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224: Red Flags Of Weight Loss Research with Jon Robison - Seven Health: Eating Disorder Recovery and Anti Diet Nutritionist

Episode 224: Real Health Radio is back with another guest interview and Chris chats with Jon Robison this week.


Jan 21.2021


Jan 21.2021

Dr Jon Robison holds a doctorate in health education/exercise physiology and a master of science in human nutrition from Michigan State University. He specializes in health promotion and human behaviour, with a particular interest in why people do what they do and don’t do what they don’t do. His presentations and workshops promote shifting health promotion away from its traditional, biomedical, control-oriented focus. Jon has also served as co-editor of the journal Health At Every Size.

Here’s what we talk about in this podcast episode:

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00:02:55

00:07:30

00:12:40

00:14:38

00:15:45

00:18:28

00:28:38

00:32:14

00:39:25

00:40:03

00:41:35

00:43:42

00:47:48

00:56:17

01:03:50

01:14:18

01:18:33

01:29:30

01:35:25

01:38:38

01:46:35

01:51:37

01:57:00

02:04:05


00:00:00

Intro

Chris Sandel: Welcome to Episode 224 of Real Health Radio. You can find the show notes and the links talked about as part of this episode at seven-health.com/224.

Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. Today on the show is a guest interview, and my guest today is Dr Jon Robison. Jon holds a doctorate in health education and exercise physiology and a Master’s of Science in human nutrition from Michigan State University. He specialises in health promotion and human behaviour, with a particular interest in why people do what they do and don’t do what they don’t do. His presentations and workshops promote shifting health promotion away from its traditional biomedical control-oriented focus. Jon has also served as the co-editor of the journal Health at Every Size.

I’ve been aware of Jon for a while now. He’s someone who’s written a ton and put it out through LinkedIn Pulse. I think the first thing I read of his was a piece on the eight red flags of weight loss research, which I loved. Then I went back and read many, many more of his articles and really liked what he had to say.

As part of this episode, we chat about Jon’s background and how he got into health promotion. We chat about the paper, ‘8 Red Flags in Weight Loss Research’, and go through each of these. We talk about complexity and wicked problems and the social determinants of health and intrinsic motivation and intrinsic coaching. We go through a couple of infographics and Jon had sent over, and we chat about some of the things that he’s doing at his company, Salveo Partners, from writing books to doing trainings.

I really enjoyed this conversation. Jon’s been doing this for many decades, so it was good to hear about some of the history with this stuff. But it’s lovely to hear someone so passionate about this all those decades on. Let’s get on with the show. Here is my conversation with Dr Jon Robison.

Hey, Jon. Welcome to the show. Thanks for joining me today.

Jon Robison: Yeah, pleasure. Looking forward to it.

Chris Sandel: There’s actually a lot that I want to cover with you. You’re someone who has been working in this field for such a long time, with many decades of experience, and I want to talk about Health at Every Size, I want to talk about weight loss recommendations and a lot of the pitfalls with it, human behaviour, workplace wellness, and everything that you’re doing at Salveo Partners. There’s lots of directions I want to go with this.

I guess to start with, do you want to give listeners a bit of background on yourself, who you are, what you do, what training you’ve done, that kind of thing?

00:02:55

A bit about Jon’s background

Jon Robison: Sure, I can do that. I have a master’s degree in human nutrition, a master’s degree in exercise physiology, and a PhD in health education and human performance, which is not a term they use anymore. I think they call it kinesiology mostly now.

Chris Sandel: Yeah.

Jon Robison: I went to undergraduate school at the University of Michigan, 1969, and I graduated with a degree in music literature. What I really wanted to do was go on the road and play rock and roll music for 15 years, which is what I did. When I got off the road, being on the road is not very healthy. So I started running and doing other things. When we got off the road, we were still playing four or five nights a week. I went to Michigan State University and I worked on those degrees for a bunch of those years.

The way I got into the whole weight thing – it’s a story. I was working on those degrees and I met a physician, became friends with him, and we started our own OPTIFAST programme. Are you familiar with OPTIFAST?

Chris Sandel: I am, just through reading around it. I have vague recollections.

Jon Robison: It was the one Oprah Winfrey was on. Very famous for after she lost all of that weight, she came across the stage with that red wagon full of things that were supposed to be fat globules.

So we had our own programme – oh, God – the way the programme works is it’s a protein-sparing modified fast. People don’t eat anything for months and months and months. They get three milkshakes. We give them three milkshakes at 700-900 calories. This is the garbage that I learned in school. So they’re eating 700-900 calories a day, and these are very big people referred by their insurance companies, mostly, and losing gobs of weight. Scores of pounds, hundreds of pounds.

Then six months later, I’d be walking down the street and they’d see me and they’d cross the street because they were feeling ashamed. Luckily, I actually met my wife there. She’s a trauma therapist, actually. She’s in the other room doing therapy right now. She said to me, “What the hell are you doing?”

I felt so bad about these people and seeing them feeling ashamed when I was the one who should be ashamed, that I quit it. I immediately began researching other things. The first person who really pushed me was a guy named David Garner. Do you know him?

Chris Sandel: I don’t, no.

Jon Robison: Old, old, old eating disorder guy. Long, long time ago. He’s probably at least my age. I’m 69; he might even be a little older than I am. But he was a very well-known eating disorder guy in the United States, and he just kept saying to me, “Read the research.” I said, “Wait a minute, obesity and heart disease and diabetes” – all the stuff I learned in school. He said, “Jon, just read the literature.”

So I did. I was determined never to do that to anybody again and to spend a good deal of my career trying to convince other people not to do that to people again. I became involved with the organisation – this was before Health at Every Size and before ASDAH, which is the Association for Size Diversity in Health – an organisation called AHELP. It was the Association for the Health Enrichment of Large People. This was back in the ’80s and early ’90s, and there weren’t very many people.

But I got to know the size acceptance community of the time, which was mostly white women, actually. I got to meet a lot of them and got involved in that, and that’s really how I started in the direction of that. When Health at Every Size began, I obviously became part of that and been fighting that battle for a long time.

00:07:30

Why he got into nutrition

Chris Sandel: When you stopped being a musician or you were transitioning from being a musician and then you started studying, what did you think you would be doing at the end of that? Or what was the pull to get into that line of work?

Jon Robison: Well, I actually didn’t stop playing. I went to school during the day and I played at night. Our band, we were together – we still play occasionally – for more than 40 years. We’ve been together a long time.

What happened was I got into running, and then I got into triathlons, part of it as a way to balance being in a bar six nights a week. In those days, in bars you could smoke. You can’t smoke in a bar or restaurant here.

Chris Sandel: No, you can’t do that here for a long time now.

Jon Robison: Yeah. But it hasn’t been all that long in the United States. It’s not a very healthy life. So I got very interested in exercise, so I decided to go to school for exercise physiology, actually, first. That was my first master’s. But at the same time I got really interested in nutrition and did that, and then I went on and got the PhD.

What did I think I was going to do? I don’t know. I just was really interested in that stuff. And I was already older than a lot of my professors. I was already in my late thirties when that happened. I got connected with the Michigan State University – they were starting a wellness programme there, so I was in charge of helping them as I was working on my PhD. I actually got some really nice publications out of it, but it was not something I would ever consider doing again. It was all incentive-driven, like it’s been in the last 10 years in this country, nonsense.

My committee had exercise physiologists on it, but also had some Skinnerian behaviourists. You know about Skinner and behaviour – again, Skinner didn’t do any research on humans. It was all rats and mice. All very much into incentives and stuff. We can talk about that when we talk about what’s going on with wellness now, or at least what has been going on.

So I really didn’t know what I wanted to do, but as I got the degrees, I was going to some conferences and seeing people speak and I thought, “That’d be cool. I love being on stage.” I’ve been on stage all my life. I’ve been in bands since I was in sixth grade. So that’s what I ended up doing – doing a lot of speaking. Just a riot. I loved it. Sometimes I actually did some singing and some speaking at the same time on stage, which was really fun too.

I really didn’t get into the worksite thing as heavily as I have in the last five or six years until I met my partner at Salveo Partners, Rosie. But we did some worksite stuff.

Chris Sandel: You said that the exercise physiology came first and then there was the interest in nutrition. What about in terms of your relationship with food? How was food growing up? When did that become a focus?

Jon Robison: It’s interesting; I know a lot of people who go into nutrition – not just nutrition; it’s true for psychology, too. The best psychologists are people who have been in therapy the longest, I think. My wife is a good example. She’s an amazing therapist, and she’s been in therapy much of her life.

 

I didn’t really have a whole lot of issues with food as a kid that I remember. I didn’t have parents who forced this or forced that. We were middle class. There wasn’t any food insecurity or anything like that. Bigger problems for me as a child were that I was very thin and very awkward. I wasn’t very good at sports. I was always the last person to be picked. Trying to climb up those ropes – you remember those ropes that were on the ceiling and stuff like that? – oh my God, I couldn’t do that.

Which is so amazing because in my thirties, I was a pretty good triathlete and pretty good runner. To this day, exercise is front and centre in my life. Part of that is because I love it and it’s good for stress. The other part is that I have multiple sclerosis, and I’ve had that for 30 years, a long, long time. Only had one attack, which was 15 years ago, and I lost the ability to walk. Had to teach myself how to walk all over again, which I can do. I can walk. I don’t walk very well. I swim and I bike a lot better. So that’s how I got into that.

00:12:40

The 8 red flags of weight loss research

Chris Sandel: Nice. I wanted to talk about one of the great articles you had on LinkedIn – ‘8 Red Flags of Weight Loss Research’. I think this will tie in a lot with some of the stuff around Health at Every Size, but also the issues with weight loss. I wonder if we can go through each of these in a little bit of detail.

Jon Robison: Sure, we can do that. I wrote that because I’m always writing on LinkedIn and talking to people about the fact that in six decades of research, there is no research that suggests that anything but a small percentage of people who join any weight loss programme keep their weight off. It’s a fact. And yet people would say to me, “Wait a minute, I just read an article and they said people lost this much weight,” and so on and so forth. I thought, you’ve got to read the whole paper.

