162: The Habits of Healthy Aging with Dr. Kate Wolin
We are joined by behavioral epidemiologist Dr. Kate Wolin to unpack why so many health interventions collapse outside the lab—and what actually drives lasting change in the real world.
From frictionless habit design and daily self-monitoring to movement, sleep, and the muscle-preserving realities of GLP-1s, she reveals the behavioral strategies that truly move the needle on long-term metabolic and overall health.
Watch the full episode to learn how evidence-based behavior science can transform your healthspan.
Learn more about Dr. Kate Wolin:
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Transcript
Disclaimer: This transcript was generated by AI and may not be 100% accurate. If you notice any errors or corrections, please email us at phil@longevityroadmap.com.
The biggest thing that I think healthcare has historically gotten wrong is that if we tell people what to do, that's sufficient, right? Like, as if that's enough.
Welcome everybody. This is Buck Joffrey with the Longevity Roadmap and, uh, today interesting conversation with Dr. Kate Wolin about, uh, something a little bit, uh, different than we usually talk about. It's, it's a sort of more. Behavioral science and epidemiology. Um, you know, one of the things that I thought was interesting about this conversation is a discussion around apps and gamification.
You know, it's, it's one of the things that I think is one of the most, uh, helpful things in this space right now. You think about wearing an aura ring or wearing an apple watch and all that stuff. We engage in these things because we're. We're interested, we compete. You know, at least for me, when I look at these things, it's like, okay, um, if you have an AA ring, I gotta tell you, I guarantee you're gonna change your behavior if you wear it, you know, all the time because you're seeing literally things that affect your sleep and you.
Want to change them. So anyway, those kinds of conversations around epidemiology and health, uh, stuff that we don't usually talk about, which I'll think you'll find interesting, uh, and we'll have that right after these messages. Hey, longevity enthusiast. It's time to take it to the next level. I've been fine tuning my longevity regimen for years, and I look better and feel better than I did a decade ago.
In fact, my blood work is even better than it was back then, and it's all because of my data-driven regimen. And it's inspired me to create a course and community just for you. It's called the Longevity Roadmap, and I urge you to check it out. If you're tired of your belly fat, tired of being tired, or just wanna optimize yourself for the next 50 years, visit longevity roadmap.com.
That's longevity roadmap.com. Welcome back to Longevity Roadmap. I'm joined today by Dr. Kate Wolin, uh, behavioral epidemiologist at entrepreneur and uh, digital health innovator with more than two decades of experience. Uh, she earned her doctorate in epidemiology from Harvard. Went, uh, on to a faculty career at Northwestern in Washington University in St.
Louis, and then took her science into the marketplace she founded, scaled Down. Which is a clinically validated weight loss platform. Later acquired by Anthem and co-founded ccia, a company dedicated to embedding behavioral science into digital health products. Uh, her work sits at the intersection of rigorous research and real world impact helping individuals and companies alike design health solutions that actually change behavior.
Uh, and last, uh, welcome to the show, uh, Dr. Roland.
Thank you. Thanks for having me.
Well, let's, let's talk a little bit about, um, you know, the things that you focus on, which, uh, behavior, behavior change notoriously hard. Um, what did you see missing in the way healthcare was trying to tackle weight loss and wellness that pushed you to start, uh, scale down?
I think, um, the biggest, the biggest thing that I think healthcare has historically gotten wrong is that if we tell people what to do, that's sufficient, right? Mm-hmm. Like, and it, it started with like with cardiovascular disease, right? If we tell people their blood pressure and they know their numbers, that will.
Motivate them to change their lifestyle. Right. And that, that like the very first, like employee health screenings, right. They were all kind of predicated on this. Right. And, and you know, it was like, oh, if I, if I tell patients to quit smoking, they will. Right? Like, as if that's enough. Um, and I think what we've seen over and over again that we.
We tend to oversize this like push, I'm gonna push people to do something instead of looking at all of the forces that act against that push. Right? All of the friction that keeps people from doing that. And so we tend to push instead of pull in a lot of what we do in healthcare. And I, you know, and I think that that is, we ignore all of those friction forces.
And so the premise was scaled down was around daily weighing and. It comes from the idea that self-monitoring is a core behavior for behavior change, right? And, and that is a hundred percent true, right? So, and, and that is the premise for all kinds of self-monitoring, right? The diet tracking apps, the like very first pedometers, right?
