Translator: Behdad Khazaeli Reviewer: Zsófia Herczeg
Ladies and gentlemen,
I am going to give you good news and bad news.
The bad news is we are too fat,
which is incredibly unhealthy and will make us sick.
Almost half of us is overweight.
Back in the '90s, that was 30 percent.
Today, this has increased to 50 percent.
This increase over the many years is extraordinary.
This also brings me to the good news, though.
Because if it wasn't always like this,
this means
it doesn't have to be like this.
And apparently, we can do something about it.
But we must realize
that the problem as a consequence of the obesity epidemic is very serious.
It means that a lot of people are getting all kinds of diseases,
such as cardiovascular disease,
cancers, diabetes
which affect our daily lives, which is completely unnecessary.
For patients, having a disease
is not just the loss of health.
It is also the loss of control, of self-confidence, of work,
of financial security.
For organizations, diseases mean a loss of work capacity.
Sick leave is very expensive and it leads to an extra workload and pressure
for the remaining employees.
And in addition, employers are facing an increase in sick leave and disease,
while at the same time
the government is asking all of us to work until older age.
Something is wrong, it seems.
I am an occupational physician
at one of the largest hospitals of the Netherlands.
I'm surrounded by doctors and patients
who are busy fighting diseases every day.
When I started my PhD research a couple of years ago,
I first wanted to look into the major cause of all these diseases.
What I found out is that of the noninfectious diseases
almost 80 percent was lifestyle related.
That is enormous.
So then I looked into lifestyle medicine.
Lifestyle medicine is an upcoming field.
More and more is known
about the beneficial effects of lifestyle medicine.
It is a way to prevent diseases and to reduce the severity of diseases.
Less pills, less complications.
This is what we call prevention.
Let me tell you what happened to me the other day.
I was sitting in my office, at my desk,
and I was just wondering
and waiting for sick hospital employees to come in and see me.
And then I asked myself two things.
First, if prevention is the key to health,
why don't healthcare professionals come in to see me
for advice on how to stay healthy and fit for the job?
Is it maybe because they don't need me?
Because healthcare professionals just aren't fat.
They know how to take care of themselves.
They have the perfect BMI, they exercise regularly,
and they sleep regular hours.
I wanted to find answers to my questions.
So I decided to get out of my office
and go for an exploration around the hospital.
And I visited clinics,
and I visited outpatient clinics: cardiology, oncology.
And I went to several labs,
and guess what I saw.
I saw overweight and obese employees,
the same as in the rest of the Netherlands.
And I didn't see healthy behaviour, I saw unhealthy behaviour.
We're eating too much. We're too fat.
We don't exercise regularly.
And we don't sleep well, and we're always stressed.
So this gave me a profound insight, which I will share with you.
Knowledge alone is not enough
to get people to change their behaviour from unhealthy to healthy.
I saw tons of healthcare professionals who know all about a healthy lifestyle,
and are still behaving in an unhealthy manner.
Many people say
we have to do more health education.
But that is not going to pay off.
Let's dare to say it out loud here.
Prevention by giving more information,
by shouting out harder what is best for people,
by pointing our fingers and saying,
'Thou shall not smoke.
Thou shall not eat any fatty hamburgers'
will not pay off.
It is a totally flawed idea
that people would not eat a Snickers, for example,
if they knew how many calories are in it.
And the reason for this is
that we make our choices based on short-term incentives.
We eat the Snickers right now
because we crave it right now.
And in the short term, there are no reasons not to eat it.
In the long run, there are many reasons not to eat it.
But those may be so many years away,
and you might not even be alive by that time anymore, you might think.
Organizations, doctors and people
all reason based on short-term incentives.
We all behave in the same manner.
For doctors, there is an extra complication.
Because disease is big business.
And prevention is not.
We are paid to be reactive.
We wait until someone develops a disease,
and we respond to the consequences,
such as burnout, depression, diabetes.
That's what we get paid for.
But for patients, it's much too late.
Serious harm has already been done,
and the way back to recovery is so hard.
So we respond to the consequences
instead of the cause: lifestyle.
This is the perfect storm.
People don't feel the urge to resist the Snickers or go to the gym,
and doctors don't feel the urge
to really help them change their behaviour.
We are all trapped in the same prison:
all in favour of lifestyle medicine but no urge to change.
People just get the urge to change if they feel short-term incentives.
So how about we exchange these Snickers by something else.
That would be interesting.
There are processes so much stronger
than our conscious, aware and knowledgeable brain.
We need to start influencing these unconscious processes.
And what are the true drivers of people's behaviour?
People want to have fun, they want to belong.
They're sensitive to their environment,
to competition,
to being rewarded.
These are the factors that we need to influence.
Let me tell you about the Efteling,
where this was done incredibly successful.
The Efteling is a theme park, just like Disneyland,
and every theme park struggles with trash being thrown on the ground.
It creates a messy appearance,
and it frustrates the visitor
who is expecting an almost perfect magical experience.
And so many years ago,
the Efteling tried to make it fun for both kids and adults
to throw away their trash.
I'm sure all Dutch people know it.
It is 'Holle Bolle Gijs'.
And when you throw in your trash,
this is what you hear:
(Video) Holle Bolle Gijs: (Dutch) 'Paper here. Paper here.'
'Hello, hello, hello!'
'Thank you very much!' (Yawns. Sighs.)
TKP: So by introducing a talking trash can,
throwing away became fun.
People changed their behaviour without it seeming like a chore.
This inspired me to make healthy behaviour fun.
Because I think
that this is truly something that is going to make the difference.
My team wanted to make healthy fun
by using technology and gaming techniques
combined with face-to-face care.
So we built a game
to help people lose weight and stay healthy.
And in our game we used the fun factor, traveling,
combined with healthy behaviour.
And what we found is that people lost 6 kg of body weight on average
and 6 cm of waist circumference,
which is amazing.
But I got even more excited when I noticed
that all participants
behaved above the physical exercise health level
for the entire duration of the game.
In our game, we used modern technology,
such as quantified self, gamification, social media,
and it can be played by using the smartphone.
The game is played over the duration of six months.
Two teams virtually travel around the world,
competing against each other for conquering continents.
Every participant wears an activity tracker
that measures their daily level of activity.
And by moving more time or more intensely,
the team gains more points and the individual as well.
This is a screenshot of the game.
And here you can see how they are traveling the world,
and they just passed Europe.
And now they are conquering over America.
And over the next couple of months, this is what will happen.
So it's a competition between teams.
In our game,
we use rewards, social bonding and nudging
as short-term incentives that led to long-term goals.
Team members were encouraging each other to take the stairs
instead of the elevator, for example.
But the most exciting point
was that they reached their health goals
while being happy and having fun.
Ladies and gentlemen,
prevention is essential for eradicating diseases.
We are helping people prevent diseases that may be 10 or 20 years away.
This long-term goal may not be something
that motivate people to take the stairs today,
and that's why gamification is so important.
But this will only be successful if doctors dare to broaden their scope.
Let's proactively collaborate
with other health innovators.
Let's blend medicine with technology for the best of both worlds.
I look forward to the moment
that I once again go for an exploration around my hospital,
hoping to see healthcare professionals
who are healthy, vital and productive
by our proactive and preventive approach.
Thank you very much.
(Applause)