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Interview with James Pshock about Workplace Wellness

James Pshock is a well-established thought leader in the area of workplace wellness. He is the president and founder of Bravo Wellness, whose mission is to deliver exceptional services and products to organizations seeking to help their workforce achieve optimal health through incentives. His experience in the health insurance and wellness industry spans over two decades. James is an Ernst & Young Entrepreneur of the Year Award winner, and is also a committee member of HERO, an advocacy group for the advancement of workplace wellness.


1) The recent documentary, Fed Up, presented evidence that lobbyists potentially have garnered a narrative regarding obesity to be too heavily focused on activity, resulting in a lackluster focus on nutrition and food intake. In parallel, there seems to be an abundant focus on physical activity with regards to workplace wellness in comparison to other areas of behavior change. In your opinion, why do you think that is?

I am not sure I completely share this observation, although it’s true most programs are activity-based (in the sense that many programs involve activities, like taking part in a step challenge or watching an instructional video) and I think in many ways it’s because activities can be measured, and because these programs are relatively easy to implement. Whereas, with food, we can think back to second grade when your mom sent you to school with an apple in your lunchbox, and you would trade it for a Twinkie, and she would never find out. You can educate people. You can give them the food, but it doesn’t mean they are actually going to eat it. And, plus, you have the complexities of allergies, and food preferences, and people who just don’t like the taste of what you’re telling them to eat.

Focusing on nutrition can open a Pandora’s Box. If you’re going to go down that path of telling someone what they ought to be eating, then you’re going to have to be willing to deal with a lot of personalization and accommodations, which is no easy feat. We tend to focus more on the “why” than the “what”, and sharing the message of personal accountability for your health… this empowers the individual with a directive, but also the power of autonomy to achieve it.

2) In a 2014 New York Times article about Workplace Wellness the author contends that programs that focus on lifestyle change potentially do not reduce costs but move them from the employer to the employee. Putting aside there is evidence to refute this claim as factual, where does the responsibility of the company end and the responsibility of the employee start?

There are a lot of deep issues loaded in this question, everything from an entitlement mentality to employees who recognize health insurance as a “benefit”. Almost any company was not founded on the premise of being a health insurance provider. Insurance is meant to be a benefit. Yet, so many people just kind of have an entitlement mentality that really shelters them from understanding the true cost. Most people are unaware of the role that they individually play in determining what that cost is. Dental insurance is a great example. Historically, dental insurance has had 100% coverage for preventative services and something like 50% coverage for restorative or repair services. Look at the statistics. The result has been a phenomenally high rate of prevention because the benefits are typically pretty inadequate for major restorative services. People take better care of their teeth. Prescription utilization versus generic utilization is another good example. For years organizations asked people to use generics and told them how much money the company would save if they used generics, but it was not until employees saw a pretty dramatic difference between the co-pays for generics versus the co-pays for branded drugs that companies began benefiting from the shift in consumerism to utilizing more generic drugs.

A final example is pension plans versus 401(k)s. For decades, the norm was to have a pension plan and your employer would pay you after you retired. And, as that shifted to a 401(k) model – you put money away, we’ll match it – it shifted the responsibility for post-retirement security to the individual versus the expectation that the company I work for is going to take care of me regardless of how I behave.

I believe we are just on the forefront of that happening in health insurance, where it’s not a cost shift thing. It’s simply shared responsibility. And, as that message of shared responsibility takes root, there are people who are going to say, “Well, you just shifted the cost to the people who refused to do anything about their personal health or their preventative risks.” And you could absolutely look at that and say, “I guess that’s one way to look at it.” But, the lens we look at it through is really more in line with the concept of transparency and shared responsibility. And for those who have a hard time accepting responsibility, they will likely be resistant to this change because their perception skews towards entitlement.  

3) For a small to midsize business (SMB) with limited resources, how does a SMB choose what aspect of wellness to focus on and what role does a company like Bravo Wellness play in that decision making process?

There is a value in having some type of wellness program regardless of the size of your organization. However, when you talk about the concept of workplace wellness, it is important to note that it is enormous and complex. For example, you might be looking at something as basic as smoking and say, “Well, you’re going to add years to the end of your life if you quit. Don’t believe us? Here, we can show you all these studies of morbidity rates improving if you stop smoking.” But smoking is not the problem, in this case it is a symptom of severe depression. I mean the last thing on their mind is living longer, and we are discussing morbidity. We are making all these assumptions that what is important to us is important to them.