I have a file cabinet at home that’s probably got 1,000 of these papers in it. Luckily we don’t have to do that anymore; we can just keep them on the computer. But I have a file cabinet full of them. I thought, maybe we’ll just go through and look at some of the – I had to take lots of statistics courses; I wish I’d paid better attention, but I’m not an expert in that. I have friends who are experts, who I ran this stuff by before I published it.

But I just thought, maybe I’ll pick out seven, eight, nine of the most common things in the weight loss research so when people read it they can say, “Wait a minute. The denominator in the beginning – there were 1,000 people in the beginning. At the end of the programme, there were 500. What happened to the other 500?”

00:14:38

Red Flag 1: Comparing participants to non-participants

Chris Sandel: Let’s go through them one by one. Red Flag 1: Comparing participants to non-participants.

Jon Robison: This is true for worksite programmes as well, not just weight programmes. Any time any study compares participants to non-participants, you should just put it in the garbage pail. Participants always do better than non-participants. That’s why they participate.

If you had 100 smokers at your workplace, for instance, and you asked them if they wanted to quit and 50 said yes and 50 said no, and then you put them both through the programme and you claim that the group that said they wanted to quit did much better because they went through the programme – that’s not why they did much better. They did much better because they wanted to quit. The other group didn’t want to quit. So participants versus non-participants, even with all kinds of gobbledygook statistical manipulations, should be a red flag.

00:15:45

Red Flag 2: Using different denominators

Chris Sandel: Red Flag #2: Using different denominators when demonstrating outcomes.

Jon Robison: Yeah, we talked about that before. Very often, I’ve seen studies where they’ve changed the denominator two or three times because they’re either eliminating some people because they don’t want them in the programme because they have diabetes or something, or usually what happens is the people who don’t do well don’t come back. You can’t assume that the people who didn’t go all the way through did as well as the people who went all the way through, because if they were, they would’ve stayed. So that’s an immediate red flag. It’s very common.

Chris Sandel: As an example, you have a study and at the beginning of the study, to make numbers easy, you have 100 people as part of that study. For the first part of it, they follow some specific diet for six months, and at the end of that six months, already 40 people have dropped out. They just couldn’t keep it up. So you now have 60 people left as part of the study.

Then for the second part of the study, you have them say work with a personal trainer for six months. At the end of that six months, another 20 people have dropped out, so you’ve got 40 people left. Then there’s a maintenance period for six months where they’re keeping food logs and seeing a dietitian, and at the end of that point, another 20 people have dropped out. At the end of the study, you’ve got 20 people left. You started with 100, and at the end of those two years, there’s say 10 of those 20 people who’ve lost 10 pounds or more.

Then the statement attached to that study is ‘50% of participants who completed the two-year protocol lost weight and kept it off’, and that’s because they’re only looking at the people who are left. They have removed the other 80 people who dropped out from the denominator. So rather than saying there’s been a 10% success rate, it’s now that there’s a 50% success rate.

I know this is something that you went through. There’s an article you did on the last man standing fallacy.

Jon Robison: I did that actually with – when I need to do math and make sure my math is right, I go to a guy named Al Lewis. I don’t know if you’re familiar with him.

Chris Sandel: I am through your writing, but outside of that, no.

Jon Robison: He’s a good friend of mine, and he’s one of the smartest people – mathematically, he’s just brilliant. I made sure that I ran this paper by him before I published it, just to make sure that I had everything right – which I didn’t. There were a few mistakes.

00:18:28

Red Flag 3: ‘Maintenance’ when the programme is still ongoing

Chris Sandel: Red Flag #3: Calling it maintenance when the programme is still ongoing.

Jon Robison: That’s the simplest one, right? We know that in almost any weight loss programme, lots of people are going to lose weight. When you restrict your calories, you’re going to lose weight. That’s what happens. The question is, what happens after? And unfortunately, it’s so rare that any of these programmes follow up on their people. In fact – and I’ve put some of these studies on LinkedIn – very often people will start gaining the weight back before the programme’s even over, which is really interesting.

The other thing they’ll do, which is really sneaky, is they’ll call it maybe six months of a programme and then six months maintenance, and then they’re giving you year results. The first six months, they’re meeting with a dietitian let’s say every week. The maintenance phase, they’re meeting with a dietitian every other week. That’s not maintenance.

We want to know what happens two, three years after the programme is over. What we find is the statistic you see thrown around is less than 5%. But I actually have a really good study from England – because of the National Health Service and everything, you have good data. It’s probably way less than 5%. Really interesting article. If you haven’t seen it, I can send it to you.

Chris Sandel: I had a read through of it. I’ll put it in the show notes. But yeah, I had a read through as part of the prep for this. The statistics are pretty terrible.

Jon Robison: It’s more like 0.05%.

Chris Sandel: The paper looked at the electronic health records of over 160,000 people in the UK, and this was across a nine year period. What they found was for people with what they call ‘simple obesity’ (that’s a Body Mass Index of 30 to 34.9), the probability of them attaining a normal weight, so getting below a BMI of 25, is 1 in 210 for men and 1 in 124 for women.

Then if you look at people who have – again, using the term as part of this paper – ‘morbid obesity’ (a Body Mass Index of 40 to 44.9; that was what they were looking at with this paper), the odds of going from there back to a normal weight is 1 in 1,290 for men and 1 in 677 for women. So the statistic is terrible. It’s nothing like the 95% failure rate that we talk about. It’s way worse than that.

Jon Robison: Chris, it’s so amazing. We see these all the time on TV. Always they’re saying, “Yeah, in six months I lost 40 pounds!” You could do that with duct tape. But once you take the duct tape off, you’re going to want to eat. But it’s still very common.

Chris Sandel: I think this is the problem in people’s minds. Even if you chuck around the figure of 95% of diets fail – and as you said, that’s a gross oversimplification and the statistics aren’t even that generous, but let’s use that as a simple number – if 95% fail, 1 in 20 succeed. And if you think within your circle of friends, within your circle of co-workers, you know a fair few people, and then it’s not that it’s the 1 in 20. You’ve then got people who are only three months into the diet or six months into the diet, so their weight is lower.

So when you’re thinking about people in the wild, you’re able to bring to mind, “There was this person that lost weight at work, and there’s this other person.” It then doesn’t seem like it’s such a big deal. It’s like, “No, lots of people lose weight and lots of people are able to keep it off.” It’s kind of that thing like a gambler who goes to Vegas and always remembers the big wins but never remembers the losses. It’s that in reverse, where you remember when someone lost weight but you tend to forget about where they are five years from now.

Jon Robison: That’s actually true, and I would add – and I don’t know, maybe this will come up in the next thing – the other problem is that if it was a situation where being in a weight loss programme was benign, where there were no negative consequences, the atherogenic consequences caused by it, you might be able to say 1 in 20 or 1 in 30, I’d give it a shot.

But the problem is there are lots of negative consequences to this ongoing weight cycling, and most people don’t just diet once. In fact, I think the average – this was a few years ago in the United States – was four or five times for a typical dieter. And that means that their weight is going down and their weight is going up and their weight is going down and their weight is going up. We know that there are some significant consequences of that. Biological and certainly psychological, because every time you go back up, you’re the failure.

Chris Sandel: Totally. And in most people’s experiences, it never works as well as it did the first time round, and the people that break that mould, it typically crosses over from being a diet to being disordered eating or an eating disorder.

Jon Robison: Yeah, I was just going to say, then they come see you.

Chris Sandel: Exactly. That’s the other point when people are looking around and thinking about “This person lost weight and they’re able to keep it off” – they don’t know what’s going on in that person’s life. They’re not necessarily privy to the fact that actually, this person has now developed an eating disorder and is really struggling with things. So you get this very one-dimensional view that weight loss is an easy thing to achieve and lots of people are doing it when that’s not the full picture.

Jon Robison: Right. That’s really important, too. I believe people should have the choice to join a weight loss programme if they want to, but we’ve actually developed – I don’t know if you’re familiar with it – Employee Wellness Program Code of Conduct. The first amendment to that was that we believe that anybody who joins a weight loss programme should be given informed consent, which should say: “Most people who join weight loss programmes lost weight. Most people gain the weight back afterwards. One-third to two-thirds gain back more than they lost, and the ongoing weight cycling can be detrimental to your health.”

If you give that to somebody before they join a weight loss programme and they decide to join it anyway – free country. You wouldn’t have a surgery without asking the doctor, “How many of these have you done? What are the negative consequences? What are the long-term effects?” If this is the medical treatment, they should all be given the same thing.

It’s interesting because lots of wellness companies have signed on to that consent, but their weight loss programmes, they don’t do it. Because probably – well, I don’t know. I don’t know what would happen if Weightwatchers and Jenny Craig and Nutrisystem and Nume – I had an interesting experience with them, which I can tell you about if you want. But they’re not going to do that. There’s no way. Could you imagine them being on TV and going, “Listen, most of you are going to gain this weight back and it could make your blood pressure and your glucose and everything else worse, but if you want to do it, come on, join us”?

Chris Sandel: No, because if someone was going to say that, they would actually be Health at Every Size. If your marketing is not about weight loss, it has to be about something else. If you’re like, “We’re not going to focus on weight; we’re going to focus on healthy behaviours and lifestyle modification” and all these things, if that’s where your focus is going to lie, then that’s more Health at Every Size as opposed to actually being a diet.

Jon Robison: Either that or you’re baiting and switching. Weightwatchers just went through that. They just changed their name, WW.

Nume is interesting. What they do that’s different on their marketing is they don’t have really thin people. They don’t show before and after pictures. I wrote something on LinkedIn Pulse about before and after pictures, because those are really – Nume doesn’t do that. They show people who are actually sort of normal-ish weight looking. Of course, their whole argument is “This isn’t a diet, this is psychology.”

I actually called them up and tentatively joined, just to see what the situation was. They got back to me, welcomed me and everything. I emailed them back and I said, “Can you please tell me what the qualifications of your counsellors are?” Because one of the things they say is you get a personal counsellor. I got back an email that said, “We’re really, really busy right now so we’re not able to answer that question, but good luck.” I thought that was kind of a red flag of its own.

00:28:38

Red Flag 4: False claims about achieving weight loss

Chris Sandel: Red Flag #4: Claiming your programme is highly effective at helping achieve clinically meaningful weight loss when it really isn’t.

