It Costs How Much?

While it seems like everyone is talking about obesity (and childhood obesity), and what it’s costing us, would you believe that it’s nowhere near our top policy priorities for 2011? In fact, it’s just about dead last (right below global warming). The Pew Research Center found only 19 percent of us rate addressing obesity a top priority.

And, until we address this issue on a national level, we will never succeed in containing health care costs (or balancing the budget).

In 2010 the U.S. spent approximately $168 billion on obesity-related costs. To put that figure in perspective, look at what some of the larger departments in the federal government spent: $26.3 billion (Dept. of Energy), $51.7 billion (Dept. of Education), $72 billion (Dept. of Transportation), $26 billion (Dept. of Agriculture), $51.7 billion (Dept. of State) and $23.9 billion (Dept. of Justice).

$168 billion is a big bill to pay—and it’s going to get bigger still. It’s estimated by 2018 (just seven years from now) obesity will cost us $344 billion in medical-related expenses, eating up 21 percent of all health-care spending. (2010 America’s Health Rankings Report)

Even though we see almost daily reports linking obesity to a number of chronic diseases (more than 53), type 2 diabetes, metabolic syndrome and too many more to list, there seems to be a disconnect when it comes to how obesity fits into our out-of-control health care costs.

Do we tend to look at it only as a personal responsibility issue that we can’t really do anything about? Is the problem just too overwhelming? Is it just that we think we lack an effective solution so we continue to return to the drawing board for yet another study? Enough.

There are a number of effective solutions in place already, ours being one of them. We continue to build momentum with workplace initiatives and program participants. And, we continue to prove that people want to be well. Most of us would rather be part of the solution than part of the problem. And, we’re not alone.

Given the choices, most of us would probably choose to live healthier, longer lives rather than face an earlier, and perhaps costly, unpleasant death. Wouldn’t we?

Auto Insurance and Wellness . . . Who’s Behind the Wheel?

We’ve heard a lot about health care costs, the Patient Protection and Affordable Care Act and health care reform during the last two years, so, being in the “wellness business” we thought we’d toss in our nickel’s worth on the subject. (And, speaking of nickels, would it surprise you to know that only 5 cents of every dollar spent on health care goes toward wellness and preventive health while the other 95 cents goes to treating illness after it occurs?)

Here’s a question . . . actually, several questions. What is “wellness” to you? What’s the connection between wellness and your health care costs? And, what is the connection with the auto insurance industry?

The answers to these questions might be somewhat different if you’re answering from the perspective of an employer rather than an individual. But, maybe not all that different. The ingredient that must be present to improve wellness, health and reduce health care costs, whether for yourself or your organization hinges on behavior change. And, there’s never been a more pressing need.

Consider two more questions: Are your auto insurance rates based on your driving history and record? Are your health insurance premiums based on preventive measures and personal lifestyle choices? (See where this is going . . .)

Between 2000 and 2010 health insurance rates rose approximately 114 percent. We are told to look for another 8.9 percent increase this year. On the other hand, auto insurance premiums have decreased 6.8 percent since 2009, in part because the auto industry creates the opportunity for its insured drivers to earn discounts—based on driving record, use of seatbelts, and driver’s education. On the flip side, accidents, multiple tickets, and poor driving behaviors result in significantly higher rates. Where health insurance is concerned, shouldn’t we be able to earn the same discounts through positive wellness and health care behaviors? Shouldn’t employers, through wellness programs offered through their organizations, receive rate discounts when their employees become proactive and make positive lifestyle changes, changes that result in lower health care costs and fewer claims?

In fact, a new study published in the March / April edition of the American Journal of Health Promotion finds that health care costs rose at a 15 percent slower rate among wellness program participants when offered a workplace wellness program. This showed a savings per participant of $332.

What if we could begin to reverse the climbing costs of chronic disease (80 percent of which is caused by poor lifestyle choices) by linking an individual’s positive behavior changes and improved health to rate discounts instead of the dreaded annual premium increase?

Think about where we would be if we all went out and actually made those positive behavior changes.

Smile and the World Smiles with You . . . Or Not

Or, maybe you’ve heard the term, “fake it till you make it?” But does it work, and is it healthy? Recent research suggests that flashing a fake smile to make yourself or others feel better, can actually make you feel worse.

The study, which appeared in the February issue of the Academy of Management Journal found that trying to cultivate positive emotions (meaning hiding negative emotions) may result in additional strain. Attempting to hide negative thoughts with a fake smile actually makes those thoughts more persistent.

According to the study’s lead researcher, Brent Scott, “Employers may think that simply getting their employees to smile is good for the organization, but that’s not necessarily the case. Smiling for the sake of smiling can lead to emotional exhaustion and withdrawal, and that’s bad for the organization.”

