Wednesday, July 1, 2026
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After a hospital admission, prior to treatment, or after stepping on the scales, people are often motivated to work on their health. Health apps that reward users with points or personalised intervention programs encourage healthier eating and more physical activity. However, long-term effects often remain limited.
How do we achieve structural behavioural change? Which methods are effective over the long term, and what psychological mechanisms underlie them? And how do we make the healthy choice the easy choice?
These questions were central during the June Medical Delta Café, organised in close collaboration with the Healthy Society Program. Under the leadership of Medical Delta chair Prof. Dr. Sanne de Vries, a lively discussion emerged between the audience and the speakers.
Knowing ≠ wanting ≠ doing ≠ sustaining
Knowing is not the same as wanting, wanting is not the same as doing, and doing is not the same as sustaining. With this single sentence, Prof. Dr. Marieke Adriaanse summarised research on behavioural change as the first speaker. Adriaanse is Professor of Behavioural Interventions in Population Health Management at Leiden University and strategic representative of the Healthy Society Program.
Even when people are motivated, motivation appears to have only a limited influence on actual behaviour, Adriaanse explained. Automatic behaviours, habits, and a lack of skills play an equally important role. And when new behaviour is successfully initiated, sustaining it becomes the next hurdle: only about 55% manage to maintain it in the long term.
But what makes behavioural change so difficult? One reason is conflicting goals, as being more physically active is usually not the only ambition. “In the evening you want to exercise, go to bed on time, and you also have social commitments,” Adriaanse reflected back to the audience.
In addition, motivation is not stable: at some moments the drive is stronger than at others. When you wake up in the morning, you tend to be more motivated than after a long working day. Finally, the environment has more influence on us than our good intentions. “We fall back on impulses and old habits.”
She offered several tips for behavioural change:
- Be realistic: failure is part of the process. If you take this into account from the start, you do not have to give up immediately after a setback.
- Make it more enjoyable: sustaining behaviour is easier when it is rewarding. The “carrot at the end of the stick” should truly be something you enjoy.
- Make it easier: nudging helps. Not by prohibiting, but by gently steering people in the right direction.
“The key ultimately lies in habit formation. When a behaviour is performed often enough in the same context, an association is formed. It becomes automatic, and you no longer have to consciously think about it. Good intentions then hardly play a role anymore.”
Cultural shift in lunchtime behaviour
Natasja van der Lely from De Nieuwe Lunchcultuur opened her talk with a simple question: who had coffee today and consciously considered whether it was a healthy choice? “No one does that, because drinking coffee is not really a choice, it’s a habit. If much of our behaviour is unconscious, then the question is not how behaviour changes, but how behaviour becomes normal.”
This also applies to how we have lunch at work. Millions of employees in the Netherlands together account for 25 million lunch moments per week. “Yet we rarely talk about the work lunch as a setting where behaviour is shaped.” And that is surprising, Van der Lely argues. The environment almost always overrides intention. People do not change because they become convinced, but because the environment changes, she told the audience. “There is therefore a huge opportunity to develop a healthy, vital and sustainable Netherlands through the work lunch.”
Having lunch together, going for a walk together, this often has more impact than any guideline
“Connection is the most underestimated element of a healthy lunch. Having lunch together, going for a walk together, this often has more impact than any guideline. Moreover, change works better when people help build it themselves: by first asking about their own ambitions and wishes, rather than imposing solutions.”
The initiative 'De Nieuwe Lunch Cultuur' is a movement that works on culture, systems, and the economy. “If we want the Netherlands to eat more healthily, make sure there are vegetables on the plate every day during the workplace lunch.” According to Van der Lely, this approach has multiple benefits. “Many employers name their people as their most important asset. The work lunch offers a chance to invest in that.”
Self-organising exercise clubs
About ten years ago, Prof. Dr. David van Bodegom (LUMC) gave a lecture in The Hague on the importance of physical activity for older adults. Scientific research shows that older people can quickly become stronger, more mobile, and mentally fitter through targeted training. At the same time, these effects often disappear once a program ends and supervision is removed.
One of the attendees, an older man from Ulft, shared his own experience. Without any program or supervision, a group of older adults in Ulft had been meeting daily for years to exercise outdoors together. He invited the professor to visit, which eventually led to the creation of the ‘Vitality Clubs’.
It quickly became clear that the idea worked in three very different neighbourhoods in Leiden: exercise groups for older adults, organised by older adults themselves, proved to function well in various districts without the help of professionals. “Precisely by letting older people organise and guide it themselves.” This led to healthier behaviour and greater social cohesion in the neighbourhood.
The self-organising and self-supporting Vitality Clubs are low-threshold and free of charge. People put on their shoes, meet on a patch of grass, and exercise together. “The people you see there live in your neighbourhood; you see them on the street and you meet them in the supermarket. That is why it works so well,” said Van Bodegom. “They are all people like you.”
Around 90% of participants stay involved. Van Bodegom said: “People feel fitter and healthier, but they also enjoy it and find it pleasant. That is why they keep coming back.”
By now, around a hundred of these Vitality Clubs exist, spread across the Netherlands from Groningen to Goes. One of the people who set up a local Vitality Club is Mirjam Touw. She worked for many years as a community nurse at Buurtzorg — according to Van Bodegom, exactly the kind of professional who can successfully establish such an initiative. “A community nurse is guided by the principle: do not take over anything the client can do themselves. That fits well with the philosophy of Vitality Clubs.”
The contagious effect of outdoor exercise
Community nurse Mirjam Touw closed the session as a practitioner-speaker. Touw lives and works in the Vijfhoek neighbourhood in Haarlem: an old urban district with considerable challenges for older residents, such as narrow alleyways, steps, crowded pavements, and old, non-adapted housing. “But everyone lives there with great love and never wants to leave. So we make sure, together, that we can continue living there together.”
People indicated that they wanted to meet and see each other more often, and to move more. From Buurtzorg, Touw therefore set up a Vitality Club. “We simply started three months ago: twice a week, in the morning between 10 and 11.” In the beginning, attendance varied: some people stayed, others dropped out. Gradually, the residents took over the club themselves, while the initiators moved into a supporting role. There is now a stable group of about ten to twelve participants who meet regularly.
Low-threshold accessibility plays an important role here: no registration is required, and people can always join or leave
“Low-threshold accessibility plays an important role here: no registration is required, and people can always join or leave,” says Touw. And this leads to results, because exercising outdoors is contagious. “People are curious about what we are doing. They stop, watch, and decide to join in. Just recently, a young woman joined us: she was out on a running route and spontaneously decided to take part in a session.”
Ambassadors for healthier behaviour
In the closing discussion with the audience, the role of ‘peers’ as ambassadors was among the topics. “In the Vitality Clubs you see that peers take on the role of coach and take the lead, does that also matter in other initiatives?” asked moderator Sanne de Vries to the speakers and audience. Natasja van der Lely recognised this: often within organisations there are a few enthusiasts who bring the rest of their colleagues along into a healthier lunch culture.
From the audience, initiatives such as the network Nederland Zorgt Voor Elkaar, which includes thousands of caring communities, were mentioned: movements emerging from society itself. The discussion also touched on the role of government versus society: an ongoing tension between paternalism and active encouragement. “We should do it together, not against each other.”
For the closing networking drinks, Van Bodegom offered one final piece of advice with a wink: “The secret to sustaining healthy behaviour is making sure you also celebrate parties every now and then.”
Photo's: Frank de Roo