Jon Robison: I don’t know what it’s been like over there, but over here, when it was very clear that people weren’t going to lose a lot of weight and keep it off, many people said, “If you just lose 10 pounds, or you just lose 10%, or you just lose 5% of your weight…” It kept going down and down and down.

Of course, one of the problems with that – first of all, the problem of maintaining is still the same. But there’s another problem, which is if you lose 5% of your weight because you change the way you eat and you change the way you exercise, who’s to say it has anything to do with the weight at all? You can improve your health, you can improve your blood pressure, you can improve your glucose, you can improve all the things that supposedly weight loss is supposed to improve by just changing some behaviours. It’s very difficult to say a 200-pound person lost 5% of their weight and that’s why their blood glucose went down.

You know as a nutritionist, the quickest way to make your blood glucose go down is to skip a meal. Years ago I was speaking to a group of diabetes educators, and instead of saying the quickest way, I said, “The best way to lower your blood glucose is to skip a meal.” Boy, did I get some – [laughs] That’s not what I meant. But I only made that mistake once.

Was there something else in that flag that I missed?

Chris Sandel: I think that was the piece. The bar used to be “Hey, we’re going to move someone who is in the obese category down into the normal category,” and then that was like “This is insane. We’re not able to do that,” so it’s like okay, 20%, and then 10%, and then 5%, and then it just got less and less.

The thing I always think about with this as well is if you think about the weight set point, the weight set point is a band. For a lot of people, they will go up and down 5%, maybe even 10%, just from normal living. It’s now wintertime, so someone’s a little heavier. Now it’s summertime, so they’re a little lighter. They’re under a bit more stress, the weight goes up. They’re having an easier time, it goes down. It’s just within the natural parameters of where their body floats without any dieting, without any tension. This just happens.

Jon Robison: That really points to the complexity of a situation that we try to make simple. I was talking earlier about these guys I was talking to yesterday. I was talking to some diet doctor here – I won’t mention his name; he’s very famous. He’s a diet doctor, and he said to them, “It’s all about calories in and calories out.”

I said to them, yeah, from a physics standpoint, that’s true. But human beings are not black boxes. Every human being is different. We absorb differently. We digest differently. There’s a million – I don’t know if you’ve ever seen the picture of metabolism that’s related to weight or something, and you get a headache just looking at it, there are so many inputs and outputs and everything else. Human beings are messy.

00:32:14

Why health is a ‘wicked problem’

Chris Sandel: It is incredibly complex. In some of your articles you make reference to the idea of ‘wicked problems’, which was an idea I came across last year. Have you read David Epstein’s book Range?

Jon Robison: I don’t think so, no.

Chris Sandel: It was basically him talking about all the benefits of having a real wide range of activity. It was kind of the opposite of Malcolm Gladwell’s Outliers, where he’s like, everyone needs to do their 10,000 hours and really narrow their band of focus and just do that one thing so that they then become an expert in that one thing. This was really a treatise to the opposite of that. Yes, you need to spend a lot of time on the things that you get good at, but that shouldn’t necessarily just be one thing. Actually, there’s real benefit to haven’t depth in lots of different areas because they can then help come together and make you better.

It looked at Nobel laureates in science and how many of them were also extremely talented as musicians and as artists and all of these different things, and how that’s actually not time that they wasted on these other things that they could’ve put into their science; it’s actually something that helped their way of thinking and their brain and everything.

 

As part of the book, he talked about the difference between wicked problems, or wicked games or wicked environments, and then – I’m trying to remember what the other one was. I think it was kind problems or something along those lines. Kind problems are the equivalent of chess or golf or whatever it may be. If you just keep practicing at that one thing, you can get better and better, and you know all of the rules of the game, whereas the majority of our real problems within life are not that nature. They’re complex. There’s so many different variables and so many different inputs that it’s not very simple.

The problem we have, especially around health, is that we are mistaking something that is a wicked problem for something that is very easy. It’s just like “Oh, eat a little less, move a little more.”

Jon Robison: This is sort of related, actually. In our books, we talk about the difference between an adaptive challenge and a technical challenge. A technical challenge is your computer screws up. Take it to Best Buy, they fix it. They know how to fix it. Or you go online on somebody else’s computer and this happened.

An adaptive challenge is a challenge like we talk about when we’re training leaders at organisations. You can teach them how to have difficult conversations. You can teach them how to do that, the steps in that. But if every time they go to have one, they feel like they need to throw up, that’s an adaptive challenge. There’s no simple solution, there’s no Steps 1 through 10 that you have to do. You just have to work with it, and it’s complex. In our new book, we talk about it a lot. It’s messy. Humans are messy. If you’re trying to make them not messy, you’re going to mess things up. You’ve got to deal with the messiness.

Chris Sandel: Exactly.

Jon Robison: It’s one of the reasons why from my standpoint – I’ve written a lot about this on LinkedIn – I think when people are having difficulties with food and body image and so forth, the place they should go is to an expert. That’s not a doctor, it’s not a psychologist, it’s not a banker, it’s not a celebrity. If you’re depressed, you don’t go to Best Buy. You go see a therapist. If your cat or dog gets sick, take them to a veterinarian. If you’re dealing with eating issues and body image issues, you need to go to an expert to do that.

Even these journalists – people like Gary Taubes and Michael Pollen and all of those people – they do all this research and all this reading, but they’re not in the trenches every day with people. That’s what I told the guys yesterday. The person they were talking about was, again, a diet doctor, and I said, if you’re going to deal with nutrition issues, go to somebody who does that every day.

With all the degrees I have – in some of the programmes we run, which I can talk to you about later, if there’s somebody with an eating disorder, I don’t deal with that. I have a master’s in nutrition. I know where to send that person. I think that’s really important. A lot of people think just because everybody eats, everybody has the right to tell other people what they should be doing with their food.

Chris Sandel: Yeah. The difficulty I also think, though, is the way that we eat has become incredibly disordered. Dieting has become so normalised and problems around food have become so normalised that even the person who’s struggling often doesn’t identify that they’re actually struggling with that as an issue. They think, “If I just find out what foods I need to cut out or I just do this thing to heal my SIBO, or if I just do this thing…”

They then go to the person who is the supposed expert in that thing, and the people I end up seeing, it can be years of going from one person to the next person to the next person before they stumble across literature or podcasts around eating disorders and they’re like, “Hang on a second, this really matches up to what I’ve got going on.” It’s only then at that point that there’s that realisation of “This is the expert or this is the help that I need.” I think that’s an issue.

Jon Robison: Yeah. That really ties into the technical versus adaptive challenge. A lot of challenges have a little bit of a technical piece to it. Obviously, if you eat only McDonald’s all day long or if you eat only broccoli all day long, that’s not going to be healthy. Technically, you should have a range of foods and everything else.

But that is not going to solve your eating disorder problem because that’s an adaptive problem. It’s complex, it’s messy, it’s psychological, it’s emotional. It’s nice to be able to say that and know that you know exactly what I’m talking about. That doesn’t happen that often. [laughs]

00:39:25

Red Flag 5: Not distinguishing impact of weight loss vs lifestyle change

Chris Sandel: Red Flag #5: Not distinguishing between the health impact of weight loss and lifestyle change, which I think you kind of already touched on.

Jon Robison: Yeah, that was the 5% thing and the lifestyle. The truth of the matter is that there’s some pretty good research – it’s kind of old now – that shows that lots of the problems that are so-called weight related can be ameliorated without changing weight at all by looking at what you’re eating. And then, of course, you have the social determinants of health, which is a whole other issue also involved. So I think we covered that one.

00:40:03

Red Flag 6: Claiming a wellness programme lowers healthcare costs

Chris Sandel: Yeah. Then Red Flag #6: Claiming savings when there isn’t enough evidence to prove it. I think this is talking about wellness programmes and how they will save money for a company.

Jon Robison: At the workplace, yeah. The Affordable Care Act, or what we call Obamacare over here, was passed about 10 years ago, and the amendment was the Safeway amendment. That’s where the Safeway supermarket guy said, “We have these wellness programmes, and if people don’t participate in these wellness programmes, we charge them more for their insurance. That helps us to lower our healthcare costs.” And that’s just not true. There hasn’t been a single study in 10 years in the United States that shows that workplace wellness programmes have any impact on healthcare costs whatsoever.

The reason for that is that the problem with healthcare in our country is the healthcare. It’s not people’s behaviours. People aren’t behaving any worse over here than they are over there. The problem is that we have a healthcare system that’s set up to make some people rich at the expense of everybody else. You guys are obviously very lucky not to have to deal with that crap over there. I’m sure you have your own issues with healthcare, but you know that we’re probably the only industrialised nation on the planet that doesn’t have universal healthcare yet.

00:41:35

Red Flag 7: Not considering the age of participants

Chris Sandel: Yeah. Red Flag #7: Not considering the age of participants.

Jon Robison: If you’re over 60 or over 65, you’re much more concerned about unknown weight loss than you are about unknown weight gain. It’s really critically important.

We had a situation here where we had a woman who was in her early nineties, and they were not letting her eat certain things because they thought she was eating too much. She’s in her early nineties. They were actually doing diets at these homes where they have the elderly, people who can’t take care of themselves or they want to be with other old people, and they were actually putting these people on diets, which is absolutely absurd because most of their male doctors are dead, and they’re not letting these women eat certain things.

We just had another situation where we had a friend who was 94, and they didn’t want to give her any oxy for her pain because they were afraid she’d get addicted. She’s 94 years old. They wanted to give her Tylenol. Just insane.

I think that’s what I was talking about in that.

Chris Sandel: As people get older and they’re in their sixties and seventies and eighties, a lot of the concern is, as you say, unintentional weight loss. We need to make sure that people are eating enough.

Jon Robison: And that they don’t have cancer.

Chris Sandel: Yeah. I guess if you’re running a weight loss study with people who are in their mid-sixties or late sixties, that’s going to give you a very different set of results that bears no resemblance to someone who is in their twenties or thirties who is then looking at these results.

Jon Robison: The only thing that would be the same is they’re probably going to gain the weight back if they live long enough anyway.

00:43:42

Red Flag 8: Lacking transparency about negative consequences

Chris Sandel: Red Flag #8: Not being transparent about likely outcomes and potential negative consequences.

