The "Top 20" easiest employee behavior changes: Parts 1 and 2

These are the combined first two parts of our 3-part series. If you read the first part last month, you can skip to #7.

Quizzify changes behavior through knowledge, not willpower. The actual changes below are quite easy and often pleasant, once you know what to do. Study after study after study shows willpower-behavior change doesn't work, so why not try knowledge-based behavior change, starting with the items below?

1. Substitute full-fat yogurt for nonfat

Dairy fat may or may not be a good thing. More recent evidence suggests it is, for most people. But here’s what’s definitely a bad thing: nonfat yogurt. Not all brands, but if you recognize the brand name from your childhood, and/or it is fruit-flavored, it contains sugar, usually in mind-blowing quantities. For example, this 6-ounce container has much more than half your total daily recommendation. Yoplait's got company. Here is our list of the 8 Most Overrated Foods.

And make sure that your vendor’s health risk assessment no longer gives advice like Cerner's below, so employees don’t get confused.

2. Treat cavities with SDF instead of “drill-and-fill”

We get almost 100,000,000 cavities annually...and >90,000,000 of them are still addressed

with the obsolete but very profitable Novocain-and-drill technique. For almost a decade, most dentists have balked at using the painless, fast-acting, FDA-approved Silver Diamine Fluoride instead, because they can only charge $30 or so. All dentists have it in the back room, but very few are like these dentists, who advertise it. That's why you must teach employees to ask for it. They won’t need much convincing, as our testimonials show.

Speaking of savings, Quizzify has a plan where you can pay for our entire program just on reduced drill-and-fill and root canals. Ask us about it.

3. Stop demanding antibiotics

Americans get plenty of antibiotics without asking for them, because doctors already overprescribe them. But many report that their patients will ask for them inappropriately.

Teaching employees that antibiotics don’t work on viruses and are no longer recommended for their kids’ earaches (unless they don't clear up on their own, which most do) will save them risk and money by not insisting on them.

4. Get checkups at clinically appropriate intervals

You should have a relationship with a PCP. This does not conflict with what you are about to read. Quite the opposite, that relationship makes checkups and checkup frequency more appropriate.

Not too long ago, questions recommending clinically appropriate checkup intervals were among our least popular. Often employer administrators would use the "remove/replace" function to make sure they didn't appear in the official quiz. And the correct answer (getting checkups at age- and health status-appropriate intervals instead of annually) was so unpopular that the "Learn More" explanation included this visual...

...with the caption: "Don't shoot the messenger."

Oh, how times have changed! Now, having read the conclusive research, many employers are finally relaxing the “one size fits all” annual checkup requirement. The EEOC also now frowns upon putting money at stake for employees to get clinical exams, as we've been cautioning since early January. And fear of COVID exposure accelerated the evolution as well. It's also the case that the 25 most common hospitalizations in the <65 population could not have been prevented with more checkups.

What's wrong with too many checkups, according to the research? The downside of too many checkups isn't the wasted expense or time away from work. Those aren't even measured by the research. The downside of checkups is, as the Journal of the American Medical Association put it, they "fail to reduce cardiovascular, cancer, or total mortality and may result in overzealous use of screening tests, overdiagnosis, and possible harm to the patient."

Oftentimes, folks in HR know this, but justifiably want employees to have a relationship with their PCPs. We now have an elegant solution that creates a relationship without redundant checkups: we propose that the form used to document the checkup include the year proposed for the next checkup. After all, who knows better when a patient should get their next checkup than the patient’s doctor? And, since doctors get graded on how many checkups they do, they will only skip years for patients they have enough of a relationship with to know how healthy they are.

For some employees the proposed year will indeed be 2023. But for many others, it will be a year(s) later. The latter group should get their incentives or points next year without having to get another superfluous checkup.

They will, of course, need to disclose the personal information that they shouldn't get a checkup in order to collect those incentives. "HIPAA" and "fun" are rarely found in the same sentence, but bragging about good health would be a fun HIPAA right to waive.

And, as with the cavities, scheduling checkups at clinically appropriate intervals can be guaranteed to pay for all of Quizzify.

5. Incline your bed

Got nighttime heartburn? Statistically, likely >25% of your workforce does too, at least occasionally. Yet heartburn is the single most easily preventable medical condition. A shocking percentage of it will go away if you incline your bed, as shown in this illustration.

Also, if you go back to the yogurt question, many full-fat yogurts (and kefirs) have active cultures. A couple of weeks of daily active-culture yogurt should also address frequent heartburn.

A set of largely underappreciated heartburn tips can be found here and here. Along with two blog postings for you, we have two full question sets for employees on the topic as well.

6. Swap out your heartburn meds

Formerly available only by prescription, Prilosec, Prevacid and Nexium may be the most hazardous drugs available over the counter. While considered safe if taken as directed, shockingly few people take them as directed.

“As directed” means following the directions on labels that no one ever reads. The labels say to discontinue use after two to eight weeks. The problem is that people get relief within a day or two, and don’t feel any side effects, and they assume the drug is safe because it's over-the-counter. So they keep renewing. And who can even read these labels? Nexium has seriously "buried the lead" here.

