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Who says employee behavior change is hard? Here are 20 easy ones.

Updated: Mar 25

This is the third in a three-part series, but you don't have to link to the others. Everything is here in one place.

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-driven behavior change rarely sticks, so why not try knowledge-based behavior change, starting with the items below?

1. Replace nonfat yogurt with full-fat yogurt

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 the one below, so employees don’t get confused by misinformation.

Especially yogurt, but "low-fat or fat-free" anything is questionable these days, as fats are enjoying a renaissance among nutrition experts. This is not to say that these experts are right or wrong and that all fats are equivalent, but rather that all nutrition and other information provided by wellness vendors must be beyond reproach, rather than controversial at best.


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

We get more than 120,000,000 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

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 January 2021.

You know who else is against the annual physical? Most large medical practices. They call it the "periodic physical" now. For some people, the period is annual. For others, it could be five years, with most of us in between.

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."

For those employers that still “require” the annual 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?

For some employees it will indeed be 2023. But for many, 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.”)

Economics is one reason employees jump into a colonoscopy without trying the non-invasive alternatives first. Your employees may not know that you cover follow-up colonoscopies at 100%. Or do you? If not, you should...and then use Quizzify to spread the word. See our popular series on colon screening.

For the most in-depth look at the clinical and economic issues in colon screening, watch our YouTube recording of our "What's the Bottom Line on Colon Screening?" webinar.


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 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 a daily multivitamin may possibly improve brain function in older adults. 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, those aforementioned iron supplements would be available only by prescription.

Garlic supplements for heart health might actually raise bad cholesterol!

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, 80% of back pain goes away on its own...but 80% of back pain sufferers are convinced they are in the other 20%. Advice:

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. It certainly helps...and Kaia has the RCT, validated by the Validation Institute, to prove it. Vendor "early intervention" keeps people away from the orthopedist. Anything that keeps people out of the "system" is fine with us!


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. Stop demanding CT scans

Per capita, Americans get more CT scans than any other country. And yet our outcomes are worse. Oftentimes people demand CT scans without knowing the risks. A "scan" sounds harmless. You "scan" the horizon and the horizon is none the worse off for the experience.

Not so with CT scans. They have 100 to 1000x the radiation of an x-ray. The odds of radiation damaging your DNA or causing cancer are very low, but why take the chance? Children are especially at risk because their cells are still dividing rapidly. This data is 2013 but well-presented. Scans have increased about 10% since then. No wonder the Journal of the American Medical Association says "Americans are addicted to unnecessary scans."

Bottom line: do not "demand" a CAT scan. If it is inappropriate, it puts the doctor in an awkward position of either saying "no" and having to go into a long explanation, while upsetting the patient – or agreeing to something that is not clinically indicated.


15. You might get sick, so keep that tick.

COVID kicked ticks off the front page last summer, of course. But no one told the ticks, so tick bites are still climbing every year, thanks to at least 15 tickborne illnesses. The two most important things to know about tick bites are:

  • Just like the rhyme says: keep the tick, in case you get sick. As one of our reviews ("real quotes from real people with real names") says: "Keeping the tick prevented who knows how many unneeded tests." Not every lab handles ticks by a longshot, so do the research in your own area. A local lab is best because some diseases are more prevalent in some parts of the country than others, meaning local labs are more likely to spot them.

  • Some tickborne illness mimics COVID symptoms. If you think you had COVID but test negative and/or were vaccinated, it could very well be a tick bite.


16. Swap out your eyedrops.

Zoom meetings are going to be a fact of life, for personal as well as business meetings. They can be very stressful, so stressful that our Six Reasons We Hate Zoom Meetings became our most popular blog post not involving coffee, COVID, or ticks.

We tend to blink less than we should during these meetings, without being aware of that. As a result, our eyes dry out faster. These vials don't have preservatives in them, and are a much safer way to moisten your eyes and stay productive and comfortable than using the "get the red out" bottles of eyedrops.

So if you use eyedrops every day, switch to the vials and toss these in the trash. (Like heartburn pills and most other over-the-counter drugs, they are fine for occasional use.)


16. Predict that preemie!

What mom-to-be wouldn't want to know her risk of premature birth? It is the #1 complication of birth, affecting more than 10% of newborns, a percentage that has been climbing.

Quizzify did an entire webinar showing how much more accurate the newer prediction tool is than the old-fashioned questions+history-taking. Once predicted, the standard tools for prevention can be applied. But because they can require some considerable effort on the part of the mom, the mom must be committed to the protocol. Accurate testing encourages that commitment. You as an employer can help by paying for time spent at extra doctor visits. (The test itself should be a covered benefit.

We are not talking about a trivial difference. The current rate of accuracy is..

Adding a government-approved lab test to traditonal methods increases the accuracy to...

The thing is, employees have to know about this test, which must be performed in the 19th or 20th week, and that's why it's featured on our prenatal quiz.


17. Use cheaper sunblock

As long as it contains UVA and UVB protection at SPF 30+, cheaper sunblock is more effective at preventing sun exposure than expensive sunblock. And prices per ounce can differ by.a factor of 10.

How can that be? Quite simple. As with anything, the more something costs, the less people use. Consciously or unconsciously, we simply don't apply enough of the "high-priced spread."

And don't get us started on reapplying, which Quizzify teaches should be done every 2 hours in the sun regardless of whether you go in the water. Most people assume that the expensive sunblock lasts longer, but no. You are paying extra for the texture and packaging, not for more or longer sun protection.

This is probably more than you need to know for this blog post, but broad-spectrum sun protection includes both minerals that sit on top of the skin and reflect sunlight as well as chemicals that go into the skin and diffuse/absorb it. The latter get "used up" the more you are in the sun, and degrade over time even if you aren't. Hence the 2-hour rule.


18. Don't stumble into any old freestanding medical facility.

Which of these costs ten times the other?

Turns out there's a reason that private equity companies own free-standing ERs. It's because they can charge a lot and make a ton of money off patients thinking they are in an urgent care center.

PS. The one on the right.


19. Easy on the laxatives.

The popularity of weight-loss drugs has sent the laxative market into overdrive. Ther were even shortages in the fall. This is surprising because if there is one thing American industry excels at, it is producing seemingly endless quantities of stuff we consume too much of.

Our "Managing DIgestive Side Effects" quiz, which is part of our Weight Loss Drug Companion Curriculum, educates on the differences among the various types and brands of laxatives. Some are much safer than others.

PS The answer to #18 was actually the one on the left. See how easy it is to be fooled? That's why you have to teach your employees the difference.


20. 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 now that airport vestibules are crowded again, 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 16 of these behavior change steps (and my daughter is going to get the preemie test, for #17). 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?


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