Beyond “Healthism”: Why I’m Rejecting the Performance Model of Health
Stop letting the wellness industry treat systemic failure as your personal flaw.
Imagine a factory where the air is toxic. The workers start coughing. Management doesn’t fix the ventilation. Instead, they hand out breathing apps. The app tracks your respiration, monitors your blood oxygen, and pings you with “personalized recommendations.” Breathe deeper. Try the 4-7-8 technique. Your breathing score is 67 — you can do better.
Some workers manage to bump their scores. Most don’t. The ones who don’t are labeled “non-compliant.” The ones who do still get sick — they just do it slightly more efficiently.
At no point does anyone open a window.
This isn’t a metaphor. This is exactly how the wellness industry operates. And after ten years of running a health tech company, here is the most honest thing I can tell you:
When a system makes people sick and then sells them tools to cope — while whispering that the sickness is their own personal failure — that’s not wellness. That’s victim blaming.
The Lie Inside the Truth
I want to be clear: the wellness industry doesn’t lie about the details. Sleep matters. Movement matters. Breathing techniques actually work. That’s all backed by real science.
The lie is in the framing.
When you’re chronically stressed because your job is precarious, your commute is two hours of gridlock, your food is engineered for addiction, and your healthcare costs a fortune — and then a wellness app tells you to “prioritize recovery” and “optimize sleep hygiene” — something cynical happens.
The cause of your suffering gets relocated. It moves from the system into you.
Suddenly, your stress isn’t a rational response to a broken world; it’s a “management issue.” Your burnout isn’t a systemic failure; it’s a “boundary issue.” If you’re sick, the logic suggests you just didn’t try hard enough. You didn’t track enough. You didn’t meditate long enough.
As Barbara Ehrenreich put it: when wellness becomes an ideology, “every death can now be understood as suicide.”
There’s a name for this. In 1980, sociologist Robert Crawford coined the term “healthism”: the ideology that locates health primarily in personal behavior — in your lifestyle, your habits, your choices — rather than in the social, economic, and environmental conditions you live in. His warning was precise: as long as healthism shapes our thinking, health promotion will remain “non-political, and therefore, ultimately ineffective.”
Forty-five years later, Americans spend $2 trillion a year on wellness. Population health is declining. Crawford was right.
The Data Is Screaming
If wellness apps were a clinical trial — spend $2 trillion, health gets worse — we would have shut them down years ago.
Obesity among young adults nearly doubled in a generation — from 23% to 40% — measured on scales, not self-reported. Depression rose 60%. Fatty liver disease in people under 30 doubled. Physical inactivity went up 5 percentage points during the exact decade that step-counting wearables went from niche gadgets to 600 million devices.
A study across 28 years of NHANES biomarker data — these are trained technicians physically drawing blood and measuring waist circumference, the same way, every cycle — found that physiological dysregulation has increased continuously from Boomers through Gen X through Millennials, in every sex and racial group.
Each generation arrives at adulthood measurably sicker than the last. And each generation has more health data than any civilization in history. More data, worse health. This isn’t a coincidence. It’s the logical outcome of a model that mistakes measurement for care.
Whose Fault Is It, Actually?
Here is the question the wellness industry does not want to ask. Because the answer collapses the entire business model.
Michael Marmot studied British civil servants for decades. People at the lowest employment grade died at three times the rate of those at the top — with identical access to the same doctors, the same hospitals, the same National Health Service. The difference wasn’t diet. It wasn’t exercise. It wasn’t how many steps they tracked. It was autonomy — control over their own work and life. Marmot’s conclusion: “What good does it do to treat people and send them back to the conditions that made them sick?”
Anne Case and Angus Deaton — he’s a Nobel laureate — documented that deaths from suicide, drug overdose, and alcoholism rose from 65,000 to 158,000 per year between 1995 and 2018 in America. That’s three full Boeing 737s crashing every single day, for decades. Not because people lost willpower. Because the economic and social fabric of working-class life was destroyed. “It is the loss of meaning, of dignity, of pride, and of self-respect that brings on despair.”
Robert Lustig, the UCSF endocrinologist, points out that 93% of Americans are metabolically unhealthy. His diagnosis is blunt: “Everyone is talking about healthcare, few people are talking about health, and nobody is talking about the food.” We didn’t hand smokers a cigarette-counting app. We regulated the tobacco industry. But with food — with work culture, with economic precarity, with the systematic destruction of sleep and community — we hand out apps.
Your job. Your commute. The air in your city. Whether you can afford childcare. Whether your boss texts at midnight. Whether you have one person you can call at 2 AM. The WHO has said it plainly: these social determinants are the primary drivers of health outcomes.
