David Shewitz
Agency—the belief that I can shape my own future—is an important driver of human health and human potential.
This is also a factor that most digital health platforms ignore.
Martin Seligman, a psychologist at the University of Pennsylvania who has spent decades studying this issue, says agency comes down to the belief that “I can make a positive difference in the world.” People with high agency believe they can do something next that might help—and then they actually try.
As Seligman emphasizes, in those moments when we “try hard… overcome the odds… persevere”…[and] Making new, creative departures” is precisely when agency comes into play. This extra effort and sustained determination—not just mindset—shows up as improved performance, greater achievement, and enhanced health. It also manifests as resilience, allowing us to not only bounce back from adversity but (ideally) to become better versions of ourselves again.
GLP-1 underscores the power and promise of the new agency. For many people living with obesity, past attempts to lose weight have fueled a “cycle of despair” – trying harder mostly means failing again. With the advent of GLP-1 drugs, many people find that they lose weight and keep it off. Oprah Winfrey called the feeling “a relief, like a redemption, like a gift.”
The deeper change was psychological: For the first time in years, the hard work felt rewarded. GLP-1 unlocks an agency bonus: the boost of motivation that comes from finally being able to take control of your health. This sense of excess possibility can translate into familiar health basics—move more, sleep better—but also, often more importantly, into how we show up in our relationships and communities, into the passion we have for our hobbies and pursuits, into the overall experience that makes life so rewarding.
Motivation is the motivational currency of health and the ATP of behavioral change—it allows success in one area to drive progress in other areas.
There are similar opportunities for connected fitness platforms. Each individual accomplishment—completing a class, riding three times a week, noticing that climbing stairs feels easier or having less back pain—is a small testament to “I can do this.”
Platforms like WHOOP, Oura, Peloton, and Tonal are giving up agency as they focus on performance metrics. The opportunity here is to help people recognize, name, and store their achievements so that the motivation from each small victory grows, making it easier to translate that confidence into the rest of life.
There are techniques that appear to support agency—cognitive restructuring, elements of motivational interviewing, healthy conversation techniques that help people develop their own plans, positive psychology exercises that increase a sense of control and possibility.
But there’s no fully proven playbook yet. The 2021 large-scale study of the Duckworth-Milkman movement and the 2022 review by Feig and colleagues both point in the same direction: Many well-designed interventions have disappointingly produced only modest, often transient behavioral changes after rigorous evaluation; in the case of large-scale studies, the observed effects were on average nearly ten times smaller than expert predictions. Cracking this puzzle remains one of the biggest opportunities in health and technology.
Moreover, as public health thinkers such as Michael Kelly, Mary Barker, and Angela Duckworth remind us in their emphasis on “situated agency,” behavior is always embedded in social practices and everyday life, rather than floating in the minds of individuals. Kevin Hall's research on obesity highlights the same point from a metabolic perspective: In an environment filled with ultra-processed, ultra-palatable, high-calorie foods, many people overeat and gain weight. Our environmental breaches may make it harder for individual institutions to gain attention.
Powerful emerging technologies—from artificial intelligence to connected devices and “health operating system” platforms—now provide us with new levers to solve this problem, but only if we use them thoughtfully. Most efforts so far have focused on treating people as objects to be managed, with platforms racing to analyze every moment and compress our lives into ever more granular scores and rankings.
I think the real white space is a platform that can reliably grow agents at scale. Building something like this means putting our state-of-the-art AI and connected health tools in the service of scaffolding human agency—helping people see real options, achieve early wins, recover from missteps, and let small successes accumulate into a life competency.
From GLP-1 to digital health platforms, none of this makes behavior change easy, but it does provide more ongoing, structured support than ever before for patients, consumers, and employees trying to stay healthy at work.
While we don’t have all the answers, designing for institutions might emphasize:
- Early, undeniable victories are small but meaningful (“I hurt less,” “climbing stairs feels easier”).
- Guide choices rather than scripts or confusion, so people experience themselves as choosing, not just obeying.
- Feedback that links progress to individual effort (“Because you did X, you are now experiencing Y”) rather than to the excellence of the algorithm or the wisdom of the clinician.
- Ways to accumulate progress so that actions add up to a living story: “I am a person who shows up.”
By focusing technology on enhancing our inherent potential, rather than just squeezing the numbers we are squeezed into, we can enhance our agency and, in so doing, our ability to live healthier, more fully realized lives.
In a year where technology's leading health platforms are racing to integrate the most empowering AI, our greatest challenge and most important opportunity may be figuring out how to leverage these increasingly powerful emerging technologies—with wisdom, humility, and humanity—to nourish the development of the most empowering people.
Dr. Shaywitz is a physician-scientist, a lecturer at Harvard Medical School, an adjunct fellow at the American Enterprise Institute, and the founder of KindWellHealth, a program dedicated to advancing health through agency science. This article was previously published on The Timmerman Report