There is not a one size fits all unfortunately. What I have seen is that where you might see fantastic results in one environment, you take that exact same program and put it in a different company, with a different environment and culture, and it could fail. An environment that is based on teamwork, and very collectively working towards common goals adopt things differently than siloed organizations. Bravo Wellness helps organizations think through what they are trying to accomplish. What has been surprising for me is how many companies want a wellness program, but have no idea what they’re trying to accomplish. If your goal is to try to be recognized as the “healthiest employer in your city”, what does that mean to you? Your health related costs are going up 20% a year but the health of your organization has vastly improved, that might be what you are after. An assessment needs to be done of the organization: What are they trying to solve for? How will they handle those issues that will appeal to the broadest number of people? If further down the road they still have some people who aren’t making any good choices, how will they pivot?

4) The definition of wellness coined in 1995 by Anspaugh, Hunter, & Mosley talks about wellness in the context of the workplace as ‘a composite of physical, emotional, spiritual, intellectual, occupational, and social health’; Given the complexity of what constitutes one’s “wellness” is it even realistic to expect workplace wellness programs to encompass all the components of wellness? Or is it suitable to assume that programs should focus on maximizing efficacy by doing a few things really well in concert with other wellness providers (outside of work)?

How wellness is defined and how you start to educate your population, you treat this as a mission. I like the fact that we’re not just saying wellness means the five biometrics mandated by legislation. Like in our case, we’re limited somewhat in that by way of regulation we really only have five things that we can tie into and have contingent incentives or penalties against. That doesn’t mean in any way we are not trying to identify other risks, educate people, and equip them to take positive action for their emotional health, spiritual health, and other things that could really have a profound impact in their life. You should put it all out on the table. Where you’re going to focus your actual interventions, after all my experience on the TPA side as a buyer of wellness programs, and then our experience in the last six years facilitating them …I have landed on saying: educate and equip, provide the tools and resources, but reward people for results, not how they chose to get there.

An important consideration is the privacy aspect of wellness, employer’s limitations on asking certain wellness questions (even if well-intended), let alone obvious legal exposure regarding spirituality and things of that nature …there’s certain angles here that no employer, after they talk to their attorney, are going to be willing to do or should do for that matter.

5) Looking back at your extensive experience in the industry, what are the key elements that contribute most to the success of a corporate wellness program? Have there been any surprises?

The sole message of equipping people versus mandating how they need to get to “wellness”, the right tools, and a focus on results is what I have become more and more convinced is critical. Trust throughout the entire organization is also important. There needs to be transparency, so the employer can share the true cost of benefits. For example, a company says, “We get charged $1,100 a month from Blue Cross. We’re paying 80% of it. But, we are willing to pay up to 90% of it if you do these things.” It is eye-opening for a lot of employees who had no idea how much the employer was already paying on their behalf and what they were basically getting for free. And that certainly adds to their acceptance of responsibility, as well as better buy-in which is at the heart of success of any wellness program that is used as a tool to improve some aspect of employee well-being.

Interview with Dr. Chris Bingham about Fostering Innovation

Dr. Chris Bingham is an award-winning professor of Strategy and Entrepreneurship at the Kenan-Flager Business School at the University of North Carolina. Dr. Bingham received his undergraduate accounting degree and MBA from Brigham Young University, and received his PhD in strategy, organizations and entrepreneurship from Stanford University. Currently Dr. Bingham’s focus is the process of accelerated learning in the context of seed accelerators. Dr. Bingham’s complete biography can be found here.


1) You have presented how one can use the Nadler and Tushman’s Congruence Model to foster and/or improve innovation within an organization. Is this more a function of a healthy organization being more innovative, or are there certain aspects specific to the Congruence Model that lend itself to creating an innovative environment within an organization?

There are different components of the Congruence Model, right? You’ve got task, you’ve got structure, you have got people, and you have got culture. And, sometimes, people will tweak this model a little bit, but those are basically the four parts. The whole point is, if one of them is off-kilter, then you can have some problems.

