Healthy Behaviors Are Contagious

Today’s Presenters

Luke Matthews, Ph.D.
Director of Data Analytics
Activate Networks

Tricia Leahey, Ph.D.
Asst. Professor of Psychiatry/Human Behavior
Weight Control & Diabetes Research Center

Rajiv Kumar, M.D.
Founder & Chief Medical Officer
ShapeUp


ShapeUp’s Mission Statement

Creating a healthier world by
leveraging social influence to
engage people in healthy activities


Today’s Agenda
1. Spread of human behavior in
large social networks

2. Social influence in a team-
based wellness program

3. Implications for population
health management

4. How you can leverage this
knowledge to achieve
success

5. Questions & Answers


Spread of Human
Behavior in Large
Social Networks


Luke Matthews, Ph.D.
Director of Data Analytics
Activate Networks


Harvard Innovation, Deep Health Expertise
• Our management team has built/led large health
companies

• 15 years of research from Harvard and UVA

• National acclaim from “Connected”
by co-founder Dr. Nicholas Christakis


Human Behaviors Are “Contagious”
• Lifestyle behaviors (good & bad)

• Clinical practice patterns

• Medication use

• Fraud & criminal behaviors

• Consumer purchasing decisions


Health Is Collective


Obesity In The Framingham Heart Study

N. Christakis and J Fowler, The spread of obesity in a large social network over 32 years. New Engl Med 2007 357:370


Spreading Contagions In Networks


Smoking In The Framingham Heart Study

N. Christakis and J Fowler, The collective dynamics of smoking in a large social network. New Engl Med 2008 358:2249-2258


Other Network Effects On Health
Obesity Christakis NA, Fowler JH (2007) The New England
Journal of Medicine 357: 370-379.

Smoking Christakis, N.A. and J. Fowler. (2008) The New England
Journal of Medicine 358: 2249-2258.

Alcohol Rosenquist J.N., J.H. Fowler, J. Murabito, and N.A.
Christakis. (2010) Annals of Internal Medicine 152, 426-
433.

Depression Rosenquist J.N., J.H. Fowler, and N.A. Christakis. (2011)
Molecular Psychiatry 16:273-281.


Activate Networks Wellness Technology
1 Map and identify employees
Most influential, “influencees,” influence patterns

2 Overlay health information
Health behaviors, participation in programs

3 Highly focused outreach

4 Two basic network engineering techniques
Build new ties and plan teams
Target key influencers


Target The Key Influencers

Node size reflects BMI

Nodes are dots if the
individual did not
engage in program

BMI significantly correlates across network ties, even after accounting for
location and rank.
(Matthews et al. in revision)


Key Takeaways From Our Research
Network approaches can help with the two key issues
in corporate wellness programs
Engagement
Using network effects will increase engagement and
participation

Sustainability
Using network effects will help participants maintain their
engagement and activity


Social Influence
In A Team-Based
Wellness Program


Tricia Leahey, Ph.D.
Assistant Professor of Psychiatry/Human Behavior
Weight Control & Diabetes Research Center
The Warren Alpert Medical School of Brown University


Why We Conducted This Research
• There is strong evidence that obesity
spreads through social networks

• Given our focus on weight reduction,
we aimed to investigate whether
these same social influence
processes can be harnessed to
promote healthy behavior change

• No one had examined whether the
social component of wellness
program enhances outcomes


About Shape Up Rhode Island
• Annual workplace-based campaign to
promote exercise and weight loss

• Thousands participate each year

• Team competition (5-11 members)

• 12 week online program includes
personal and team progress tracking,
weekly newsletters, community events

• Yields significant weight losses (-3.7kg)1
and increases in physical activity
(+2,300 steps)2

1Wing et al., Obesity, 2009; 2Leahey et al., Prev Med, 2010


The Team Effect For Weight Loss

• Team members influenced individual weight loss
outcomes
• Individuals on the same team achieved similar
weight losses (ICC = 0.10)

Leahey et al., Obesity, in press


Optimal Environment For Weight Loss
• Effects of team
characteristics on
individual weight loss

Those who reported
greater teammate social
influence for weight loss
had higher weight losses

Having more teammates
in the weight loss division
yielded greater weight
losses



Clinically Significant Weight Loss
• Team membership also influenced
the odds of achieving a clinically
significant (i.e. 5%) weight loss,
which is associated with reduced
risk for cardiovascular disease
and diabetes

• Achieving a 5% weight loss
clustered within teams (ICC=0.09)



Optimal Team Characteristics

• Effects of team
characteristics on
individuals achieving
a 5% weight loss
Greater social influence
for weight loss increased
the likelihood

Having more teammates
in the weight loss division
increased the likelihood



Team Effect For Physical Activity

• Team members influenced
individual physical activity
outcomes

• Individuals on the same
team achieved similar
increases in physical
activity (ICC = 0.09)

Leahey et al., Prev Med, 2010


Optimal Team Characteristics
• Team characteristics
influenced individual
activity outcomes
Individuals on teams
that had high levels of
activity within the first
two weeks of the Shape
Up program achieved
the greatest increases
in activity

Leahey et al., Prev Med, 2010


Key Insights From This Research
• Social networks impact weight loss and physical activity

• Wellness programs should tap the organic social influence
potential of coworkers, friends, and family to enhance weight
loss and activity outcomes

Ensure that everyone on the same team is working towards a similar
health goal

Set team goals to maximize social accountability and encourage
regular reporting of individual progress

Promote a culture of social support and cohesion among team
members by offering teambuilding activities


Next Steps For Our Research
• Conduct a randomized trial comparing an “optimal” team
environment to an “average” or “poor” team environment
and examine the effects on weight loss and physical
activity outcomes
• Further examine the social influence processes by which
social networks impact health

Social norms

Social modeling

Peer accountability

Social support


Implications For Population
Health Management


Turns Out Dr. Christakis Was Right
“…Social influence also suggests that it may be possible to
harness this same force to slow the spread of obesity.
Network phenomena might be exploited to spread positive
health behaviors.”

-Nicholas Christakis, M.D.


Key Takeaways from Today’s Webinar

 Health behaviors, like many other human behaviors,
spread in social networks

 Unhealthy outcomes that spread include obesity and
alcohol consumption

 Healthy outcomes that spread include smoking cessation,
increased physical activity, and weight loss

 Interventions that target key influencers are more likely to
achieve maximum engagement and activity

 Interventions that promote social influence, teamwork,
and shared goals are likely to produce better outcomes

How You Can Leverage This
Knowledge For Success


How You Can Leverage Social Influence

1• Map the social network of your population

2• Facilitate peer-to-peer recruitment through influencers

3• Focus on organizing teams and groups for wellness

4• Promote teamwork and peer support

5• Utilize competitions to organize & motivate

6• Share results & comparisons to promote accountability

7• Link incentives to team goals and team outcomes


Take Our Health + Technology Survey!
• How is technology shaping the way
you help your employees manage
their health?

• 10 minute online survey

• Chance to win a Fitbit activity tracker!


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Healthy Behaviors Are Contagious

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