No wellness app controls any of them. But every wellness app quietly implies that you should be able to compensate for all of them — through better habits.
The New Solutionism: “The Bot Will See You Now”
And just when you thought the performance model of health had peaked, we are entering its ultimate phase.
As access to actual, living physicians becomes a luxury for the ultra-rich — or a six-month waiting list for everyone else — the system has found its perfect band-aid: AI Chat for Health.
Evgeny Morozov, the technology critic who wrote the book on Silicon Valley’s hubris, has a perfect word for this: “solutionism” — the compulsion to recast complex social problems as neat technical puzzles with app-shaped answers. AI health bots are solutionism at its most cynical. Because it’s becoming nearly impossible to see a real doctor, we are told to just talk to a bot. Here, have an LLM. Tell it about your symptoms. Let it give you more tips on how to fix yourself.
The pitch sounds democratic: world-class medical knowledge, available to everyone, 24/7, for free.
The reality is measurably different. The largest randomized trial on AI medical advice — published in Nature Medicine in February 2026, conducted by Oxford — tested what happens when the same powerful LLMs interact with real patients instead of doctors. The models that correctly identified the right diagnosis approximately 95% of the time when queried directly by clinicians gave the correct answer in less than 34.5% of cases when used by regular people describing their own symptoms.
Read that again. Same AI. Same medical knowledge. But accuracy dropped from near-perfect to barely a third — simply because the person asking wasn’t trained to ask the right questions, provide the right context, or evaluate the answer.
This isn’t a failure of the models. It’s a failure of the premise. We are handing people a powerful, complex tool and saying: “If you’re smart enough to use this correctly, you’ll be fine. If it doesn’t work? Well, that’s on you. You probably didn’t prompt it right.”
Sound familiar? It’s the same pattern. The same relocation of blame from system to individual. Except now it’s not just your diet and sleep — it’s your ability to correctly interface with artificial intelligence during a medical crisis.
We are handing people the world’s most sophisticated tools to help them ignore the fact that the building is on fire.
Why We Stopped Giving “Recommendations”
In our first year, we did what everyone else did. We gave advice. We set goals. And then I saw the reality in our own data.
We’d show someone their HRV crashing for weeks. They’d tell us: “I know, I need to sleep more.” But at 11 PM, after the kids are finally down and the day is finally over, they don’t sleep. They scroll. They stay up.
Not because they’re weak. Because the nighttime version of a stressed person runs on completely different machinery than the morning version.
BJ Fogg at Stanford calls it the “Information-Action Fallacy” — the belief that the right information changes behavior. It doesn’t. Wendy Wood at USC proved that 43% of daily behavior is habitual — automatic, driven by environment, not by willpower. The most rigorous wearable trial ever conducted (JAMA, 471 adults, 24 months) found that the tracker group lost less weight than the group without one.
And the neuroscience explains why. Chronic stress literally shrinks the prefrontal cortex — the part of your brain responsible for planning and impulse control. It grows the amygdala — the part responsible for fear and reactivity. The person who most needs to change their behavior is biologically least capable of doing it.
Byung-Chul Han, the philosopher, names the deeper trap: “The achievement-subject exploits itself until it burns out. Perpetual self-optimization, which coincides point-for-point with the optimization of the system, is proving destructive.” Nobody forces you to optimize — you do it voluntarily. Which makes the exhaustion feel like your fault too.
Giving a stressed person a recommendation is like handing someone with a broken leg a running program. When they can’t complete it, they don’t blame the program. They blame themselves. They feel shame.
And shame is the opposite of health.
So we made a choice. Welltory doesn’t give recommendations. No programs. No “streaks.” No discipline. No guilt. If a product makes a struggling person feel worse about themselves, that product is part of the problem. Period.
What We Do Instead: Translating Biology into Meaning
If we aren’t giving you a “to-do” list, what are we actually doing?
We are building the bridge between human biology and how life feels.
The wellness industry is obsessed with “optimization,” which is just a fancy word for treating your body like a machine that needs to be tuned. We make the invisible visible through metaphor.
Your autonomic nervous system is the lens through which you experience your entire life. When your physiology is in a state of “High Stress” or “Low Recovery,” it’s not just a number on a screen. It’s a filter on your reality.
It is the biological reason why a minor comment from your partner feels like a personal attack.
It is the reason why a task that felt easy on Monday feels like an impossible mountain on Thursday.
It is the reason why the world feels grey, sharp, and overwhelming.
Most apps see a low HRV and tell you to “breathe.” We see your vitals and help you understand why your reality feels the way it does.