That were spring loaded and they had a very simple ui, right? And the idea was these are tools to help people. Self-monitor and self-monitoring is super important for behavior change. Big believer in it. But it's not sufficient. And like we sort of have had this idea that like, we're gonna have people monitor, right.
Write down like the old school days. Right? Right. Like we'd give people a, a notepad and a calorie king book. Right. And it was like this thick. And you tell them to write down everything you ate and then look it up and, and do the calculation of your calories. And that's an important tool. 'cause most people.
Don't realize how many calories they're getting in a day. Right. And, and there's a useful learning that comes from realizing like, oh my gosh, like I'm actually taking in way more calories than I thought. Right? And, and that's an important moment in, and it's important value of a, of a feedback loop that, that self-monitoring creates.
And I don't mean to discount that at all, but what we see over and over again is that people that's really burdensome to do, it's very like taxing. It's time consuming. That one in particular requires actually a lot of numeracy skills that not everyone has. And so people don't stick with it, right? Like it, it's a behavior that just like you see this drop, whether we use digital tools or paper tools, you still see the drop.
You see less of a drop with digital tools, but you still see it either way. Um, it's really not something that. Aligns with what psychology thinks of as habit science, not what pop psych, not what like, you know, your, your average person, right? But like. Truly like habitual behaviors you don't have to think about.
Right? And you think about like diet logging as like, I'm sitting, we're having a meal, we're catching up, right? And I'm like, oh, let me pull out my phone, scroll to my app, open the app, scroll for the food, right? Like there's nothing habitual in that right now. We might get to the point where I can make it habitual for you to think about, I should log right because you repeat that behavior.
But it's very like. It's a multi-step behavior that's very hard to make habitual, whereas getting on the scale and weighing yourself in the morning is actually something much more amenable to habit formation. Right? You sort of think about like, I get up, I do my morning void. I step on the scale, I brush my teeth.
Like you can just sort of see how it becomes like the next thing in this sequence for people. And so the question sort of behind scale down, that was the question that Gary had done in his lab. If you just ask people to do that, you just ask them to step on the scale, right? Like, could you create that feedback loop, that self-monitoring loop without all of the friction?
And so I think that's what I think is really interesting in digital health and behavioral science around longevity is how do you make these behaviors you want people to do easier? How do you take the friction out of it? So that the healthy choice is the easy choice or the self-monitoring behavior that you want someone to engage in the time management skill you want them to develop.
How do we take friction out of that and make those things easier? 'cause we live in an environment that's obesogenic, right? We live in an environment that makes it far easier to eat, like ultra processed foods than to eat fruits and vegetables. Yeah.
You talk about some of these behaviors and when it comes to, like, for example, daily weigh-ins, just a couple thoughts on that for me.
Is that one, is that, yeah, it's easy to, it's a, an easy habit. That's true. But one of the things is there's an immediate, um, immediate feedback and what I think is interesting about apps and health apps, uh, that require very little effort, but that monitor you is uh, there's a gamification element. Where it just seems to me that, I mean, I find, you know, with oral rings and Apple watches, I constantly wanna know and like it's a game for me, right?
Like, did I sleep well? If I didn't sleep well, I try to sleep better tomorrow night. I'll do a few different things, that kind of thing. Um, so you've written that health apps need to be. More than useful. They need to be, you said delightful. Is that kind of what you're getting at?
Yes and no. I mean, I think, um, you find that delightful.
Not everyone does, right? So like, and, and I think that, you know, that's one of the things is like some, I think, my guess is you, you can be a little bit of a competitive person, right? And you're competing with yourself, which is what you enjoy about that. Some people really enjoy collaborative. Competition versus like a more like who's on top competition?
Mm-hmm. Right? Like what can we do together? So what I, when I talk to people about that kind of thing, I actually say like, stop thinking about your health app and think about like great video games, right? And like, not everyone is like super into video games, but like almost every, well, I'm gonna age myself.
Everyone, gen X, like had Donkey Kong or Frogger or Mario Brothers, right? Like we played these games and like the thing that was, that was amazing about them. The thing that makes for a great game, not gamifying enough. The thing that makes for a great game, right, is there's a learning to it, right? Like if I keep playing this level, I learn and I get better at it each time.
'cause I figure out what happens when I try X and it doesn't work, right? And I'm like, okay, I'm gonna try again. Because it's easy to try again. Right? And And I've learned something and then I'm gonna get a little bit further and a little bit further. So there's something in that that is like, yeah, it's competition, but it's also learning, right?