Many jobs require friendly, courteous and frequent interactions with other people. That mean’s smiles. The study points out that when these smiles are generated from “deep acting” (based on positive thoughts), they tend to be authentic smiles, even when they are smiles on demand. It’s the smiles based on “surface acting” (fake smiling on demand) that tend to backfire.

The takeaway—your game face says a lot, but so do the reasons for it. Forced smiling can actually result in withdrawal and mood deterioration when that smile is fake flash after fake flash. But, focus on pleasant thoughts and memories, and fake a smile, and you’ll be more likely to generate a real smile—and improve your mood.

So, what does this have to do with wellness (since we’re in the wellness business)? When you give yourself a chance to have an “authentic” smile, you’re actually improving your health. And, the best way to create the opportunity for that authentic smile? Do the smallest positive thing every day for only two months and you will improve your attitude, ward off anxiety and depression and begin to create the self-belief that you are in charge of your health—and that’s something worth smiling about.

Try it for yourself. Adjust your “smile feelings.” How do you feel? What are you thinking about? Does it bring a real smile to your face?

Death by Sitting

You might want to stand up while you read this. You may not think of yourself as sedentary, especially if you are one of the few who actually find time for that recommended hour per day of physical activity. And if you are one of the few, how do you spend the remaining 15 to 16 hours when you are not actively running, walking, biking, swimming, playing tennis . . . you get the picture? If you spend those 15 or 16 hours commuting to and from work or school, sitting at a desk, in front of a TV or any other screen, guess what—you are sedentary. This new sedentary is different from the way we’ve defined sedentary for the past 50 years.

In general terms, the new definition of sedentary behavior means if you are sitting down, you are sedentary. This also means it is possible to meet the recommended physical activity guidelines yet still live a very sedentary lifestyle. Dr. Marc Hamilton of the Pennington Biomedical Research Center sums it up by saying, sitting too much is not the same as exercising too little. And, it’s not an equal equation. Sitting too much may actually be worse. It involves an enzyme called lipoprotein lipase which works to reduce the amount of fat circulating in your blood, which also influenced cholesterol. When you’re sitting, this enzyme activity is significantly reduced.

According to a new study published in the American Journal of Epidemiology, time spent sitting is more important in determining mortality rates than the amount of structured physical activity. As part of the American Cancer Society’s Cancer Prevention Study, researchers found the more time a person spent sitting down, the higher their risk of dying. In fact, women who reported more than six hours of sitting per day were 37 percent more likely to die during the study period than those who sat for fewer than 3 hours per day—and that association didn’t change after adjusting for physical activity levels.

Here’s the hard part—our society involves a lot of sitting—at work, school, in our cars and at home. Here’s the good part. We can take breaks from our sedentary behavior. We can get up and walk. We can stretch. We can fidget. Skip the text or email to your colleague at the next desk—walk over and deliver it in person. We can wash our own cars rather than drive them through the car wash. If we look, we can all find ways—and very good reasons to move more.

Save Us From Ourselves . . .

What do you get when you mix up economic science and psychology? You get behavioral economics, a relatively new but already widely accepted field—Behavioral Economics. It’s founded on the premise that a number of factors, including the context in which they occur, influence our individual judgment, preferences and decisions. It even becomes tactical when applied to marketing, framing our decision-making in the moment. (As an example, the next time you’re in a check-out line, anywhere, look at what’s around you and at the price-point. It’s there, carefully placed, so you will pick it up, look at it, and think to yourself, “sure, why not?”) Think nudge.

Every day most people make at least a few seemingly irrational decisions—poor choices on some level—eating too much, spending too much, driving too fast. The list goes on. But, when we understand the “why” of these choices, the principles of behavioral economics can step in to create solutions.

And, how exactly do behavioral economics move us to make healthier and more cost-effective choices?

Consider what behavioral economics calls the Prospect Theory. We’re motivated more by the threat of a loss than we are by the promise of reward. (We’d all like to win $50, but we’d really hate to give up $50.) So, applied to our own health, the loss of our personal health and wellness, as in “change or die,” is a greater motivator than becoming healthier.

There’s also what’s called the Endowment Effect. In essence, we become attached to what we already own. Our own doctor, our own insurance policy, our own table at our favorite restaurant, our own lucky lottery numbers. We get used to these things, and others, and resist changing even when it’s in our best interest to do so. We might be suspicious of change, and stubbornly hold onto even unhealthy and costly behaviors—because they are ours’. But again, when we understand “why” and begin to explore other options we become more willing to make better, and perhaps more cost effective choices. Now we “own” better choices.

There are basic tenets at work here, such as loss aversion (we fear loss because it causes more pain than the pleasure we receive from a new gain) and status quo bias (because we are reluctant to change, we let changes be made for us or happen to us).

The trick in saving ourselves from ourselves is in finding ways to create a forgiving environment. Every element of every design has the potential to influence our choices. Do we close our eyes and hope for the best, or do we take what we know and apply it to making rational behavior choices? If others are doing it for us, shouldn’t we find ways to do it for ourselves?