How Our Internal Values Shape Our Health

One of the most persistent observations in recent health research is the poor practice of basic health habits in the U.S. In 2005, for example, a paper in JAMA Internal Medicine reported that just 3 percent among more than 153,000 Americans routinely practiced four healthy lifestyle habits–not smoking, engaging in regular exercise (five plus times/week for 30 or more minutes), maintaining a normal weight body mass index (18.5-25), and consuming five-plus servings per vegetables per day.¹

Fast forward to 2016, and these same health habits were assessed again by an independent group of researchers in a paper published in the Mayo Clinic proceedings. This time only 2.7 percent of 4,745 Americans achieved these healthy habit recommendations.²

For perspective, consider some of the incredible resources that became available between these 2005 and 2016 studies to help Americans adopt healthier lifestyles: smartphones, fitness trackers, sleep monitoring watches and rings, apps to improve nutrition, weight loss, exercise, and sleep, artificial intelligence services through companies such as Google, Apple, and Amazon, consumer health companies offering personalized data about genetics, health biomarkers, and vitamin deficiencies, and podcasts and YouTube channels providing virtually unlimited hours of health information to anyone with internet access.

Surprisingly and frustratingly, none of these resources seem to make a difference. Despite unparalleled access to information and technology, research such as that cited above indicates that a person resolving to improve their health habits in 2022 has no better chance of success than a person committing to the same goal decades ago.

But the news gets worse. At the same time, for example, that these information and health technologies were showing remarkably little effect on health habits in the U.S., behavior change data regarding government interventions such as expanding information on grocery food nutrition labels and requiring calorie listings on restaurant menus are also disappointing.³ And research in the psychological sciences has long disproven myths about willpower and motivation as the secrets to long-term behavior change.⁴

In short, the practice of basic health habits in the U.S. is shockingly low and may even be declining. Because these health habits are direct contributors to major chronic conditions such as cardiovascular disease, cancer, diabetes, and Alzheimer's disease–costing an estimated $3.7 trillion (almost 20 percent of the entire gross domestic product of the U.S.) each year–the stakes for reversing this health behavior trend could hardly be higher. Yet despite the urgent need for improvement, none of the most intuitive solutions are effective.

To understand these counterintuitive results, consider that the way we pursue changes in health habits in the 21st century is much like how we pursued reductions in air pollution from cars in the 20th century. In the latter case, society focused on technological solutions to improve automobile fuel economy, engine life, and exhaust systems. In parallel, the government established regulations to increase fuel efficiency, eliminate leaded gasoline, and mandate smog tests.

Although these efforts were well-intended and brought about positive changes, it became clear by the 21st century that achieving vehicle air pollution reduction goals required a more radical solution: the fundamental design of the car itself had to change (e.g., to electric or autonomous vehicles).

Behavioral science suggests that the same fundamental shift is needed for you and me to achieve lasting changes in health habits.⁵ Based on this science, attempting to adopt new exercise or nutrition habits through technology, willpower, or information alone is similar to a fisherman casting state-of-the-art nets in a barren ocean or a farmer planting high-tech seeds in depleted soil. Major improvements often require changes at a more basic level. In our case, converting healthy intentions and behavioral goals into long-term health habits requires that they be firmly rooted in a healthy identity and healthy environment. To change your health habits, you first have to change yourself.

Source: Thomas Rutledge

The figure above contrasts how health habit changes work according to habit formation science versus how it is typically practiced. In our consumer-oriented society, health changes are primarily pursued through sellable commodities. These include wearable technologies, books, diet and exercise programs, gym memberships, healthcare visits, motivation seminars, supplements, and personal trainers. Many people make short-term changes using these approaches. Yet long-term change rates are poor.

According to habit science, new behaviors are most likely to become enduring habits when they reflect core beliefs about ourselves, our cardinal values, our self-image–sometimes called our "identity"–and our surrounding physical and social environments.⁵ Identity and environmental changes are the seeds and fertile soil in which health behavior change can take root. Although healthy identities, relationships, and physical environments may not be available for purchase, they are achievable through learning, practice, and personal growth.

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When Self-Improvement Becomes Self-Surveillance

Forming a healthier identity and reshaping our environment to support this new identity is neither swift nor simple. For most people, the process more closely resembles a journey that can last for years or even the rest of their lives. However, the beginning of this journey can be initiated as soon as today through the recognition that few people consciously choose their identity. Instead, their core beliefs, values, and self-image are mostly taught through parents, schools, and early life and formative experiences. It is usually only later in life that we discover our abilities to self-author, rewrite or relinquish the past and see our world–as Shakespeare wrote–as a stage on which we can play many parts.

Summary

Water invariably finds its level. In the same way, your identity–your core beliefs and values–inevitably find its form through your habits, relationships, and physical and mental health. And just as the shape of water can be transformed by putting it into a new vessel, your habits and quality of life can change by upgrading your self-image. Your health depends on it.