To your point, like I'm learning about like, oh, if I do this, I sleep a little bit better. There's a learning in that and people like that. It increases from a psychology perspective, right? And, and we talk about self-determination theory, this idea that people want to feel competent, right? So as you learn, you're building competence and then you're more confident and you have more self-efficacy that you're gonna be successful the next time.
If you feel like every time you tried the video game level, you failed and you didn't make any progress, you'd quit playing the video game. 'cause you'd be like, what's the point? I keep trying. I'm not getting any better. This game stinks. But if you get better each time, 'cause you learn, right? Then you're like, I wanna keep playing this video game 'cause I keep leveling up, I keep getting better.
Right? And you, it taps into something that is intrinsically motivated because you have choice, you have autonomy in it to decide like, am I gonna go after the mushroom or the, like the little guy spinning over here, right? Am I gonna jump or am I gonna swim? Right? Like you get these different choices in the video game.
And so you have choice, you have autonomy, and you make progress. You learn something, you get better at it. And, and so I think like what? Great games give you that, right? And great learning experiences in health give you that, right? So you're gonna try different things are, you're gonna come out of the gate fast in a race, are you gonna go slow and pace yourself, right?
And you kind of try different things and you learn, um. I think like when we tend to talk about gamifying in apps, what tends to happen is people are like, we're gonna make a leaderboard. We're gonna give people badges. And they're like, these really? Oversimplified, um, like almost like tropes of what great gamification is like, like you would n like you get fired at a video game company.
If that was like your proposal for how to make a great video game. Right. So when I talk about delight, it's that right element of it, of like, think about what makes for a great game design, but it's also like. Is the UI great, right? Like is it, is it pretty, like that matters to people, right? And the other part of it I say to people is like a lot of people, particularly patients with chronic conditions, do not want to be reminded day in, day out that they have a condition, right?
Like they want to feel normal. And so I, you know, I like, I'm like, remember, I'm not like if I have a new health app, I want you to put on your phone. Yeah, I'm competing with your Aura app and your Apple app. But really I'm competing with like Instagram and TikTok, right? Because I'm competing for your time and where you wanna put your time and are you gonna open my app?
Right? Like, are you gonna have a good experience? And so that might be that like. There's just some element of it that's enjoyable versus, it's just about like telling you that like your, you know, your weight is up from yesterday.
So what's an example of a, an app that's delightful?
Um, you know, I think it, it's different for different people.
Um, you know, but like, I remember I worked on an app with a team that was building for, um. Asian market. Right. And they had, they had built like all these Tamagotchis into the app, right? Because like, that was like a, that got great feedback from their users, right? Of like, as they did things, they got to like hatch their tamagotchi, right?
And I was like, you know, I wouldn't bring that to a market for the Medicare advantage population in the US right? Because probably not going to be delightful for them. Um, and they might actually find it like. You know, like, oh, you're trivial trivializing my healthcare condition. Right? So there's some element of it that is context, um, and population specific that you have to consider.
And it mi might be different for different groups of people, right? But like, if you're designing a health app for kids, like it sure as heck isn't gonna look the same as you're designing a health app for like my dad.
Yeah. Let's go back to the idea of just behaviors in general. So if you had to pick, say, the top two or three behavioral strategies that consistently move the needle for people, you know, across, say, weight, exercise, sleep, what would they be?
Um, I'd start with movement, right? I, I think it's the thing that is associated with so many chronic conditions, right? And. Uh, like it, you know, it, it's like the drug that has no side effects, right? So, you know, like any, some is better than none, right? There's a, there's a enormous health risk to not moving.
Um, you know, people have to kinda start where they are and progress up. Um, but, but for me, that's, that's the big one. I, you know, sleep is the one that I think also fascinates me 'cause. Makes me feel old. But I did train some number of years ago. We didn't talk about sleep at all. Right? Like I, I did a, I did a multiple risk factor interventions multiple times for cardiovascular disease, for diabetes, for cancer prevention.
Sleep wasn't on the table. Um, and so I, I think it is, it's great that we're talking about it. It's great that the science has evolved, which is fantastic. Um, you know, and I think it is. One that just like went underappreciated for a really long time.
Sure. I guess as, as a behavioral epidemiologist, um, you look at both the personal and population level, so what's the biggest gap between what works in a lab study and what actually sticks in the real world?
