Unhealthy lifestyles are clearly linked to serious long-term health problems as well as significant short-term wellness impairment. The answer is behaviour change, but this is not happening

In the South African financial services sector, some 55% of people are overweight, 60% do not exercise, 20% smoke, and 20% report serious stress problems … the list goes on and paints an alarming picture: few live well and few are well. The most worrying issues are the classic ones of being overweight and lack of exercise.


Body mass index (BMI) is a simple formula (weight in kilogrammes divided by height in metres squared) that describes how under- or overweight a person is, independent of gender or age. BMI classifies people as:

  • Underweight (BMI <18,5)
  • Healthy weight (BMI 18,5 to 24,9)
  • Overweight (BMI 25,0 to 29,9)
  • Obese (BMI 30+)

Despite being imperfect (for example, the formula does some injustice to the very muscular, the pregnant, and young children) BMI has been repeatedly shown to be accurate for the vast majority of people. BMI is reliable, practical, and remains the universal standard.

Peer-reviewed research has demonstrated that being overweight increases the risk of developing cardiovascular disease (mainly heart attack and stroke), diabetes, osteoarthritis, many cancers (including breast, prostate, and colon), and psychological issues linked to poor self-esteem and stigmatisation (the notion of the ‘jolly fat person’ is a cruel myth).

There has been some debate around the question of ‘borderline overweight’ and at just what level health concerns begin. But most experts now agree that there are real health risks for all people who have a BMI over 25, albeit that the risks increase as the BMI does – a logical enough view recently substantiated in a 2015 study of 65 million people across 125 countries and 25 years.

Active living

The human being is intended to live actively – and did so until the time of the industrial revolution. This is no longer the case, with almost half of us now living sedentary lives. The active living recommendations most widely used are:

  • Exercise: 120 –150 minutes of moderate deliberate exercise (sweaty, short-of-breath exercise) per week
  • Activity: 30 minutes of non-sweaty, gentle activity, or 10 000 steps a day
  • Sitting: Less than 5 hours per day

All three are important. Each confers health and risk benefits of its own – it seems that each is an independent risk factor and so, for example, even very fit athletes have some health risk if they sit all day at work. The research on sitting is relatively new, but it seems possible that sitting may be the most important risk factor of all (watch this area for more developments in the coming years).

The impact of sedentary living includes an increased risk of developing cardiovascular disease, diabetes, osteoporosis, many cancers (including breast and colon), depression and anxiety.

The short term

Besides the serious long-term effects of couch-potato living, there are also profound short-term effects. It is clear that overweight and sedentary living are associated with low energy levels, concentration problems, reduced productivity, lower mood, and sleep problems. It’s as if the way we feel is a result of our lifestyles, and that’s because it is!

The paradox

These are well-known facts for the most part, and yet the prevalence of overweight has doubled since 1980 (in the ‘Western’ world) with similarly alarming declines in exercise and activity. The truth is that a great many people are ignoring what they know is good (and bad) for them, or not doing anything about it. This is sometimes called the ‘wellness paradox’ and is a definitive challenge for individuals, healthcare professionals, behaviourists, employers, governments and society in general. Despite huge investments, much advertising, a massive industry, and much concern, there is little evidence of real change.

How to change?

Change is hard. Certainly it is hard to achieve in the area of lifestyle behaviours. What has become fairly clear is that simply presenting information to people does not work (largely because people already know what you’re telling them in the Google age). Even presenting personalised information (typically as health risk assessment reports) has shown disappointing results as regards behaviour change. So the classical wellness programmes based on information and health risk assessment have under-performed – they do raise awareness and create a valuable platform but on their own, do not deliver the required behaviour change.

It is fairly clear that the issue is a deep and complex behavioural one – it’s psychological and emotional more than anything else and as long as this is ignored or under-emphasised, as has largely been the case to date, results will be disappointing. Some principles are emerging, however:

  • Tell the truth: Quick fixes, miracle cures, painless diets and no-sweat exercise plans are all nonsense. Cruel nonsense at that, usually aimed to generating profits. We disrespect ourselves if we believe these false promises.
  • Make it easy: The healthy choice should be the easy choice. This is about making showers and healthy menus available at work, putting your exercise bicycle in front of your TV rather than in the garage, etc.
  • Respect and empower: People want to be acknowledged and supported, not instructed or commanded. Every person is the expert on themselves, always. This is about the tone and approach used in all communications and programmes.
  • Make it the norm: Peer pressure and social norms are hugely powerful influencers. Leading from the top/front, doing it together, being an active family, and creating ongoing focus on wellness are all effective approaches.
  • Make it fun: ‘Gamification’ (a horrid word if ever there was one) seems to work. This includes competitive elements and fun interactivity.
  • Recognise: Noticing and applauding healthy behaviours is motivating for the individuals and for the broader audience. Celebrate successes, especially involving those with ‘typical’ challenges – the story of the first-time 10-kilometre walker is probably more meaningful than the one about the runner completing her 20th marathon.
  • Incentivise: A controversial one, with many experts suggesting that material incentives ‘cheapen’ what should be an inherent motivation. Yet ‘real-world’ programmes often benefit from material incentivisation.

These principles can be applied individually, with others, within a company or in broader, society-wide strategies. They do improve the odds of creating sustained change, although in truth there is much still to learn. You can look at your personal, family, company or medical scheme approach and test it against these principles if you want to optimise results.

We really do need to eat-less-eat-better-move-more-sit-less. We also need to be brutally and totally honest about why we do not.

Author: Dr Colin Burns is Health and Wellness Consultant at Sanlam Health