So, I believe in the model. I believe in the congruence. If I were to look at one of the elements that I find the most intriguing, it’s probably structure and here is why: Because I believe the counter-intuitive insight when you’re trying to innovate is that when markets become more dynamic, more ambiguous, often the best strategies are the most simple. And that’s an insight that a lot of people don’t get because what happens over time in organizations is you build up more and more structure – that is, more policies, more rules, more manuals, more routines… what that ultimately does is create inertia. It creates bureaucracy. It makes it difficult to change. Organizations are trying to become more efficient and that’s what the structure does, organizations become efficient but at the expense of flexibility.

So, if you think about a spectrum, you’ve got efficiency on one end and you have got flexibility on the other. There is a natural force pushing firm imperceptibly towards efficiency at the expense of flexibility. And so I think, as leaders, what you have to do – if innovation is key for you – is you’ve got to deliberately pare back structure. I’ve been looking at innovative companies across many different industries, and what you see is they will provide a little bit of structure, but within that structure, there’s a lot of room to adapt. For example, Yahoo, in its early years had a few simple rules shaping their partnerships: (1) don’t do deals if it jeopardizes the user experience, (2) no exclusive deals, and (3) the product or service must be free.  Those rules provide some structure and guidance (securing some efficiency), but within those rules there was a lot of room to adapt.

2) You have also stated that there is evidence to suggest a diverse team dynamic promotes an innovative culture (highlighting Under Armour’s Board as an example of this). In addition to simply gaining expertise outside of an organization’s industry, are there other considerations or strategies one can use in building an effective team through diversity?

You can think about diversity from lots of different angles, right? Functional diversity, gender diversity, age diversity. But, I believe the key point here is trying to find people who disagree with you. And that’s a little non-obvious. You want to create task conflict (i.e. when people disagree with you) without creating affective or personal conflict. Task conflict often is helpful because an organization can avoid premature convergence on what might be a suboptimal plan. It keeps you from jumping into things too quickly. Also, studies show task conflict leads to improvement in team decision making effectiveness. And when this works, team decision making effectiveness improves not only satisfaction with the team, but also team performance.

The other question is, how can you find these sort of disagreements naturally occurring within organizations and what do you want to do about it? I think what you want to start looking for is internal disagreements that might come up when you are trying to develop a new service or a new product. Marketing and finance almost always are going to support the status quo because their incentives generally come from knowing the existing product. New innovation presents a risk to their livelihood.

Engineers and R&D folks are often the ones who will be pushing new and disruptive ideas. They are looking for what’s going to be best from a customer perspective and/or from a product perspective. This natural tension is good. Look for those natural disagreements to find balance.

Diversity is also key for brainstorming. A dictum at IDEO is, “Go for quantity” in its brainstorming sessions. So, it’s not untypical in an hour-long brainstorming session at IDEO for them to come up with ~100 different ideas for something. Without this practice guideline what will often happen is the power players in the room are going to get out their ideas first. And, then other players in the organization start conforming. They are going to start saying, “Oh, yeah, that’s a good idea.” Any idea they might have had gets stifled and factions start to form around the power people’s suggestions and you don’t get much further than that. And, then, it becomes just sort of a power game. In contrast, if you can just start saying, “Hey, look. Let’s get out 30 ideas in the next 30 minutes and let’s get 100 ideas in the next hour,” what happens is it quickly becomes more objective. So, you actually depersonalize it by getting high numbers of ideas out there from a diverse group maximizing the organization’s available choices.

3) One way an organization can successfully tap their market for ways to innovate is to ask themselves, “what job is our customers hiring us for?” What are some other key strategies an organization can use to tap their external market for ways to innovate, rather than simply continuing to iterate and improve?

There is an innovator’s series of books: Innovator’s Dilemma, Innovator’s Solution, Innovator’s DNA. There is now a new one out, Innovator’s Method. What I believe these books are missing is an understanding about the social innovator. Not social in the sense of social causes, but in the sense of innovators that tap community. Crowdsourcing is a great example. For example, Monopoly fans voted on Hasbro’s Facebook page to get rid of the old flat iron playing piece and adopt a new cat playing piece instead. Scrabble players vote on which new word to add to the Scrabble dictionary. It is a really powerful channel when an organization taps into its external constituents.