We use metaphors—fluidity, turbulence, battery, flow—because biology is too complex for a dashboard, but it’s perfectly suited for meaning. When you can see the connection between your biology and your perception, you gain something far more powerful than “compliance.” You gain Agency.
You realize you aren’t “failing” at your job or your marriage; you are experiencing a physiological state that makes those things harder. When you understand the why, you don’t need an algorithm to tell you what to do. The path becomes obvious.
This isn’t wellness. It’s a way of making sense of yourself. It’s the realization that your “mood” isn’t a mystery—it’s a message from your nervous system. And once you can read that message, you stop being a victim of your biology and start being its partner.
Opening the Window
I should tell it out loud: An app is not a savior.
An app cannot fix the food system. It cannot give you a less toxic boss or an affordable apartment. It cannot replace a community. I refuse to be the person selling breathing apps in a toxic factory while the windows are nailed shut. I refuse to use AI to “prompt” people into believing they can ignore the fire in the building.
But there is a specific, quiet power in seeing.
When we reflect your data back to you as meaning—without judgment, without “goals,” without “streaks”—we are doing the only thing that actually matters in a broken system. We are helping you walk over to the wall, find the latches, and put your weight against the frame.
We don’t optimize the coughing worker. We help the worker see that the air is the problem.
Because once you see the smoke, you stop trying to “breathe better.” You start looking for the exit. Or you start looking for a way to fix the ventilation for everyone.
From that clarity—not from guilt, not from discipline, not from an algorithm—sometimes people make changes. Sometimes they protect their sleep. Sometimes they leave the job. And sometimes, they make the hardest choice of all: they finally believe that they aren’t the problem.
The choice to act is yours. Our only job is to open the window and let you see the air for what it is.
No shame. No blame. No pretending the air is fine.
Further Reading:
Barbara Ehrenreich — Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer (2018) A sharp polemic from a writer with a PhD in cellular immunology. Ehrenreich argues that the wellness industry converts systemic social failures into personal moral failures — and that the obsessive drive to optimize health can consume the very life it intends to preserve. The quote “every death can now be understood as suicide” comes from her analysis of healthism as ideology. 🔗 https://www.labyrinthbooks.com/natural-causes/
Anne Case & Angus Deaton — Deaths of Despair and the Future of Capitalism (2020) Nobel laureate Angus Deaton and economist Anne Case document how deaths from suicide, drug overdose, and alcoholism rose from 65,000 to 158,000 per year between 1995 and 2018 among America’s working class. Their conclusion: the cause is the destruction of economic dignity and social meaning — not individual weakness. 🔗 https://books.google.com/books/about/Deaths_of_Despair_and_the_Future_of_Capi.html?id=anK0DwAAQBAJ
Byung-Chul Han — The Burnout Society (2015) The South Korean-German philosopher argues that contemporary society has shifted from external discipline (”thou shalt not”) to internal self-optimization (”I can”). The result: individuals exploit themselves until burnout — and feel personally responsible for their own exhaustion. Source of the “achievement-subject exploits itself” quote. 🔗 https://books.apple.com/us/book/the-burnout-society/id1023741312
BJ Fogg — Tiny Habits: The Small Changes That Change Everything (2020) The founder of Stanford’s Behavior Design Lab introduces the concept of the Information-Action Fallacy — the false belief that giving people the right information will change their behavior. Fogg’s research shows that behavior change is driven by motivation, ability, and prompts — not data. 🔗 https://www.forbes.com/sites/melodywilding/2020/01/13/forget-big-goalswhy-tiny-habits-change-everything-according-to-a-stanford-professor/
Wendy Wood — Good Habits, Bad Habits: The Science of Making Positive Changes That Stick (2019) USC professor Wendy Wood’s research shows that 43% of daily behavior is automatic and habitual — not driven by conscious decision-making. The implication: information-based wellness interventions largely miss the mechanism through which behavior actually changes. 🔗 https://dornsife.usc.edu/wendy-wood/good-habits-bad-habits/
Evgeny Morozov — To Save Everything, Click Here: The Folly of Technological Solutionism (2013) Technology critic Morozov coined the term “solutionism” — the compulsion to reframe complex social and political problems as neat technical puzzles with app-shaped solutions. Directly relevant to AI health bots being offered as a substitute for systemic healthcare access. 🔗 https://www.publicaffairsbooks.com/titles/evgeny-morozov/to-save-everything-click-here/9781610393706/
