Health insurance plans and health care providers have a clear stake in consumer behavior change as the United States grapples with the consequences of ever more prevalent obesity and chronic disease. With weight loss and weight management spending projected to reach $206 billion within two years, it’s clear consumers share that interest, too. So why is it so hard to motivate healthy behavior changes?
It may be in large part that programs designed to help support behavior change fail to adequately account for an organ that contributes just 3 pounds to the human anatomy: The brain. Dr. Kyra Bobinet, founder of engagedIN and author of Well Designed Life: 10 Lessons in Brain Science & Design Thinking for a Mindful, Healthy, & Purposeful Life, took attendees at AHIP’s Institute & Expo on a tour of the mind, sharing insights into how the brain works and how to design behavior change programs to align with this physiology.
The problem with many behavior change programs is they start with a solution, such as an app, and design a program around it. A better way is starting with a clear understanding of the brain-behavior gap, a concept articulated in ancient Greece as akrasia and by Bobinet as: “I know what I should do. I don’t know why I don’t do it.” The answer to akrasia, Bobinet says, is rooted in the brain’s white matter, in which it takes a full year (not the 3 weeks commonly believed) for new behaviors to become established enough just to compete with entrenched patterns.
So program design must start with a simple question: What does the brain want to do? And the answer to that question should underlie programs built around motivation, systems and a plan for relapse.
Motivation must account for the brain’s stochastic dominance tendencies – meaning dominant behaviors, patterns and systems are the default. Effective motivation also deals in realism, such as offering healthy snacks in a vending machine and not just empty platitudes, and capitalizes on the brain’s tendency to store information in groups. Bobinet says program designers must understand the factors that will dominate and also stabilize motivation.
Systems for fast and slow brains
Behavior change programs will work for few people without a system, Bobinet says. She breaks the brain into what she calls the fast brain — the unconscious mind, which encodes 95% of behavior — and the problem-solving, decision-making slow brain, where willpower lives. When designing behavior change programs, “you’re trying to make the good stuff fast and the bad stuff slow to converge on this brain-behavior gap,” Bobinet says.
She classifies people as MacGyvers, a rare breed of people who use their slow brains readily to figure out how to surmount obstacles; and Homer Simpsons, the rest of us who don’t realize we’ve picked up a cookie until it’s already eaten. Homer Simpsons are fast-brain people.
For all of us, slow brain exists in short supply. By the end of the day, your capacity to use it is limited, like an overworked muscle. This is visible on brain scans: The brain understands the need to make good decisions, but it is weak after a full day of dealing with life’s challenges. Consumer engagement professionals need to understand this framework because it’s the context within which any behavior change program will exist. “No behavior will survive the fast brain without a system,” Bobinet says. “Habit equals systems. You create a system for it, and now you have a habit.”
When systems fail
And how do you make the habit permanent? Plan for relapse. “Relapse isn’t a matter of if; it’s a matter of when,” Bobinet says. It’s critical to plan for this, and for people trying to make change in their own lives to understand the inevitability of relapse so they are not sabotaged by a sense of failure. The brain houses a region known as the habenula, which Bobinet calls a “failure counter” that ratchets down motivation with each failure. “If you think you’ve failed, it will take away and dial down your motivation,” Bobinet says.
The right intervention will vary, but common threads for relapse messaging should include:
- “You’re not bad.” (Behavior change is hard; relapse does not signal a personal shortcoming.)
- “You’re not alone.” (Other people have been in your shoes and gotten through this experience; you can, too.)
- “Here’s a way out.” (Here us a new system that will work with your life now.)
People who surmount failure and go on to experience success are those who can take a broader view, see that life disrupts systems, and understand that when it does so, they need a new system. “Behavior change is a skill like algebra,” Bobinet says, and the kind of resilience it requires can be built up like a muscle. Behavior change designers are likely to see more success and truly make a difference in consumers’ lives when they account for these principles.