Jon Robison: That’s the weight cycling thing. Back when I first started this, there really wasn’t much on that, but there’s quite a bit now on what happens with The Biggest Loser. Now, that’s a lot of weight loss, but messing up the metabolism, slowing down the metabolism permanently and so forth.

And the weight cycling. There are some studies that talk about relationship to inflammation, which of course is a huge thing now – and blood pressure and blood glucose and lots of other things that can be problematic aside from the psychological stuff, which of course can be physiologically problematic too, if you’re always stressed out and anxious and so forth.

Making sure that people understand that it’s not benign – if you read the informed consent, if you actually have the informed consent and you read it, and you decide to go ahead anyway, you need to know that there are some potential consequences.

Even with the vaccines now that just started over there and we just started here, it’s important that people know. I was talking to a woman yesterday, and she’s on the fence about whether she’s going to get the vaccine or not, like a lot of people are. She said, “Some of these people have gotten headaches and flu-like symptoms. I don’t want to do that.” I said, “That means it’s working.” The reason you get a fever after you’re given a vaccine is because your immune system is going, “What the hell?” Some people get a little bit sick. Now, there doesn’t seem to be very much sick, but the fact that you feel something – that’s not a bad thing. It means for sure it’s working. She didn’t know that.

It’s just really important that people know that losing weight and gaining weight and losing weight and gaining weight is not benign.

Chris Sandel: Yeah. There is the physical side that you talked about there, but I think the psychological piece is huge.

Jon Robison: Oh, huge. Absolutely.

Chris Sandel: It then traps people within that cycle.

Jon Robison: “I failed. I failed again.” I’m sure you see that all the time with people that come see you.

Chris Sandel: Yeah. It makes it more likely you’re going to end up with an eating disorder or disordered eating, and then having this very messy relationship with food. That can be a really long, ongoing lifetime struggle for people. So yeah, you’re right. It’s not benign, and especially within the culture that we live and the focus around weight and health and all of that. When you feel like “I did this thing and it hasn’t worked out and I feel like a failure,” that’s not something small.

Jon Robison: And imagine if you’ve done it 10 times, which I’m sure lots of people you’ve seen have. I know lots of people I know have. Over and over and over again. Some people have done the damn Weightwatchers thing 10 times.

We have a programme we call Health for Every Body, an amazing programme. It’s a worksite programme. Pure HAES (Health at Every Size). Very often a company will call me up and they want to do that programme and they say, “We have a Weightwatchers programme going on at work at the same time.” I say, “I don’t care. That’s fine.” In fact, usually what I’ll suggest is, let’s do a pilot. Let’s compare the two. Some people choose one and people choose the other and let’s see what happens. That never happens. Weightwatchers would never – I can’t imagine them agreeing to that.

00:47:48

Jon’s Health for Every Body programme

Chris Sandel: Talk a little more about the programme, Health for Every Body. What do you cover as part of that?

Jon Robison: It’s interesting how that started. This was, jeez, almost two decades ago, maybe. I was doing a keynote at I think National Wellness Conference at the time. There were some people from Mercy Hospital there in Mason City, Iowa. They were just about to start their wellness programme, and she came up to me afterwards and she said, “This is a mess. Everything that you said I shouldn’t be doing is what I was going to do. I want to redo it completely. Thank you very much.”

I didn’t hear from her for about two or three years, and then she called me up and she said, “Would you like to come talk at our programme?” I said, “What is the programme?” She said, “It’s everything I learned from you at that talk. I completely changed everything when I went home.” I said, “What’d you wait three years for to bring me in?” She said, “You were way too radical for Iowa three years ago. Now it’d be okay.”

One of the people involved was an eating disorder social worker, who I’m still very good friends with. After a few years, she developed this programme called Health for Every Body. We did it down there, we did it in Canada. The programme was called Kailo, and it was really way ahead of its time. Very holistic, no incentives, none of that crap. Politically, we got in trouble with it. In Canada we didn’t get in trouble with it, but somebody stole it. It was a mess.

Anyway, we did get to keep the Health for Every Body programme, and a few years later, somebody from a big company in California somehow found out about the programme and called me up and said, “I want to do this at all our places all over the country.”

Chris Sandel: Nice.

Jon Robison: I thought, shit, it’s a 10-week programme. I can’t go flying everywhere else for 10 weeks. Because I was connected with the size acceptance people and everything, they had places in San Francisco and Texas and New York and everywhere else. So I would call somebody up who I knew really well from my work with AHELP and then with ASDAH, and I would say, “I’ve got this programme, I’ve got all the slides, I’ve got everything else. I’ll fly out there on the first day, I’ll introduce you, and we’ll tell whoever wants to join the programme to come. I’ll do an hour presentation.” So I would go out and do that, and then I would give the person the programme, and the company would pay that person, and they would run the programme. It worked out really well for a couple of years.

But then people started calling and wanted to buy the programme. I said, “I’m not selling you the programme. You’ve got to know what you’re doing here.” It was just people who I didn’t know, who weren’t really steeped in Health at Every Size.

So we started training. We trained facilitators. It’s a 12-week training, and what we do is put the facilitators through the programme as if they were participants. The first week is me doing background science; the last week is follow-up. During those 10 weeks, it’s an hour and a half, and we put the facilitators through the programme the first hour, like we would at a worksite, and then we have them put their facilitator hat on and talk to them about how to facilitate that. We actually just finished another cohort just recently. It’s great because then they go back and do this at their workplaces. We know that they’re trained properly because we trained them properly.

Basically, it’s a programme about wellbeing. Health for every body. It’s not just for large people. All kinds of people take it. We talk about all the research that you and I have been talking about and we talk about weight stigma, we talk about social connectedness, we talk about everything having to do with wellbeing, social support and social determinants of health. We talk about all of those kinds of things. Then they go and run these programmes, and we teach them how to market it. We actually have a 30-minute video that we give to them that they can show their company, so that people know it’s not a weight loss programme and they know what it is and what it isn’t.

It’s one of the most fun things I do, doing the facilitative training, because then I know I’ve got 10 people that are now going out to their companies and they’re spreading this stuff all around. Even if they’ve got a Weightwatchers programme going, so what? This is just something new, something different that people can try and get a different perspective on.

So, Health for Every Body. That’s one of the things. I do it through Salveo, but I did it before – Rosie and I have only been working together about six or seven years, but I’ve been doing this programme longer than that. It’s very rewarding.

Actually, it’s kind of interesting; Beaumont Health System in Michigan is the biggest health system in Michigan. Big health system, lots of hospitals. We just trained a bunch of their people, and they run the programme at some of their hospitals. Because of that, they just gave us a grant and we just did a four-week training – this was by Zoom because of COVID – of their nurses and their doctors, teaching them how to work with larger people, which was really, really interesting and really fun to do.

It was myself, one of my colleagues who helps me teach the Health for Every Body, and then a woman named Michelle May. You know who she is. “Am I Hungry?” is the name of her programme. She’s very, very cool, by the way. That’s somebody who, if you wanted to talk Intuitive Eating, she’s a physician, actually, but she quit being a physician and all she does now is teach mindful eating. Bunch of books out and stuff. She’s really, really smart and really cool. One of my favourite people. Very tuned in.

We talk about, in the Health for Every Body programme – and I talk about it when I talk about Health at Every Size – I see Health at Every Size as much of a social justice movement as a health movement. She’s very into that aspect of it too. So it was really fun doing the thing. It would’ve been a lot more fun to have been doing it in person, especially since the hospital is only 45 minutes from my house in Michigan.

Chris Sandel: Did you get much pushback or anything from the doctors or nurses?

Jon Robison: The feedback we got was all good. Because I’m somewhat of a scientist, I understand that it’s a pretty self-selected group. It was marketed as what it was: a different way of taking care of larger people. But we were lucky; there were two doctors who already were Health at Every Size people, which is not that amazing. I mean, that hospital system probably has 50,000 doctors and nurses. It’s huge. There was at least one, so she came on. Most of the feedback we got was very positive.

Chris Sandel: Hopefully it is starting to then trickle down into those places.

Jon Robison: Yeah, and we talked about all kinds of things, about how to take care of larger people in your office and weighing and all kinds of very practical things. The other woman that helps me is very practical, hands-on. She’s in the minutiae. She gets it. Me, I’m sort of a 40,000 foot kind of guy. I try to pair up with people like my partner, Dr Rosie Ward. She’s the most detail-oriented person I’ve ever met in my life. I don’t know how the hell she does it, but it’s a good combination because I’m not.

00:56:17

Why people do what they do (behavioural change)

Chris Sandel: As part of your bio on LinkedIn, it states you have a particular interest in why people do what they do and don’t do what they don’t do. Talk a little about this, because this is definitely something that is an interest of mine as well.

Jon Robison: I’ve had that in my bio for three decades. I’ve had that little thing in there, and I’ve given a lot of thought to why. People change their bios and take stuff out and put it in over three decades.

I think it’s a combination of I grew up in the ’60s, I was very politically active – I was at all the anti-war demonstrations in Washington. I got maced and knocked out. I’m adopted, so there’s that piece. I’ve always been sort of ‘take it to the man’ or don’t like to be told what to do, like to do my own thing. What I really wanted to do was go on the road and play music. I didn’t want to go to college. I went to college because my parents, who I love dearly, raised a Jewish boy, and a Jewish boy is supposed to go to college and become a doctor. I didn’t really want to do that. I wanted to play music.

I think it’s a combination of that and being in health promotion before I was in worksite wellness – well, sort of worksite. But the idea of incentivising and forcing people and trying to make people do stuff by either feeding them carrots or hitting them over the head with a stick has always really pissed me off.

I got into a lot of trouble way back in the day with the health promotion community when I was doing all the speaking because everybody was talking about incentives and this, that, and the other thing, and I was just saying, look, if you have to incentivise people to do something, you should be asking yourself why. If people are not coming to your wellness programme and you have to say to them, “If you don’t come, we’re going to charge you $2,000 more on your health insurance” – people will say, “Well, if we don’t do that, they won’t come. What should we do?” I said, “You should try to think about why they won’t come. What is it that you’re offering them?”