The other thing you’re starting to see, from a social perception, is innovation tournaments. Netflix did this a couple years ago to improve one of their predictive algorithms. My understanding is it was a very diverse team of academics and industry experts that came together for this. You are starting to see more of these innovation tournaments produce some really amazing ideas. Customers prove to be really helpful for insights. They can help you identify problems and solutions in ways that prove difficult for internal resources (for a variety of reasons).

4) It appears that health-related wearables are in the process of “crossing the chasm” and are here to stay. In your opinion, what is important to get right as we move on from early adopters, to catering to the early majority regarding these products?

So I think your question, simply put is, “how can you help the early majority?” In other words, how can you help cross the chasm, right? What do you need to do to help this new market? If you look at innovation diffusion theory, it’s actually a pretty old, well-established theory. We know early adopters are a fairly small group, where the early majority is a bigger category (more than double that of the early adopter group). If you look at differences between early adopters and the early majority, what you will see is the early majority is more pragmatic, a little more cautious, and want some proof of benefit. What they really want is the understanding that this is going to become a social norm, not just a benefit. They want refined technology to improve ease and convenience. They want a lot of stories of the innovation’s effectiveness. An interesting thing that builds on this diffusion model is actually looking at how adoptions occur. And what you’ll find – and this is actually pretty interesting – is in the early years adoption is generally based on mass media, but when you start hitting the early majority, what becomes really critical is adoptions occur more due to interpersonal communication. The social component therefore becomes really critical to get the early majority onboard.

5) The way people consume fitness is changing, especially with regards to modality, delivery, and provider. Michael Porter says a disruptive technology is, “one that would invalidate important competitive advantages.” Now that you have examined the health and wellness landscape, what are some of your predictions about how people will consumer fitness and wellness over the next five to ten years, and what does that mean for traditional health clubs?

I wish I could look into my crystal ball and get a more precise answer for you. There are broad trends that are affecting lots of different industries we can discuss. One key trend is mobility. If you look at the time spent in mobile apps in 2014, it’s gone up 50% from 2013. And that’s crazy, 50% in one year, and most of this is coming from just mobile apps. How does that exactly work for the fitness industry? I’m not quite sure. But, I think ignoring it or assuming that you don’t need to address it is not the right approach. So, I think that’s one very big influence that’s going to affect how people consume fitness and wellness over the next five to ten years.

Another trend is the idea of accessibility and simplicity. Some think of innovation as additive. I’m adding new features, new services, or whatever. Yet some companies like Google are innovating by subtracting things, and pulling things out, and making their product simpler, and more accessible. With Google Docs you don’t get all the features of Word, but you get the most essential ones. I think if you think about these three big trends of mobility, simplicity and accessibility; I think that’s going to really influence the way that people consume fitness and wellness over the coming years.

Interview with Ben Greenfield about Elite Fitness and Endurance Training

Ben Greenfield is an ex-bodybuilder, Ironman triathlete, professional Spartan racer, coach, speaker and author of the book “Beyond Training: Mastering Endurance, Health and Life” (http://www.BeyondTrainingBook.com). In 2008, Ben was voted as NSCA’s Personal Trainer of the year and in 2013 was named by Greatist as one of the top 100 Most Influential People In Health And Fitness. Ben blogs and podcasts at http://www.BenGreenfieldFitness.com, and resides in Spokane, WA with his wife and twin boys.


1) There appears to be an uptick in reports lately about the role and importance of conscientious thought as it relates to longevity and performance. In your opinion, (when looking to optimize performance) what is the relationship between adjustments of the mind/thinking and adjustments in nutrition? We tend to discuss these subjects separately, but should they be?

When we talk about conscious thought as it relates to longevity and performance, we can talk about gut/brain access and the thought that both are pretty intimately intertwined. The two elements of the nervous system, the central and the peripheral nervous systems, are essentially connected and stay connected via the vagus nerve as we grow and reach adulthood.

Whenever you talk about optimizing performance, you have to understand that anxiety and disruptive thought patterns can affect the gut, and there is also a lot of evidence showing that what you eat can have an effect on cognitive performance. So there is no doubt that a synergistic relationship exists between the two.