Robert Crawford — “Healthism and the Medicalization of Everyday Life” (1980) International Journal of Health Services, Vol. 10(3), pp. 365–388 The original paper coining the term “healthism” — the ideology that locates health primarily in individual behavior rather than social, economic, and environmental conditions. Crawford warned that healthism makes health promotion “non-political, and therefore, ultimately ineffective.” Still widely cited 45 years later. 🔗 https://pubmed.ncbi.nlm.nih.gov/7419309/
Crawford revisited his own paper in 2026: 🔗 https://pubmed.ncbi.nlm.nih.gov/41730689/
Marmot et al. — Whitehall II Study (1991) The Lancet, Vol. 337(8754) The landmark cohort study of 10,314 British civil servants showing that mortality and morbidity follow a strict employment-grade gradient — even when healthcare access is identical. Men in the lowest grade died at three times the rate of the highest grade. The key variable: autonomy and control over one’s own work and life, not lifestyle habits. 🔗 https://pubmed.ncbi.nlm.nih.gov/1674771/
Wikipedia overview of the full Whitehall study program: 🔗 https://en.wikipedia.org/wiki/Whitehall_Study
Jakicic et al. — “Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss: The IDEA Randomized Clinical Trial” (2016) JAMA, Vol. 316(11), pp. 1161–1171 The most rigorous wearable tracker trial to date: 471 adults, 24 months, University of Pittsburgh. Result: the group using wearable activity trackers lost 2.4 kg less than the group without one. Directly contradicts the premise that more data leads to better health outcomes. 🔗 https://pubmed.ncbi.nlm.nih.gov/27654602/
Zheng & Echave — Physiological Dysregulation Across Birth Cohorts (2021) NHANES biomarker data spanning 28 years, across Boomers, Gen X, and Millennials. Found that physiological dysregulation has increased continuously across generations, in every sex and racial group — measured objectively by trained technicians (blood draws, waist circumference), not self-reported. Each generation arrives at adulthood measurably sicker than the last. 🔗 https://www.healthday.com/health-news/general-health/3-25-gen-x-gen-y-in-worse-health-than-prior-generations-at-same-age-2651169.html
Related PMC study on generational cardiovascular health: 🔗 https://pmc.ncbi.nlm.nih.gov/articles/PMC9154229/
Bean, Mahdi et al. — “Reliability of LLMs as Medical Assistants for the General Public” (2026) Nature Medicine, February 2026 — University of Oxford The largest randomized trial of AI medical advice to date: 1,298 participants. The same LLMs (GPT-4o, Llama 3, Command R+) that correctly identified diagnoses ~95% of the time when queried directly by clinicians gave the right answer in less than 34.5% of cases when used by regular people describing their own symptoms. Users with AI performed worse than the control group using Google. 🔗 https://www.nature.com/articles/s41591-025-04074-y
Oxford press release: 🔗 https://www.ox.ac.uk/news/2026-02-10-new-study-warns-risks-ai-chatbots-giving-medical-advice
U.S. Surgeon General — “Our Epidemic of Loneliness and Isolation” (2023) U.S. Department of Health & Human Services The 81-page advisory declaring loneliness a public health epidemic. Key finding: lacking social connection carries a mortality risk equivalent to smoking 15 cigarettes per day — greater than the risks associated with obesity and physical inactivity. The report calls for structural, not just individual, responses. 🔗 https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf
WHO — Social Determinants of Health (ongoing) The World Health Organization’s framework establishing that the primary drivers of health outcomes are structural factors — income, housing, working conditions, education, access to healthcare — rather than individual behaviors. The foundation for the article’s argument that no wellness app controls the variables that actually shape population health. 🔗 https://www.who.int/health-topics/social-determinants-of-health
Robert Lustig, MD (UCSF) — Metabolic Health Endocrinologist and author of Metabolical. His research supports the claim that 93% of Americans are metabolically unhealthy, and that the primary driver is the ultra-processed food system — not individual willpower or tracking failures. 🔗
https://robertlustig.com
This is one of the clearest signals I’ve seen from inside health tech not because it’s new but because it finally names what’s been felt.
The factory metaphor lands because it exposes the quiet fracture measurement has scaled but care has not. We’ve optimized for output visibility not human state.
The real unlock ( I believe) is in the distinction between who you are in the morning, and who you are at night. Not as a story, as a system shift. Same person, different operating conditions, different machinery online.
That’s where most systems break. They try to advise across states they never bothered to identify.
What’s needed isn’t another layer of recommendations, it’s classification.
A lens that locates you precisely in your current state physiologically, behaviorally, emotionally so the path forward doesn’t need to be prescribed, It reveals itself.
No guesswork,no overreach Just clarity of state, to clarity of action.