And it’s still – it’s better now here. We call it ‘wellness or else’. That’s actually a term I coined, and that was right after 2010 when the ACA (Affordable Care Act) passed here. Wellness or else. It’s just always something that’s really bothered me. I’ve studied Skinner, spent a lot of time reading about this stuff, and it just doesn’t seem human to me to do that. Our new book is called Rehumanizing the Workplace. In the last 10 years, it’s just been – because of the incentives thing.

But why is it that people do what they do and don’t do what they don’t do? It’s so much more – I keep saying complicated, but I mean complex. It’s just complex. There are so many things to take into consideration. It’s really interesting, because if you look at the worksite wellness literature for the last 10 years – are you familiar with the Net Promoter Score (NPS)?

Chris Sandel: I am not, no.

Jon Robison: It’s a really interesting measurement tool that companies use to see how people feel about their products, their services, all that kind of thing. What’s really interesting about it is it’s only one question, and it’s very accurate. It’s a scale of 1 to 10, and the question is something like: How would you feel about recommending this product, this service, this resource, whatever you’re measuring, to other employees, other companies, your friends, your parents, everything else?

Workplace wellness programmes have some of the lowest Net Promoter Scores of any industry. I do this when I do my talks – I don’t speak as much as I used to because travelling is difficult for me. Well, now I’m not travelling at all because of COVID. Very often, if I’m doing a talk on behaviour change, I’ll walk out on stage and go, “Raise your hand if you like to be told what to do.” Out of 300 or 400 people, it’s very unusual you’ll get anybody that will raise their hand.

Then the question will be, “Why don’t you like it?” Or better yet, “What happens when somebody tells you what to do? What do you usually do?”

Chris Sandel: The opposite.

Jon Robison: Yeah. People say the opposite, or they’ll say “I give them the finger, tell them to go away.” That’s the reason people don’t like these programmes. We have a saying that comes from Margaret Wheatley, who’s one of my favourite authors. She says people only support what they help to create. So when people are saying, “Why don’t they like these programmes?”, I say first of all, because you’re punishing them or rewarding them. Same thing with kids. I talk about kids all the time, about forcing kids – saying, “You can only have your ice cream if you eat your broccoli.” The kid knows that must be because broccoli is yucky.

Chris Sandel: I’ve got a three-year-old. We’re going through all that at the moment, and we don’t make any demands like that. I think his dinner tonight was a mince pie and some muesli. It’s definitely not always like that, but yeah.

Jon Robison: We know – and you know this too, I’m sure – do you work with kids?

Chris Sandel: I don’t, no. I’ve got one and he is enough. [laughs]

Jon Robison: Are you familiar with Ellyn Satter?

Chris Sandel: Yes. We do the division of responsibility. I love her work.

Jon Robison: She’s a really cool woman too. I think her work is really seminal, really basic. The people I talked to yesterday that I was telling you about had never heard of her. I said, if you’re really trying to get into making recommendations for people for eating, you should read her. She talks about that all the time. Kids are born pretty much intuitive eaters. We un-intuitive them. We beat it out of them.

This guy I was talking to yesterday was saying, “So you’re saying if I decide to become an intuitive eater tomorrow, I won’t have any more problems with food?” I said, “No. You’ve not been an intuitive eater” – he’s my age – “probably for the last 60 years.” It’s a learned skill. You have to learn it. You have to work on it. You don’t just go, “Tomorrow I’m going to become an intuitive eater.” It doesn’t work that way.

01:03:50

Intrinsic coaching

Chris Sandel: I know as part of your training, you did intrinsic coaching certification as well. Is that connected to that statement of why people do what they do and don’t do what they don’t do?

Jon Robison: Yeah, I think it is. I actually did that intrinsic coaching when I started working with Rosie when I was over 60. She basically said to me, “You need to do this.” She not only is an intrinsic coach, but she also has done mentoring and training and so forth.

Most of the coaching that goes on in the United States – I don’t know if it’s true in England or not; my guess is it might be – is motivational interviewing (MI).

Chris Sandel: That’s what is part of the registered dietitians training over here. It definitely wasn’t part of my course, but it’s something that I found after my course and it is a big part of the way that I think about and work with clients.

Jon Robison: This is very, very different. MI is based on Stages of Change, psychosocial model and so forth. That model doesn’t really work very well for health promotion. Stages of change was really designed for drug addiction. If you read the literature on the impact that that has on health promotion behaviour change, it’s not very good.

Part of the problem is that it’s not taught well. It’s taught very quickly sometimes. If you wanted to invest in something that I think you would find amazing, intrinsic coaching would be it. It’s interesting because when I did it – I think I was 62 when I took it – it’s all online, which is really nice. It was me and 12 MI trained coaches. That was the cohort. It was so interesting because it’s really all based – I don’t want to say it’s based on chaos theory. I’m a huge chaos theory fan, chaos and complexity, because I think it explains human beings so much more than the Skinnerian approach.

It was so interesting because at first they were all really “I don’t know about this. This is really different.” MI is pretty behavioural. You set up “On a scale of 1 to 10, how much do you want to do this behaviour?” or those kinds of things. I don’t know if that’s the way you do it, but a lot of that is done here, and then you’ve got those Stages of Change. Are you moving from pre-contemplation to contemplation? It’s very linear. It’s a very linear model. Human beings are anything but linear.

Chris Sandel: Yeah. I’ve studied it and I use it as a way of thinking about things, but it’s not a methodology that I’m going through in a paint by numbers fashion. I’m not even really thinking about those different Stages of Change. It’s just a way of starting to think about the more you try to push someone to do something that they’re not wanting to do, the more they have resistance to it. I use it as a way of thinking about collaboration. I think motivational interviewing, at least for me, is more an ethos as opposed to a real set in stone thing.

Jon Robison: Yeah. I would still think about it. Think about trying that training. From talking to you – I don’t get any money from it or anything, but if you ever decide to do that, make sure you contact me first and I’ll tell you who to get. The trainers are good, but there are some that are just amazing. The woman I had was unbelievable.

By the end of the training, all of the MI coaches were going, “Oh my God, what have I been doing?” Most of them were, I don’t think, as thoughtful about what they were doing as you just explained. They were really using it and using Stages of Change, sort of plugging people in and stuff like that. But it was an amazing, amazing training. And I don’t even coach. You use it in your family, you just find yourself using it all over the place. It’s a very different approach.

Chris Sandel: Can you explain what it is in a nutshell? So I get a sense of how it’s different and what the core of it is.

Jon Robison: Here’s what you do 90% of the time: “After we just talked about that, what’s coming up for you?” That’s really what it is. What we understand is that motivation comes from within, not from without. Nobody’s motivating anybody. You’re trying to help them figure out how to motivate themselves, how to figure out the problem for themselves.

To give credit, in Miller’s original work on motivational interviewing, the guy who wrote the book, there’s more of that in there than what I see most people who are using it doing. And that’s because the training has been truncated. Over here, you can be doing that after going for a weekend. For intrinsic coaching, it’s 100 hours. It’s a lot of stuff.

You really want people to motivate to find the answers for themselves. It’s not therapy, but it’s very therapeutic. There’s an understanding that the changes that happen don’t happen during the session. They happen in between the sessions. My guess is you probably find the same thing with eating disorders. I know my wife finds it with her trauma therapy.

It actually wasn’t a different way for me to look at things, but it’s a very different way than people look at things. When you think motivational interviewing and you think Stages of Change, you think about leading a person to make a change. That’s not what this is about. It doesn’t sound like that’s what you do.

Chris Sandel: No, it’s definitely not. God, I’ve been working in this field for long enough; I know that change is anything but linear and that there are lots of two steps forward, one step back. It’s rarely people having these ‘aha’ moments. It’s more these gradual things where you look back three months later and you’re like, “Oh wow, that thing’s not happening the way that it was before, and that’s really good” or whatever. So I definitely agree with your statement of things happening mostly outside of the sessions and where people have time to think about things or put things into practice and see how that is.

But definitely, as I said before, the process I’m going through with a client is very collaborative. As much as possible, I want them to be coming up with the solutions themselves and being like, “How do you want to deal with this?” Or we have a conversation, and like you said, “What’s this bringing up for you? What are you thinking about now?” That’s definitely part of the regular conversation I’m having with people as opposed to feeling like I’m underhandedly pushing them towards this end goal. It’s more like, “Let’s do this at the pace that’s right for you. Let’s focus on the thing you want to be focusing on.”

I know in terms of intrinsic motivation, I’ve read a lot of Alfie Kohn’s work. I’m a really big fan of his.

Jon Robison: Huge fan.

Chris Sandel: So yeah, I really do understand the importance of intrinsic motivation versus extrinsic motivation. If someone can understand the reasons why they want to be doing it, how they can find joy in the process – all of the things that make someone want to do it for themselves as opposed to because Chris is going to be really pleased with them when they turn up for the next session or any of those external things that actually don’t matter.

Jon Robison: I love that you like Alfie Kohn. I had some nice interactions with him way back in the day when I was writing some stuff on behaviour change and he was writing his books. I love his books.

The other thing I really like is Deci, self-determination theory.

Chris Sandel: I don’t know if I’ve come across that.

Jon Robison: You’d like him. I’ll send you a 10-minute video clip of him talking about – hang on, let me write it down or I won’t send it to you. Self-determination theory is his thing, Deci and Ryan. He’s got this 10-minute video clip about behaviour change that is so powerful and cute at the same time. He’s been doing this forever, and you can just tell that he absolutely loves what he does and he knows what he’s talking about. We show it in all our trainings, and I try to show it in my presentations when they have the facilities. It’s really cool. I think you’ll really like it.

Chris Sandel: Cool. I know the name in terms of hearing Alfie Kohn make reference to him a lot of times in different studies that he’s done and that kind of thing, so I’ll definitely be interested in that.

Jon Robison: Yeah, you’ll love it.

01:14:18

Why autonomy is important

Chris Sandel: I also know autonomy is a really big part of your focus.

Jon Robison: Absolutely, and it’s really interesting – if you think about life, just life, living things, some biologists, at least progressive ones, will say that in order to be alive, something needs to be able to recreate itself, and it wants to be in relationship. It wants to be the author of its own journey.