2) When you’re working with clients, how do you effectively make adjustments and/or additions to nutrition? How do you determine which interventions are beneficial and which are arbitrary? When making recommendations regarding nutrition — specifically any supplement recommendations — how important are therapeutic windows, considering ADME will be unique in different individuals?

We live in an era where genetic testing, gut testing, hormone testing and full blood panel testing are pretty convenient and becoming more and more affordable too. I always recommend at a minimum to get a blood panel, and if you really want a gold standard (especially in regard to nutrition), get a gut test. Get a genetic test, too. A spectral cell analysis will give you a look at micro-nutrients and minerals. If someone is experiencing a lot of autoimmune food allergen-type issues, the tests I recommend are a Cyrex Panel 4 or Cyrex Panel 5.

Really, the goal is to get a good idea of where someone is at from a food summary standpoint. Once you put all of that information together, then you can make a decision, but until then you are taking a shot in the dark. If your budget is limited, you might say “okay, whatever, I’ll start on a full spectrum multivitamin” and skip the testing. In those cases, basically I would recommend best practices for someone based on symptoms and goals, but it is always better to test. People generally get better results when they test, and continue to retest.

Testing can also include something like heart rate variability, where you look at how the sympathetic and parasympathetic nervous systems are responding to a change or intervention. In short, you put an intervention in place and you test to see what’s going on with the blood, or gut, or salivary gland to access the response to treatment. A lot of the folks I work with are testing at least one parameter every eight to twelve weeks.

3) In my interview last year with Dr. Howard Jacobson, we discussed the downsides of using reductionist research when addressing broad nutritional questions. Presumably you make some of your assertions based on this type research. How do you mitigate any potential risks?

I am a proponent of using natural whole food sources when possible. My recommendations come down to assessing whether a supplement or dietary strategy is going to get you a lot of bang for your buck. Take phosphorus compounds for example, they likely have some sort of anticarcinogenic effect — as such I am a bigger fan of incorporating broccoli, cauliflower and onions as staple components of a diet, versus suggesting someone use a sub-level glutathione.

But ultimately there are some situations where, by taking a food group or ingredient down to its complete reductionist form, you can concentrate it and get higher amounts of it. A good example is Chinese adaptogenic herbs, something that I use. I can take the isolated compound in a tiny little packet and it’s the equivalent of 40 pounds of the whole herb, which I physically couldn’t consume all at once.

4) In my 2009 interview with Chris Talley, he indicated there would likely be future developments for those interested in hacking their myostatin levels if they’re willing to experiment with antisense therapies (note: he highlighted the potential for considerable risks, too). I saw this year you mentioned cold thermogenesis as a safer alternative (since this type of therapy might have an effect on irisin). Do you find this to be effective with your clients who are looking to gain muscle? And, do you have any other suggestions regarding reducing myostatin?

With myostatin, one of the big goals is to not be in a consistent anabolic state. I think what you are referring to with a cold thermogenesis type of approach is the upregulation of m4, which is going to essentially downregulate myostatin, helping with muscle cell growth. However, you could potentially get undifferentiated cell growth.

I like cold thermogenesis because you do get hormones like irisin that help activate m4, and yet at the same time you are getting the upregulation of AMPK. That’s actually a perfect example of a strategy I like: an anabolic approach that uses caloric cycling on certain days that have higher levels of physical activity coupled with cold thermogenesis, because strategic fasting is also a way to reduce myostatin.

5) Piggybacking off cold thermogenesis: If you ask Tim Ferriss for his cliff notes on unconventional tried-and-true tips for weight loss he’s likely to tell you ice baths, his PAGG regimen, and 30 grams of protein within 30 minutes of waking up. What are a few of your unconventional tried-and-true tips for amateur endurance athletes looking to improve performance?

If you are asking for tips that fly under the radar, I am a fan of isometric protocols like long 30-second eccentric contractions and holds for 3, 4, or even 5 minutes in lunge or squat positions. Basically, it’s filling your muscles with a bunch of lactic acid, so you are upregulating your lactic acid buffering capacity.

If someone has a lot of inflammation and muscle damage from chronic repetitive motions, I am a fan of curcumin. I have been using a lot of curcumin phytosome, and there is a brand called Meriva, which a lot of supplement manufacturers are using now. It is a form that is well-absorbed and has really good anti-inflammatory effects.

