transcendence

Need to move the focus

Towards a new paradigm

• If we focused more on well being as an essential input (fuel) we may tap the full potential that exists within people as an essential resource for our nation– Health costs would decrease as a side

effect

• What might this look like? How can health and prosperity coexist in the 21st century?

Purpose

Energy

Wellness

A sustainable resource

A strategy for the 21st century:Where and how do we start?

Schools & Home

Commerce, the “Environment”

Workplaces

Health as a valuable, depletable resource

Employees ProductivityInnovationSustainability

Health/Wellness

Inputs Outputs

Worksites

Want to be healthyTime challengedNot enough energyNeed help being healthy

Want healthy employeesValues productivityFocus on growthBenefits from healthy employees

IncentivesPunishmentPersonal responsibilityConflict

Wellness is fuel for prosperity for both

Employee Employer

Tactics

How can we bring wellness into the workplace?

• Right now, wellness is thought of as a “program”…not as part of the business.

• Right now, the reason for doing it is not aligned with the business purpose (reducing health care costs is not the core mission of the business).

• Right now, the incentive and rewards systems are not aligned with wellness goals (people do what they are rewarded for).

• The way to bring wellness into the work place is to see it as core to the business.

We need to build a culture of wellness in to the workplace

• Think of it as an operating system…like “Windows for Wellness”.

• It is not opt in…it is part of what is expected of everyone.

• The reason for doing it is that good health is good for the business…productivity, recruitment, retention, etc.

• It is no different than why we adopted total quality, or safety, or diversity, or sustainability.

Isn’t wellness “private” behavior?

• Not when it affects the business…• Business already regulates behavior in the

workplace…dress codes, secrecy codes, harassment codes, safety codes, etc.

• And, if certain behaviors were expected of everyone it cannot be seen as discriminatory.

• We should evaluate people on their behavior not just on their biometrics (those are by products of genes and behavior and will change when behavior changes).

• Wellness and employee health are built into the organizational mission and values…alignment of purpose

• ALL employees are evaluated in part on how they are supporting a culture of wellness

• Organizational policies and procedures reflect wellness goals, when applicable

• Wellness culture is key element of recruitment and retention

• The value to the business shows up in productivity and results

What would a culture of wellness look like?

A strategy for the 21st century:Where and how do we start?

Schools & Home

Commerce, the “Environment”

Workplaces

School of the future

• Better health = better learning (aligning purpose)• Promoting good health is expectation of teachers and

administrators, and they are accountable• Physical activity used as learning modality• School breakfast and lunch aimed at supporting learning• Schools must provide permission, time and resources • Students, teachers and administrators are rewarded for

healthy behaviors

A strategy for the 21st century:Where and how do we start?

Schools & Home

Commerce, the “Environment”

Workplaces

Creating a Healthy Community

• Worksites and schools catalyze the demand for healthier options in the community

• Businesses respond by doing what they do best…innovating and delivering

• Health and wellness in the community increase…driving further engagement and innovation

• People want to live there, its fun, it’s energizing…it’s good for the economy and its good for civic capacity

What would a plan look like?

• What to do– Align purpose in worksites and schools– New labor policies, school policies,

community policies

• Why to do it– Productivity, learning,

economic viability

• How to implement it– Start with willing companies,

schools and communities

Johnson, 1992

The “Paradigm”

Rituals and

Routines

Stories and Myths

Symbols

Power Structures

Control Systems

Organization Structures

We can create a new paradigm…

Thank You!