We use this a lot when we’re doing leadership training. We talk about, for instance, a flock of birds. When you see the birds flying in a ‘V’ formation with a leader, they’re flying thousands of miles, sometimes tens of thousands of miles. If they only had one leader, they’d never make it. When the leader gets tired, the leader goes back to the back and somebody else becomes the leader. We actually know this because they’ve put heart rate monitors on these birds. I don’t know if you’ve ever bicycle raced, but it’s like bicycle racing. The heart rate on the birds in the back is much lower. They’re resting.

We talk to people at companies about this. We want everybody at a company to be a leader, because otherwise you’re not going to get where you want to go in the long term. These birds would never get to where they’re going if that bird had to lead the whole way. What’s really fascinating about that is it’s learned. It’s not an innate behaviour. They know that because they’ve actually found birds that were orphaned, and they trained them – you can go online, google this – they trained them with an aeroplane. At first they were bumping into each other and they didn’t know to do, and eventually they figured out how to do this.

It’s a complicated thing, actually. They don’t just go somewhere else, because you also have to deal with the wings and everything else. It’s actually a pretty complex thing. And birds learn this. When we talk to leaders, we talk to them about that. You want to have everybody to be able to step up as a leader. Leading is a behaviour. It’s not a title. Just because you have a title that says you’re the leader, doesn’t mean you’re the leader.

We talk about this a lot with self-managed companies, companies that don’t have a hierarchy. You go there and nobody has a nametag that says ‘I’m the human resources guy’, ‘I’m the vice president’. Everybody is equal. Those companies are really interesting. There are quite a few of them, and they actually do really, really well. There’s no anarchy, but there’s lots of autonomy. It’s really interesting.

I visited one down here in Florida about two years ago. It was in Tampa. They make very sophisticated parts for machines, and I went and met with the HR guy. We did some interviews for our book on self-managed companies. There are a lot of interviews in the new book. So I met with the HR guy and I went in, and he has his tag on that has his name but doesn’t say ‘HR’, and nobody has their titles on there.

He told me a story about the guy who started the company – because it’s been a self-managed company for a long time – the guy who wanted to do that, and he said there were two things that were really important to the guy who started the company: that it was self-managed and that they had a lot of plants, that they brought greenery and stuff inside. He said the only person in the company who had a tag with her title on it was the woman who watered the plants. The title was ‘plant manager’. Everybody else didn’t have a title they used except for her, which I thought was a great story.

01:18:33

The Food for Thought Pyramid

Chris Sandel: Yeah, that’s really cool. You sent over this great infographic in preparation for this recording, and I’m going to link to it in the notes so that people can see it, but I think it’s fairly self-explanatory enough that we can talk about it without having to see it. It’s called the Food for Thought Pyramid. Do you want to chat a little about it?

Jon Robison: Just a little bit about this history, about where this came from. I mentioned there was a woman who came to hear me speak from Mercy Hospital in Iowa, and she was starting a wellness programme. I was speaking at the National Wellness Conference. As part of that programme, they had a social worker. She was working with the EAP (Employee Assistance Program). They brought her into the wellness programme. I don’t know if they have EAPs over there, but they’re usually associated with organisations, and they’re usually associated with stigma. The human resources person will send you to the EAP if you’re having problems. It’s got a big stigma with it.

So they took the social worker and they put her in the wellness office. You could just go in there and have a session. Lots of people who went there had never gone to a session, and it turned out to be very helpful. And she was an eating disorder specialist also. Laura McKibbin is her name.

I think it was 2010 when the new guidelines, food pyramid for Americans came out, and it was a disaster. It was basically a diet for everybody in the country. She was so mad about it that she went and created this Food for Thought Pyramid. She created this on how to really enhance your health. As soon as she created it, she realised that I would love it, so she went it to me and we worked on it together. But it’s her work.

You can see on the bottom, if you look at the sources, that my name comes up after Jesus, which I thought was really interesting. Again, I don’t make any money off this, nothing like that. So she put this thing together, and I just thought it was so creative. So, so creative. She sold them for a while, and she donated some of the profit to charity. You could buy it and then you could say where you wanted the money sent and stuff like that. Just a really good thing.

But it really speaks to the underlying issues, whether it be in the culture or in an organisation, that it turns out are much more determinants of not only our health, but our longevity, than the individual health behaviours that health promotion has been so obsessed with for the last – well, I’ve been doing it 35 years, so for the last 35 years. These pyramids both speak to how critically important the context is for health.

So that’s where it came from. Again, if we look at the bottom of the Food for Thought Pyramid – and it’s set up just like the food pyramid was for the United States. There were a certain amount of servings of each thing and so on and so forth.

She starts with 6 to 11 servings of genetics and luck and 6 to 11 servings of socioeconomic factors. That’s the context. If your genetics are bad, if you have bad luck, if you have issues with income, access to healthcare, freedom from violence – if you don’t have those things, how many servings of broccoli you eat a week is not going to make much difference. And if you have those things, you have the foundations of good health. Those things are absolutely critical. So we put them on the bottom of the pyramid.

It’s sort of like Maslow. Everybody’s sort of familiar with Maslow’s hierarchy. You don’t get to self-actualisation if you have no place to live and you’re in the middle of a warzone. It just doesn’t happen that way. You have to build from the bottom up. And that’s what she did here.

Chris Sandel: I’ve done podcasts before – over here, they have the Marmot Review that was done, and then more recently they had the 10 years on Marmot Review, and that is so much of what the Marmot Review focuses on. For anyone unfamiliar with that, I’ve done a whole podcast on it that you can check out, and I’ll link to that in the show notes. It looks at health inequalities and where health inequalities stem from in the UK.

When they look at that, it’s not coming from the places most people are focusing on from a health perspective. It’s coming from the fact that there are socioeconomic issues, that there is an inability to be able to have regular work or to live in an environment where your house isn’t covered in mould or things aren’t falling down. It’s these really basic things that, when you’re in a place of privilege, you forget about, you don’t even think of as being something that’s impacting on health because it’s just a given that you’re going to live somewhere that feels safe and that has green spaces, and you have the luxury of being able to think, “Am I going to include quinoa or kale or whatever it is in my eating?” because those things have become so ubiquitous to you in terms of having a safe place to live and all of that that you don’t even think about it.

Jon Robison: Yeah. Marmot is the guru. All of the work I do is based on his book, his writings, his work. He’s the dude when it comes to this stuff, there’s no question. I’m constantly talking to my health promotion people about reading his book, the original book.

When you were talking about the things we just don’t think about that we take for granted – a new study came out very recently. I think I read it in the New York Times. There’s two neighbourhoods around the city of Chicago. They’re seven miles apart. One of the neighbourhoods is mostly people of colour; the other neighbourhood is mostly white. In the neighbourhood that’s mostly lower socioeconomic people of colour, life expectancy is around 60. In the neighbourhood seven miles away, it’s 90.

I was doing a podcast/blog kind of thing a couple weeks ago and the guy said to me, “That’s longevity, but what about health?” I said, wait a minute. If people in one neighbourhood are living till 60 and people in another neighbourhood seven miles away are living till 90, you don’t think there’s a difference – what do you need to know? They’re not just living 30 years longer because – I don’t know what. They’re living 30 years longer because they’re healthier. That’s how it works. And, of course, because they have better healthcare and so on and so forth.

To me, without a focus on the social determinants of health, a lot of health promotion is just a waste of time. On the top of the Food for Thought Pyramid is nutritional advice. The very top. And on the top of the Thriving Organisation Pyramid, which is the other one, we have wellness programmes. What we always say to people is that wellness, wellbeing, health starts at the bottom of these pyramids, not at the top. The top is – I like to refer to it as either icing on the cake or cherries on top of the icing on the cake.

When we go to the Thriving Organisation, we can talk about that, but if you don’t have the lower parts of the pyramid, there’s no way what you do at the top is going to make that much difference.

Chris Sandel: Yeah, with the Food for Thought, it says ‘Nutritional advice, 1 serving’ and it says ‘use sparingly’.

Jon Robison: That’s right. That’s, of course, because – if you notice, on the top if people are looking at this, it says ‘Nutritional advice, use sparingly; instead, rely on internal cues’. We’re teaching adults to do what kids do naturally, what infants do naturally. They eat when they’re hungry, they stop when they’re full.

Chris Sandel: For anyone who’s not looking at this, above the genetics and the luck and the socioeconomics, there is relationship and social support, which says 3 to 5 servings, and then there’s purpose and meaning, 2 to 4 servings – which is like spirituality and contact with nature and forgiveness. Then there’s humour, optimism, and play, 2 to 3 servings, and then emotional resilience, 2 to 3 servings, and then also exercise of 1 serving.

Jon Robison: Just in case you didn’t get enough moving around in the play, we threw in an exercise because exercise is important. When she sent this to me, Chris, I was just blown away. I thought, this is so creative. So creative.

01:29:30

The Thriving Organisation Pyramid

Chris Sandel: You made reference to another pyramid that you sent over, which again I can link to in the show notes so people can see it. This is the Thriving Organisational Pyramid. Can you talk through this one?

Jon Robison: Again, it’s really based on the same contextual approach to things. This pyramid was recommended to us by a colleague who went through our training, Dr Rosie Ward and me, at Salveo Partners. They said, “We should put this in a pyramid.” So then we played with it and played with it and played with it. It actually wasn’t in our first book. It’s in the new book.

It’s interesting because if you’re looking at the pyramid – I’ll leave the very bottom one out for a minute, but the biggest ones on the bottom – it’s kind of set up like the Food for Thought Pyramid – are humanistic culture and quality leadership. All the way on the top, just like nutrition was on the other one, are wellness programmes. What we’re saying to people is if you don’t have a humanistic culture, if people don’t feel valued, trusted, listened to, if you don’t have quality leadership, leaders – not managers. Leaders inspire. Managers make people do stuff, but leaders are meant to inspire people.

Then the next two up are trust, connection, and support, purpose over profit, supportive climate, effective communication – if you don’t have all of those things, then throwing a weight loss programme – you should never throw a weight loss programme in, but doing anything – some companies will pay for gym memberships or they’ll have foosball machines or places you can go meditate in the building, all those things. If you don’t have that underlying culture, those things are not going to work any more than if you don’t have a place to live and you’re in the middle of a warzone that you’re going to somehow reach self-actualisation. I don’t know how the hell you’re going to do it.