Lastly, it’s not sexy, but I am a big fan of making sure that you engage in low-level activity all day long — basically standing on your feet, getting a standing work station, or even using a treadmill desk. Avoid sedentary positions for a long periods so that all day long you are building low-level physical endurance, which you can then rely on during your interval training and endurance training. A lot of people do not understand that a lot of your available endurance simply comes from your daily routine. If you are trying to improve performance you are not doing yourself any favors by sitting at a desk all day long.

Interview with Nir Eyal about the Hook Model and Product Development

Nir Eyal is an educator, entrepreneur, author, and blogger who maintains the website NirAndFar.com. In addition to his blog, Nir has written articles for TechCrunch, Psychology Today, and Forbes. Nir’s new book, “Hooked: How to Build Habit-Forming Products,” debuted on the Wall Street Journal business best seller list this year.


1) What is a creative “growth hacking” method you have seen bolted onto the Hook Model that can positively influence the viral coefficient (or alternative variable) and amplify the effect of your model? Clickbait is one potential example (adding a trigger to a hijacked audience); are there any better ones?

Clickbait is an okay example. I tend to think of engagement and growth as two things that can be connected, but that do not necessarily have to be. So when I look for opportunities to invest in or consult with companies, the three criteria I always look for are: growth, engagement, and monetization. A startup must possess two of these at the onset, with a strategy to obtain the third, or I’m likely not going to be interested.

Most viral strategies have nothing to do with engagement. This is important to note; most viral growth strategies lack engagement. These strategies are usually just a way to get people in the door. Sometimes you see innovators get so hung up on virality that they stop there, and unfortunately stop short of incorporating engagement into their product. For me that is what is interesting: how can you make engagement part of the product itself, part of the growth strategy? It is pretty rare to see engagement as part of the overall growth strategy. It’s pretty hard to do well unless you are a social network. Most others are doing it as a bribe: “Here is ten dollars; invite your friend.”

2) In your teachings, you speak about the power of negative valence and how feelings such as boredom, fear, and depression can be effective mechanisms to get someone to act. In your opinion, why have emotions with positive valence (such as a joy) proven to be less effective action triggers?

When we feel happy, we don’t have a problem. Every solution is used to address a problem. Negative valence states are painful. They create pain points and we seek to correct those pain points. One could also argue this is teleosemantic… two sides of the same coin. For instance, is someone lonely or do they simply desire connection? I like to focus product makers on the negative so they understand that they should be solving a problem. Unfortunately opportunities are generally not found when people are hunky-dory; opportunities are found when people are suffering from something.

3) In the process of your research, what are one or two of the most effective reoccurring external triggers you’ve seen that do not use the computer or mobile phone as the conduit? Is there anything on the horizon that might match or come close to the utility of smartphones with regard to effective trigger conduits?

Mobile devices are fairly new, but visual triggers obviously are not… advertising, storefronts, etc. Smartphones simply let us interact more effectively with these triggers. As far as something on the horizon, I think the smartwatch is going to be huge. Whenever there is a broad base interface change, it opens a world of opportunities to build innovative products. And as simple as this sounds, some of the most powerful triggers are often hidden in your pocket. You cannot see that you have an incoming email if you have put your phone on silent. A watch is ever-present; however, the downside is there is a lot less real estate to grab your attention (than a phone). This is going to make creating habits more important because with less real estate there will be less opportunity to grab your attention. It creates a more competitive environment for app makers.

4) In a previous conversation, you and I discussed that fitness is hard to position as a reward because fundamentally it’s punishment, making it inherently difficult to inspire this action. Are there strategies to help bolster the perceived intrinsic value of a difficult action in an attempt to strengthen the perceived reward?

It is not my position that fitness is “fundamentally” punishment. I don’t think it creates pain for everyone; some people are clearly passionate about fitness and get a lot out of it. They get pleasure from exercise. It is rewarding and they love it. It is what they like to do in their spare time.

What I do suggest is that those who do not enjoy exercise feel that way because it is potentially perceived as punishment and not viewed as rewarding. I believe that these people view exercise as not fun; simply put if they thought it was fun they would be doing it. The problem is people who don’t already enjoy it make up a majority of the general market, right? People making fitness products, or at least most of them, are trying to create behavior change in the hope of making inactive people become active. It is the proverbial brass ring that people in the fitness industry are reaching for.