I think what in the labs we, historically we did a lot of studying, like single factors in isolation, right? Like fiber vitamin, like whether it was a macronutrient or a micronutrient. I think this was like one of the challenges of, of a lot of the work that's happened in nutrition. Um, right. And then you realize like, if I'm increasing my fiber, like am I decreasing protein?
Right? And like the example I give people all the time is like. I went to, you know, I went to college in the Snackwells era, right? Where we were all told like fat was bad, right? With this very wonderful intent of cardiovascular disease, right? And we didn't separate. Like a lot of the messaging, right? I would say this, a lot of the scientists knew, but a lot of the messaging in an effort to simplify for people didn't distinguish between saturated and unsaturated fats, right?
And, and so we took all fat out of things, but what we replaced that fat with was a lot of sugar, right? So you ate fat free cookies, right? Rather than sort of saying, eat fewer cookies, right? It was like, so, you know, it was like there were people eating like a whole box of fat-free cookies, like. It's not, it's not a good choice either way.
Right? And so I think we tend to end up with these, the question like, and I remember having a conversation with someone and she was like, had very successfully lost an enormous amount of weight. And she was like, you know, I've realized I can at the end of the day have a glass of wine or a small scoop of ice cream and I can keep my weight off, but I can't have both.
So I have to decide which one is more important to me and like, which one leaves me feeling satisfied at the end of the day? And to me it was this great example of like when you're having an individual level conversation, you can talk about the trade-offs that people actually make in their decision making in their lives, right?
Like and the sleep versus exercise one is a great example, right? Like, are you gonna get eight hours of sleep? Are you gonna get seven hours of sleep and get a workout in? Because many people actually make those very real trade-offs every day 'cause their lives are busy. Um, and so we tend at the population health level to talk about like, these are the things we want you to do.
Right. But at an individual level, like. You know, people are making trade offs, and so talking about those, like, I, you know, trade-offs to me is like the fun part of a conversation, right? Like the, I remember, you know, I, I talk a lot as a cancer prevention researcher early in my career about eating fruits and vegetables.
And I remember someone saying to me, but like, organic strawberries are so expensive. And I was like, who said organic strawberries were like, the thing, you know? And I was like, so. You know, like, yeah, if you can afford organic, and organic is available, like great, right? But I'd rather you had a non-organic apple than a, or orange, right?
Than like did a highly processed snack food, right? Because organic strawberries aren't available. So the question for me is, what's the trade off?
Yeah. Yeah. So you've worked with, you know, major players like, uh, um, in, in terms of like, um, uh, health insurance companies, Anthem, Optum. So what advantages do, I mean, I can imagine, but you know, you'd let us know what, what you're seeing in terms of these large platforms having the advantage of scaling behavior.
I, I think they do have an advantage at, of being able to scale something, right? Mm-hmm. They can reach a lot of people and I think that also places limitations 'cause you're trying to build for everyone, and that sometimes the risk is you build for no one. So I think sometimes there are startups that have an advantage 'cause they understand their population really well.
Um, and I can give you an example. I was talking with a colleague in the behavioral health space, right? And so employers and payers have a lot of solutions in the behavioral health space, but sometimes a company that really understands X specific diagnosis. Does much better because they meet the needs and they understand the needs of that population much better.
And so I think sometimes what happens with these big players is they build like a wellness solution or a health solution. And what you might do for patients with diabetes and patients at risk of stroke are different, right? Like maybe not entirely. They both should exercise, they should both eat well, but like the barriers may be different, that sort of thing.
So I think. We all would like to get to a place with more personalization, right? Where we can tailor solutions to that need. But I think sometimes what's happened with those is they'll say like, okay, Kate is, doesn't eat any vegetables, she doesn't sleep enough and I dunno, pick something. Right? Like she's smoking, right?
And then they send three different solutions to me. Versus saying like, Hey, if Kate slept more, she might be less stressed and then she's more open to and more successful in a smoking cessation intervention or whatever that might be. Right. But thinking about how like we actually are whole people, we're not sort of in these individual things.
Sure, sure. Well, uh, just to get into some, a few specifics, I'm just curious. Yeah. Uh, a lot of people these days when it comes to weight loss, you've got GLP once. Um, you know, changer resistant training, protein targets. So from behavior perspective, what's the biggest pitfall do you see about, you know, trying to sustain body composition in metabolic health?
I mean, in, in the context of. All of a sudden you got G GLP ones and it's like this miracle drug and
Yeah. And they are, right. And they have, I mean the, mm-hmm. I think the, the miracle of GLP ones is we keep learning about more benefits from them. Yeah. You usually, you think of like, drugs come in the market and we learn about like, oh, there's actually this side effect or that side effect.