It’s really set up the same way. Then the very bottom of the pyramid, if you look at it – we added this actually afterwards. We call it 21st century organisational design. We talk about this a lot in both of our books. The idea that an organisation is a machine – if you think about the structure of an organisation, how you usually see it structured, you see rows of boxes. You’ve got middle management, you’ve got the CEO, the CFO, human resources, and they’re stacked up like this. But that’s not how communication happens in an organisation. Communication happens around the water cooler. It happens at lunch. It happens when people walk by, people working on projects together.

Chris Sandel: Probably less so all of those things happening now in a pandemic. [laughs]

Jon Robison: Well, that’s true. Now it’s all happening on Zoom.

Chris Sandel: Yeah.

Jon Robison: What we say in our books is that organisations are much more like living things than they are like machines. They’re made up of human beings, who are all living things, who are all imperfect, who are all complex, who are all messy as hell. So you have a big group of messy, complex human beings. That’s really a living thing. Our book is called Rehumanizing the Workplace.

Just to go back, if you think about early 20th century United States and you think about the factories, basically what happened there is everybody did exactly the same job and they were basically extensions of the machine. You stuck a part in, you pulled a part out. If that person got sick, you moved them over, you put another person in, they did that. There was no autonomy, very little mastery or purpose. You were just part of the machine.

The problem, of course, is that organisations aren’t like that anymore. We don’t live in that kind of a world anymore. We live in this world where things are changing really quickly. Companies have to be really flexible. The term they use in Europe is agile. Here we use flexible, but agile is the term from Europe that’s used a lot.

The things that are important for an agile, flexible, able-to-react organisation are very different from that earlier 20th century automobile factory or women sewing something.

Chris Sandel: I think, as you described there, it does very well represent that in terms of what is important for a healthy workforce and to create healthy employees. I was wondering in terms of your book, how much of it is directed at the employer or business owners versus employees and what they can do to change things?

01:35:25

Psychological safety

Jon Robison: Let me say one more thing before I go to that, but then I’ll go to that. One thing we really focus on in both books that’s really critical is what we call – the term here is ‘psychological safety’. When you think of safety in an organisation, you think of if you’re running a machine, to be safe so you don’t lose your arm.

I remember working on these punch machines when I was going to college. You would stick a part in, and then this hand would come down like this, and it was for you to get your hand out of the way. It made you get your hand out of the way. If you didn’t, you’d lose your arm. But it would knock your arm off. You think about safety, you think about those kinds of things.

But really, psychological safety is so important in a workplace. What is psychological safety? The way I like to think about it is – Brene Brown is a huge promoter of this – psychological safety is knowing that when you go to the place that you work, if you do well, if you do something good, you’re going to be recognised and you’re going to be congratulated. If you do something that isn’t quite so good, that doesn’t quite so work, it’s going to be used to help you get better. It’s not going to be used to “Oh man, you screwed up. You really screwed this one up.” This is where good leadership comes in. A good leader will say, “What do you need from me so that the next time you do this, it comes out better?” That’s what a great leader does.

So psychological safety is really clear. Brene Brown talks about this all the time. She says people very often go to work and have two jobs. One is the job they got hired for; the other job is to armour up so nobody sees that they’re not perfect, so nobody sees that they make a mistake, so nobody questions what they’re doing. With that armour on, the organisation simply cannot be as effective. People have got to be able to take their armour off and feel safe. That’s psychological safety. Really as critical as any other thing in an organisation, I think.

Chris Sandel: Yeah. In an organisation, in a relationship, in so many areas of life.

Jon Robison: Anything were human beings are involved, trust, psychological safety – they’re just absolutely critical. We just don’t talk about them that much. They weren’t that big a deal in the factories in the early 20th century. What was important was physical safety because you were basically part of the machine. But if you screwed up, they just moved you over and put somebody else in.

01:38:38

Jon’s books + why autonomy, mastery and purpose are critical

As far as the books are concerned, the first one is How to Build a Thriving Culture at Work, Featuring the 7 Points of Transformation, and that’s just an approach where we compared building a thriving organisation to building a safe, well-built house that also is a home. There are 7 steps, and we go through that process.

In the book Rehumanizing the Workplace, it’s really an accumulation of that stuff that we’ve done at workplaces and what the results have been. I’m trying to get to your question about that. It’s a good question. I’m trying to think of the best way to answer it.

I think it’s written for both, but it’s definitely written for the C-suite. It’s definitely applicable to HR. Benefits, safety. In fact, we put on our own conference called Fusion. If you notice, on the Thriving Organisation Pyramid, we have the fusion. We call that the interrelationship between employee wellbeing and organisational wellbeing, and we say they’re inextricably interconnected. They have to both be done together. You cannot possibly have an effective organisation, a thriving organisation, if you don’t have thriving employees and vice versa. You’ve got to have them both, and you’ve got to work on both of them.

We actually put on a conference two years ago now. We were going to do it this year again, but of course COVID made that – we didn’t want to do it virtually because it was really in person. But we invited, and we had there – I don’t know how it is in England, but here, you have a health promotion conference, you have an HR conference, you have a safety conference. They’re all separate. Everybody goes to them separately. But that doesn’t make any sense because they’re not separate in an organisation. They’re all inextricably interconnected.

So we had people from all of those, and we had speakers from all of those. The new book is talking about our experiences over the last four or five years with the companies, using the Thriving Organisation Pyramid and working with companies to help them to develop their cultures, develop their leaders. Those in some ways maybe relate to the leaders and managers and more, but then we also talk a lot about autonomy, mastery, and purpose. This is from Dan Pink’s book. I don’t know if you’re familiar with him.

Chris Sandel: Drive?

Jon Robison: From Drive, right. He talks about that a lot, we talk about that a lot – how critically important it is for employees to have autonomy, to be able to make their own decisions, to be able to have the freedom to innovate. Of course, that ties right in to psychological safety because if you feel like you have armour on, you’re not going to innovate. You’re not going to take a risk. And especially in this day and age, in the VUCA world, in this rapidly changing, crazy world, organisations have to be able to innovate quickly. We talked about being agile. You can’t do that if you’re afraid to take a risk. So autonomy is critically important.

Mastery is just getting better at what you do, and the companies that are being the most successful are pushing people to master things. And once they master things, then they move them on to learn something else. You understand mastery. Golf is a perfect example for mastery. If you want to be good at golf, you’ve got to do it a lot. Think about an alien coming down from some other planet and seeing people try to get this little tiny freaking ball 300 yards away into a hole that big.

So the good companies do lots of, lots of, lots of, lots of training. The difference between the companies that are thriving and those that aren’t, you can see it in the trainings that they do.

And then, of course, there’s purpose. That’s so critically important. It’s so important that people feel that their work is not just to get a pay check. Their work has meaning. They’re contributing to something bigger than themselves. I love the explanation – I can’t remember exactly who this comes from, but it’s a really good analogy. If you think about the human body, if you think about red blood cells, they provide the oxygen. But the purpose of humans is not to get oxygen. The purpose of humans is to have oxygen so you can live, so you can do something purposeful.

The same with companies. Companies need to make a profit or they won’t stay in business, but the purpose of a company is not to make a profit. If that’s the purpose, the company is not going to survive. The purpose is to do something to improve the lives of people, the bigger picture, if that makes sense.

Chris Sandel: Yeah. I have had conversations around this with clients in terms of health. Health cannot be the ultimate goal. Health is something that then helps you to do all of the other important things in life in terms of relationships and –

Jon Robison: That hopefully you want to do.

Chris Sandel: Yeah.

Jon Robison: The things that you want to do, the things that you need to do. It’s easier to do those when you’re healthy. And even when you’re not healthy – one could make an argument that I’m not healthy. I have MS. I have early prostate cancer. I have high blood pressure, which is controlled. And I’ve had them for years. But I’m writing books, I’m doing podcasts, I’m doing things. Health is such a relative term.

And as you know from the work that you do, blaming people for their health problems is never productive. In fact, it’s always counterproductive. And yet we do that here. We have been doing that here in health promotion. For 35 years, I’ve been fighting like hell against it, because we’re always doing it. “You didn’t eat this. You should’ve eaten this. You shouldn’t have done that. You didn’t do this.” Not helpful.

And the same is true at the workplace. That’s the psychological safety piece of that. “This project didn’t go so well. Let’s sit and talk about it.” As your leader, I say to you, “What was it that you didn’t have? What could I have done better to make sure that you would’ve thrived in this situation?” Then you coach.

01:46:35

Are Jon’s books useful for employees as well as employers?

Chris Sandel: Getting back to my original question around if it’s for employers or employees, it sounds as though even if someone’s an employee and they’re reading it, even the bits that feel like aren’t relevant to them can give them examples of what a really thriving workforce does look like that they can then start to use as a bit of a litmus test for thinking about “How do things stack up where I am working? How could this be having an impact on so many aspects of my mental health and my life in general?”

Jon Robison: Yeah. I told you, we do some trainings – this isn’t for the Health for Every Body training. We call this the Thriving Workplace Culture Certificate training. We’re training people in the 7 points of transformation, how to do this. We’re training them with the pyramid. That’s the basic thing we’re training them with.

It’s interesting because we’ve had HR people, we’ve had some higher ups, but we have lots of employees as well who are working either wellness or HR or safety or whatever they’re doing. This is not a great way to market the programme, but we’ve actually had people who have said to us, “After reading this book and going through this training, I can’t work here anymore. This is not how I want to spend my life.” We joke about that with the people very often. But we’ve had quite a few people – and of course, I always say to them, don’t throw away Plan A till you have a Plan B. You can always be looking for a Plan B, but you don’t want to jettison Plan A until you’ve got a safe Plan B.

But yeah, it’s totally appropriate for employees as well as employers. I would also add, Chris, that it’s appropriate for employees anywhere. This isn’t just for people in big organisations or fancy, high-tech Google, Jeff Bezos, Amazon – it’s not just for those people. Anybody in any job can work on autonomy, mastery, and purpose, even if it’s somewhat of a struggle given the organisational structure.

There have been some really wonderful, fascinating studies about, for example, people who work as maintenance crews in hospitals. They clean the floors, they clean the bathrooms, they clean the ICU rooms. Some of them are very able to – they call it job crafting. This is how people make sense of their work. Think about people who have purpose – doctors and lawyers and nurses – that’s easy. But what about a person who’s cleaning bathrooms? What about a person who goes in and cleans the ICU after somebody’s been really, really sick? Can they have purpose in their life as well?