From what I have seen to date, it just doesn’t work; it is just punishing users. Look at the phenomenon of “moral licensing”: when we do something that we feel punishes us, when we feel we are suffering in one area of our lives, we tend to go overboard in other areas. That’s been shown with charity giving, and it’s been shown with recycling: sacrificing in one area of life leads to indulgence is other areas of life.

If someone gets into this spiral — for instance they workout each day and burn 300 calories but then reward themselves with a 400-calorie Jamba Juice — what happens over time when they do not see results? They ask, “why am I gaining weight? I guess I am just a fat person.” In the end they come to a conclusion, “well, I’m just fat; it’s who I am.” And that’s the saddest part of this story, because “being fat” has become a part of their identity, and identity is much harder to change than behavior.

At a global level, a person’s environment is going to play a major factor in the obesity crisis. People make poor choices about what they eat because unhealthy food is easy to get. If we had better access to healthy choices, I believe that would go a long way. In that regard I love what the company Pantry Labs is doing. Pantry Labs makes it easy for companies to offer fresh foods to their employees through vending machine innovation. If you enable people to make healthy choices, I think this is an easier intervention to implement than expecting everyone to pick up exercise.

5) Continuing the theme of influencing healthy behavior change, in your TechCrunch article Why Behavior Change Apps Fail to Change Behavior you state, “When our autonomy is threatened, we feel constrained by our lack of choices and often rebel against doing the new behavior.” I believe this to be true as well. However, I also believe Barry Schwartz’s contention that choice can often be paralyzing. Personally I struggle with the coexistence of these concepts when it comes to prescribing varying fitness modalities to a population (especially in light of data that suggests you get higher participations rates when you limit choice). Where do you believe the balance exists, if there is a way to find balance? 

I believe you are talking about two different things here, I don’t think it is apples to apples. When we talk about the “paradox of choice,” we address things we desire, like picking between 24 flavors of jelly. We want the jelly, but we cannot decide which one we want. When we are talking about issues of autonomy and choice, we’re addressing things that we do not want to do. “I do not want any jelly; I hate jelly,” is different than the statement, “I want jelly, but which one do I get? It’s just too difficult to decide.”

There is some crossover — there is the concern that making choices, even simple choices, may tax one’s willpower — and there is this other issue of behavior, high willpower versus low willpower. The “behavior change matrix” can be helpful in explaining the difference and how it relates to forming positive habits.

Automatic behaviors — in other words, our habits — fall into one of four modes: amateur, expert, habitué and addict. I categorize them by how much self-control is required (high willpower vs. low willpower) and whether motivation can be classified as pleasure seeking or pain alleviating. Amateur and Expert are both pleasure-seeking modes, but amateur requires little willpower while expert requires a high degree of willpower. Both modes tend to result in beneficial behaviors that people want to increase.

Habitué behaviors are pain alleviating but require little willpower. They may be beneficial or destructive. Addictive behaviors are primarily negative and people seek to rid themselves of them. If you want to change someone’s behaviors, or help them develop new ones, you need to understand the matrix and use techniques in line with these four behavior modes. In other words, we do not need to frame this as “finding balance” rather understand that various desired behavior change types call for different strategies depending on the situation.

How Can Health Clubs Benefit From Wellness Initiatives?

How Can Health Clubs Benefit From Wellness Initiatives?
Earlier this year I wrote an article for the CCD News Update about how the Affordable Care Act is affecting the health club industry. The article summarized how new incentives and public policy changes put forth through health care reform are opening up great new possibilities for health club operators who want to boost membership and improve their club’s bottom line. The simple truth is as the cost of health care goes up, employers that self-insure are bearing most of the burden. Many have turned to wellness programs and employee incentives as a way to lower their costs and encourage their employees to stay (or get) healthy.

We are also now seeing doctors and allied health professionals start to work more closely with health clubs as a way to encourage their patients to make positive changes in their lives. Overall there’s an increasing trend toward prescriptive wellness — and this positive trend, and the opportunities that come with it will undoubtedly continue to increase in the coming years. As an extension of my prior article, this quarter we take a little closer look at examples of how clubs in California are benefiting from this rising tide in the hope of fostering ways your club might be able to benefit too.