Way towards the bottom, it says: "You may repeat a 14-day course every four months." But why "repeat" or even use these powerful meds in the first place? As our article on this topic observes, there are many, many lower-risk, lower-cost solutions for heartburn.

7. Stuff that colonoscopy

As our most recent blog post described, colonoscopy screening is soooo 2019. An annual painless, non-invasive fecal immunochemical test is both less expensive and more effective at identifying early disease, with no chance of complications. Plus, no prep fluid needed! (In the immortal words of the great philosopher Dave Barry: “I don’t know what’s in that stuff, but it should never be allowed to fall into the hands of America’s enemies.”)

8. Pop popcorn

Every Quizzi-fan knows by now that the single most popular snack food, the ubiquitous granola bar, is full of sugar. Quaker hides the sugars deep in the ingredients labels. Clif Bars "hide" the sugar with a ten-dollar synonym: "Organic brown rice syrup." Not to mention "organic cane syrup," "cane sugar," (somehow "cane" makes it healthier?) and "barley malt extract."

Popcorn has no sugar. It also contains fiber, which is by far the #1 deficiency in the American diet. Sprinkle some olive oil on it and, yes, even a touch of salt...to get something which is tastier, healthier and more economical than a packaged granola bar.

9. Change your light bulbs.

No, not to the more energy-efficient ones. Quite the contrary: to the less energy-efficient ones, for your bedroom. The old-fashioned, Thomas Edison-type incandescent bulbs are far more conducive to sleep than the new curlicue ones , because they give off much less blue light.

If you have trouble sleeping, this swap-out should be high on your to-do list.

10. Don't waste your money on nutritional supplements.

Most supplements for most people are a complete waste of money and may cause harm. There are exceptions, of course. FIber-rich supplements for people who don't get enough. Vitamin D for people who don't get any sun or eat dairy. Folic acid and possibly iron for women who are, or plan to become, pregnant. B-complex for heavy drinkers. B-12 for older people in some cases and vegans in all cases. Melatonin does help some people sleep a bit longer. And if you want to take a daily multivitamin, far be it from us to stand in the way. A good list of indications and supplements can be found here.

But that's where it ends. In most other cases, employees are wasting their money. In some cases, such as iron supplements, they could seriously harm themselves. For example, in the ideal world, t hose aforementioned iron supplements would be available only by prescription.

And don't assume the information on supplements is correct. Vitamin B3 supplements, once thought to protect against heart attacks, turn out to make them more likely. Vitamin E supplements, once thought to protect against cancer, increases risk of prostate cancer.

Almost without exception, any supplements whose name you don't recognize, or which have ten+ times the daily recommendation of a nutrient whose name you do recognize, are much more likely to harm than benefit you.

11. Got back pain? Do nothing.

Aside from trauma, 90% of back pain goes away on its own...but 90% of people are convinced they are in the other 10%. Advice:

Don't get surgery. Spinal fusions are getting easy and easier to perform, meaning easier to agree to. A one-day procedure in an outpatient clinic sounds much more palatable than a major inpatient surgery. But the long-term outcomes are still the same: lousy.
Don't "baby" your back. Bedrest might make it worse.
Fancy scans are often wrong .

Just go about your daily activities and wait it out. This works most of the time. Obviously, consult a doctor if symptoms include a fever, numbness in the legs or groin, or loss of bladder control.

Postscript: Since publishing this, we have received complaints from 3 musculoskeletal vendors that we're wrong, and that "early intervention" -- more than coincidentally, what they do -- is key to recovery. Unfortunately for their business model, the only thing "early intervention" does is allow these vendors to charge and claim credit for recoveries that would have happened anyway,

12. Ditch the situps.

Speaking of back pain, these are earth's most overrated exercise. They -- along with "crunches" -- can make back pain worse. Planks are the way to go.

13. Advil and icing probably slow recovery.

These are the two cheapest and safest pain relievers (especially ice, of course). But they do nothing to speed recovery. Ice probably slows it down. Advil is the same, and also includes the possibility of side effects. It is among the safest drugs if taken for a short period of time, but people tend to take four pills four times a day for rather extended period. No matter how safe a drug is, it is still a drug, and could be harming you in ways that you are not aware of. In the case of Advil, it could be kidney damage. This is especially the case if, like many people, you have high blood pressure, which itself stresses your kidneys.

14. Walk faster.

The #1 excuse not to exercise is “I-don’t-have-the-time.” But one exercise saves time – and is free besides: faster steps. A faster pace of steps noticeably reduces risk. How fast is fast? Fast enough that you are conscious of your speed. Fast enough that you can feel your heart beating. And once we can return to crowded airport vestibules, fast enough to get annoyed at how slow everyone else is.

Speaking of steps, data is not the plural of anecdote. Nonetheless, I myself have taken all of these behavior change steps. As a result, while I do get annual Hb a1c screens due to a sweet tooth, I haven’t been to the doctor since the wacky, crazy, "treatment trap" that spawned Quizzify.

Or have needed to go, because my PCP plays in my ultimate frisbee group. She says that's my checkup. Now you know. See how much fun it can be to waive your HIPAA rights?