It turns out they can. The research is very clear. Not only do people who have purpose in those jobs do better, but you can actually train people because you can have all of that maintenance group meet, and they can share. One person can say, “I really feel good about cleaning the floor because I know people aren’t going to slip and hurt themselves in the hospital.” Other people say, “I hate that. I like this and I do this.”

There was one great story – I love this story – about a guy who cleaned the ICU rooms, and he would go and actually change the pictures in the rooms. He would move them from one room to the other. Now, remember, in the ICU, a lot of people are in comas. In fact, my wife was in an ICU room in a coma for six weeks, so I’ve had the experience of this. Even though they’re in a coma, though, they’re not completely out of it. So his explanation was, “I just thought when they might wake up or when they might be a little more conscious, they would see and they would really like a different picture in the room than was there all the time.”

He created purpose for himself. That’s very powerful.

Chris Sandel: Definitely. That is a very sweet story.

Jon Robison: Yeah. And that was a study, actually. It was written up in a study because they did a study to see which people in that maintenance crew had purpose and which people didn’t have purpose, and why. Half of them did, half of them didn’t. Fascinating research. That’s out of a positive psychology –

Chris Sandel: Martin Seligman.

Jon Robison: Yeah. This wasn’t Seligman. This was Amy Wrzesniewski. But that’s the sort of frame of thinking from which this comes.

01:51:37

How Salveo Partners got started

Chris Sandel: I know you made reference to it already, but how did Salveo Partners all come about?

Jon Robison: Rosie read something I wrote or heard me speak or something, and she asked me to come in and speak at a company that she was working for at the time. We met, and I hadn’t met anybody – well, the woman I wrote my first book with, we were very sympatico, thought a lot alike, but that was many years before that, and I really hadn’t met anybody in health promotion who thought like I did. She’s 30 years younger. I’m old enough to be her father.

Our brains are – we think so alike. We’ve been together six or seven years now and we’ve written two books together, lots of trainings, lots of speaking. We’ve had three or four disagreements in six or seven years, which we’ve resolved quite amicably. She’s extremely smart and as I said, extremely detailed, almost OCD. I tease her about it sometimes. She’s just so organised and really passionate. I don’t think she’d care if I said this – she’s not afraid to use her language when necessary, which I really like. I’m being a little careful here because I don’t know what your readers are like.

What happened was I called her up. The first book I wrote was called The Spirit and Science of Holistic Health: More Than Broccoli, Jogging, and Bottled Water, More Than Yoga, Herbs, and Meditation. It was about holistic health, the holistic approach. I was getting ready to think about writing a new edition of it because it was older, and the woman who I wrote the first book with wasn’t in health promotion anymore. So once I met Rosie and we had so much in common, I said to her, “I want to write a newer version of this book. Would you write it with me?” She said yes, and we started talking about it and we thought, “Nah, shouldn’t do this. We should write our own book.”

So that’s when we wrote the first book together. People read the book, How to Build a Thriving Culture at Work, Featuring the 7 Points of Transformation, and people were calling us and saying, “Boy, this is really good. I’m really enjoying this and everything, but I need more.” So we started an online training about five or six years ago called the Thriving Workplace Culture Certificate Training. We go through the book and teach people exactly how to do it and homework in between and all of that stuff.

Then people were saying, “We really love this training, but we want to keep in touch.” So we have a licensing group now, so all the people who went through the training, we meet once a month and either Rosie and I present or we bring in a speaker from the outside, or sometimes people from the group will bring a problem they’re having at work and everybody else will crowdsource. It’s really cool. We’ve put probably 300 people through it now. They’re all movers and shakers. We call them Paradigm Pioneers.

So that’s how that happened. She’s been trained by Brene Brown, so she’s running some of –

Chris Sandel: Is it Dare Leadership?

Jon Robison: Yeah. She’s running some of those programmes now. Everything online, of course. All kinds of leadership trainings. That’s really her thing. Her PhD is in management leadership training, something like that.

It was not something I was planning on doing after 60, writing two books. I was not planning on getting involved in all of this, but I’m really glad I did. I’ve really enjoyed it. It’s been really enjoyable, with her especially.

Chris Sandel: Obviously you having this background in wellness and going into – it sounds like it was a good match.

Jon Robison: Really good match. She’s got a bunch of other degrees, too. I think she’s got a master’s in public health and an exercise degree too. So we have tons and tons in common. We feel exactly the same way about incentives and about behaviour change and about the science. I think I probably brought that in more because I have a non-technical interest in quantum physics and chaos theory, which I wrote about actually in my first book in the late ’90s.

But I really think there are lots of applications of both of those to humans because they’re messy and unexplainable and unpredictable, and that’s humans.

01:57:00

How chaos theory + quantum physics relate to behaviour

Chris Sandel: Yeah. I know of chaos theory in passing and the ‘if a butterfly flaps its wings’ type thing, but I don’t really know any more than that. Is there a way you can explain it in an easy-to-follow explanation?

Jon Robison: The thing about the butterfly effect is that it’s true. That’s true. That’s not just a saying. What chaos theory basically says is everything affects everything, which is very different, of course, from a linear explanation. If you have a linear equation, if you remember your equations, and you add something to one side, you add the same thing to the other side. If you add 1 to one side, 1 comes up on the other side.

That’s not true with nonlinear equations. A very small change on one side of an equation can make a huge change on the other side. A very small butterfly flapping its wings in the Amazon can actually impact the weather a couple of weeks later on the other side of the world. The math is way beyond me, but I’ll send you an article if you’d like that somebody wrote on comparing chaos theory and health promotion and how it works out.

Quantum physics is a little bit more difficult to talk about in terms of how it affects human beings. The way I’ve always used it is in the early 20th century, physicists were pretty sure that everything was done with physics, they’d figured it all out. There was a little problem with gravity, they weren’t sure exactly what that was, but basically they’d figured it out. Then all of a sudden, this quantum physics thing happened.

What they found out was that if you think about an atom and you’ve got protons and neutrons and you’ve got the electrons going outside – which isn’t exactly what happens – and they’re pairs, usually. They’re paired up. What they discovered was that if you split that pair of electrons up, which they were able to do, and you take one to New York and you take the other one to California, and you change the spin on the one in New York, the spin on the one in California will change instantly. No time in between. There is a connection between those two things.

Now, that goes against everything that anybody believed before the 20th century. In fact, Einstein went to his grave not believing it. He called it ‘spooky action at a distance’. But it’s been proven, and theoretically, if it was the other side of the universe, it would also happen. So there’s some kind of a connection between those two things, which is really amazing.

There are a whole bunch of other things with quantum physics. What it told me was that things are much more complex, much less understandable, and much less predictable than we think. And I think human beings fit that really perfectly.

I always say to people, when we’re talking about workplace wellness and behaviour change, if anything you’re talking about doing at your workplace sounds like a lawnmower or a rodent, it’s a problem. The thing to compare human behaviour with is the weather. Unpredictable, uncontrollable, changeable. If you think about all the things we do at these workplace wellnesses – maybe think about the maze; when you put a piece of cheese at the end of the maze, the mouse will run through the maze and get cheese every time. If you take the cheese away, it won’t do it anymore.

That’s the difference between – that’s weight loss, that’s exercise. That’s all of those things, because again, these are adaptive challenges, more complex. People are much more complex. I don’t know. [laughs] I haven’t tried to explain quantum physics and chaos theory.

Chris Sandel: No, you’ve done enough to get me to understand the complexity side of it, and that’s interesting.

Jon Robison: There are a whole bunch of books that I read way back when, and I looked and picked them because there wasn’t a lot of math in it. There are books on chaos theory that are loaded with math that’s way above my head. Even above Al’s head, actually. These are physicists. But there are people who write books relating these things to human behaviour. Human experience, really, is what I should say.

Chris Sandel: The ones that come to mind are Kahneman and Tversky. A lot of their studies around human irrationality and all the heuristics and biases and all of that.

Jon Robison: That relates some, yeah. I hadn’t thought about that for a while because we don’t talk too much about that anymore these days. Except, actually, in the beginning of both books we deal with it a little bit, sort of introduce these. It’s really important to Rosie and I that everything we do is – couple things that are important. One, everything we do is science-based. The other thing is when we tell people ‘don’t do that’, we suggest what they should do instead. Instead of just ‘Don’t do weight loss’, what do you do instead?

This is what these guys were asking yesterday. “What would you do at the workplace?” They wanted the workplace to not have any snacks, any cookies or candy or cake at the workplace. I said, “No, that’s not the solution. The solution is to give people choices.” The solution is that you’re never going to fix somebody’s eating problem by telling them what to eat. You’re going to fix people’s eating problem by letting them figure out what the problem is.

The way I would recommend that they do that at the workplace is to teach Intuitive Eating. In our Health for Every Body programme, we only have one week that’s on Intuitive Eating, so obviously we’re not teaching people Intuitive Eating; we’re just introducing it. Very often we’ll do our programme and then we’ll do Michelle May’s programme afterwards on mindful eating. You can make a dent in that time if it’s done properly. Yeah, interesting.

02:04:05

Where to find Jon online

Chris Sandel: Jon, this has been awesome. Where should people be going if they’re wanting to find out more about you? Where’s the best place to point people?

Jon Robison: Salveopartners.com. All of our trainings are up there. There’s tons of free whitepapers and eBooks and all kinds of stuff, and connections to order the books if people are interested in the books. Salveopartners.com is the place to go.

Chris Sandel: I’d also recommend your LinkedIn, because you’ve got lots of articles there.

Jon Robison: Yes, that’s true. [laughs] LinkedIn Pulse, I’ve written a few articles there.

Chris Sandel: You have.

Jon Robison: This was a pleasure, Chris. I enjoyed it. I hope we can stay connected and share different things since we have so many things in common, what we’re doing. Keep doing the great work you’re doing. Such needed work. Again, I’ll say this again: it’s so nice to see a male doing this. We just don’t see that very often over here. Of course, eating disorders are becoming more prominent in males now. So it’s very cool.

Chris Sandel: Perfect. Thank you for your time. This has been great.

Jon Robison: Been fun, Chris.

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