Health Care Reform and Health Clubs

So where does your health club fit into this changing landscape? In the first article, I highlighted that the Affordable Care Act (ACA) includes provisions addressing two kinds of wellness programs: participatory programs and health-contingent programs. Participatory programs can potentially subsidize the costs of a club membership across an entire employee base. Health-contingent programs, on the other hand, require participants to meet specific health-related criteria. An example of this type of program in California is California WorksWell (for more information visit: http://www.calhr.ca.gov/employees/Pages/wellness.aspx) , which provides state employees with discounted memberships at health clubs across the state through a partnership with GlobalFit, as well as free guest passes at partnered health clubs. It is no secret that major corporations in California are increasingly offering wellness discounts for its members. If you are club operator on the MINDBODY platform it may behoove you to learn more about their Exchange program (for more information visit: https://www.mindbodyonline.com/exchange/get-listed).

Focusing on Health-Contingent Wellness Programs

Among health-contingent wellness programs are physician-referred exercise programs (PREPs). These programs have several potential benefits. First, physicians are an often-untapped source of prospects. Doctors and allied health professionals are increasingly encouraging their patients to get more active (reference: http://www.cdc.gov/nchs/data/databriefs/db86.htm). Second, if you convert these referrals they are generally more likely to be intrinsically motivated, couple this “drive” with effective economic incentives from their employers, and the data supports that your are likely to retain these members for longer than your general member based (for the supporting data visit: http://exerciseismedicine.org/documents/ACSMRoundtable_GlobalizingEIM_MegBouvier_webversion.docx).

Finally, these programs can also benefit your staff by reconnecting them with a higher purpose. With PREPs, the goal isn’t just selling memberships – it is about helping people change their lives for the better. For general managers worried about employee morale, reminding your staff about the positive change they create every day is a great way to get them reengaged your club’s “why”.

If you want to try to use PREPs as a way to improve membership, try these tips for connecting with the medical community:

  • Make friends with the office staff of local medical centers
  • Host an event for medical professionals at your health club or find other creative ways to encourage them to visit your club
  • Attend events you know will attract medical professionals and network
  • Hire a liaison to help you make connections with physicians
  • Have a knowledgeable staff member provide guest content for a local medical website and negotiate some sort of reciprocity agreement

Boost Business by Targeting Key Demographics

You can also boost your club’s business by targeting underserved demographics. For example, SilverSneakers (http://www.silversneakers.com) is a nationwide program available through various health care providers, including Medicare, that encourage senior citizens to focus on their health. It empowers them to get fit by providing free memberships for seniors. And the market holds plenty of potential for this segment. Consider these statistics:

  • People 55 and over control more than 75 percent of America’s wealth
  • Baby boomers, the people born between 1946 and 1964, spend more than any other generation — $400 billion more each year — on goods and services

By offering special programming targeting this group you can draw in an otherwise underserved demographic. SilverSneakers provides compensation to health clubs based on participation, along with additional opportunities for revenue from supplemental programs. You also get access to program and marketing support, free class equipment, and free training to better serve your members. You can attract SilverSneakers members by emphasizing benefits such as fewer hospital admissions and lower medical care costs.

It is important to note that these opportunities transcend the baby boomers demographic. The ACA also needs low-risk populations to buy health care coverage from their exchange. Covered California, the state’s health care exchange, is awarding millions of dollars in grants for outreach programs that educate young adults about the benefits of health and encourage them to enroll.

More to Come

There are many more ways health clubs can use health care reform to their advantage. If you are willing to deal with the often-complex regulations of HIPAA, you can collaborate with employers to offer health screenings and track biometric data. This biometric data can be used by employers to offer discounts on health care premiums. There are California startups like Jiff (http://www.jiff.com) that you can partner with to make it easier to offer these type of services at scale.  

Furthermore, in 2018, health insurance benefits exceeding a certain threshold ($10,200 for individuals and $27,500 for families) will be subject to a 40 percent excise tax. High-end employers will start looking to wellness programs to help further reduce their costs and alleviate this particular burden. Given this segment has significant disposable income it could be an advantageous group to target if your club is properly set up to cater to a high-end demographic.

For the original California Clubs of Distinction print version please click here.