Right. And we're just learning really interesting additional, um, therapeutic benefits from them, which is. Kind of a, a very different world for us to be in. Um, you know, but, but I do think the, you know, just the, the risks with muscle loss are material, right? Particularly for. An aging population. Um, and I think about like the needs of aging women in particular, right?
Where you've got bone, right? You, you need that muscle strength to support around the bone. Um, you know, and, and I think that's a really important factor is sort of thinking through what are the, what are the needs of a specific population group, to your point around populations versus people. Um, you know, and, and what are, you know, what are folks, you know, are people also engaging in strength building exercises while they're on these drugs?
Right. And I know from having worked in a prior generation of weight loss drugs. You know that there can sort of be this like, oh, the drug is gonna take care of it for me for some people, right? And for other people it's like the drug is gonna unlock my ability to go, you know, be active, right? Like the drug has made me lose weight and now it doesn't hurt to exercise.
So now for the first time, like I can, I actually found out I like exercise, right? Because it doesn't cause pain anymore. And so I think it's also important that we don't make assumptions, right? Like, yeah, there are some people who are gonna say, I just wanna take the drug and I don't wanna do anything else.
And there are people who are going to take the drug and say, oh my gosh, this is a gateway for me to do all of these things that I like, didn't know I might like before.
Right. Right. Totally. So, um, another, I guess another area, women's health. Um, where do you think behavioral, uh, change science could make the biggest difference for women in midlife say, on menopause?
Oh, uh, I mean, I think the conversations we are having around perimenopause and menopause right now are fantastic. Right. We're, we're like, these were top. No one talked about it a few years ago, right? So that it's such I can't open Instagram these days without getting a, something in my feed about the topic, which is a fraction of my, my age and the area I work in, I suppose.
But, you know, I think the recognition that it is multifactorial, right? Like somewhere, right? We've documented between 30 and 40 different symptoms of menopause, right? Like there's not one. One way that people experience it. And so, to your point around populations versus people, um, I think it's such a great opportunity for us to think about what is someone willing to do?
And, you know, to where we started the conversation, how do you tap into that intrinsic motivation, right? Yeah. How do you find the, the thing that's gonna give someone a sense of autonomy, um, and a sense of competence, right? Because this, this kind of theme. I hear over and over again in the narratives. I, I went and saw a screening of the M Factor documentary recently about menopause.
Is, you know, just how unempowered so many women feel. Right? It's like, like I don't own my body. I don't recognize my body. Like I see, you know, like with the, you know, brain fog and they feel like they, they're just sort of like, you know, like, I don't know what's going on. Yeah. I don't recognize myself.
Right. And my, my family doesn't recognize me. And so, you know, I think that. The things that you can do to find, like where are the small wins? How do you help someone build up up that competence and feel like, okay, like I did a thing, I'm gonna build on that thing and continue to lean into it. I think that's one of the most important areas of opportunity.
Um. For, for behavioral science, for midlife women. Um, you know, and I think it's colleagues of mine, uh, at a couple different investment firms have done some reports around, like, I mean, midlife women control the economy, right? Mm-hmm. Like they are the chief medical officers of the family. They, they exercise enormous buying power, right?
Yeah. So if you talk about that population not feeling confident and empowered. What are you leaving on the table from a health perspective, but also from an economic perspective. Mm-hmm. And an ability to influence other people in the population. Right. Um, right. And, and so, you know, I think that that is just a really untapped opportunity in healthcare.
Interesting stuff. Uh, Dr. Woolen, I appreciate you being on the show today. Where can we learn more about, you know, your work and some of your companies?
Um, well, I, I have a, I guess my, like my website is the easiest place. Um, I haven't been great lately about writing, but I try to, I try to write on, on dr Kate Wolin.com, um, and, and link from there to things.
Um, but. That's probably the best place. Okay. I'm, I'm, I'm not on X anymore. Yeah, I quit. So
it's just addictive. It's addictive
was not a good use of my time. That
that's another story entirely. Right. So,
yes.
Thanks so much. Uh, thanks for having me. Thanks for listening. A quick reminder that while I am in fact a surgeon.
Nothing I say should be construed as medical advice. Now, make sure to include your physician in any medical decisions you make, and also, if you're enjoying the show, please make sure to show your support with a, like, share or subscribe.
