“We can now go on vacation and come back rejuvenated – instead of the way we normally come back which is exhausted, broke and fat.” The response is from one of our interviews at a leading wellness destination in the United States, where we are researching this fast-growing sector of the medical tourism industry. Wellness tourism is what we consider the “softer” side of medical tourism. People travel for three different types of medical treatment – invasive, diagnostic and lifestyle. Wellness tourism – also referred to as lifestyle tourism — involves nutrition, stress reduction, weight-loss and anti-aging. The potential for this segment of medical tourism is huge.
Research suggests that wellness tourists are not taking wellness vacations at the recommendation of their doctors, but are instead motivated by other forms of education, such as social networking, peer pressure, media, and access to online medical and health forums and research. Little, however, is known about the outcomes of wellness tourism. Do such vacations achieve much beyond what might be expected during the course of a more traditional vacation? Does wellness tourism lead to an improved physical and psychological wellbeing?
We have been conducting interviews and focus groups at Hilton Head Health, a facility in South Carolina, to find out more. The operations at this facility include a variety of spa treatments, fitness and physical activity sessions, caloriecontrolled gourmet meals and self-development lectures. The benefits that guests derive from a stay Hilton Head Health are two-fold: physical and psychological, although these categories clearly overlap.
Brand Manager Adam Martin said that although guests come with the idea that they want to lose weight, they also come with a broad range of health and fitness goals. He sees a growing number of otherwise healthy individuals visit Hilton Head Health for essentially a fun, active vacation experience along with the chance to take part in a variety of leisure activities that include “to go kayaking and walking, that sort of thing.” These guests say they are hoping to “do something good for myself – to rejuvenate,” he said. Other guests visit Hilton Head Health intent on jumpstarting a healthier lifestyle or to get back on track in terms of health and fitness. Some have acknowledged they need help managing their weight where repeated efforts to “go it alone” have failed.
Beginning a healthier lifestyle is facilitated at Hilton Head Health through educational lectures on eating habits and
…the weight doesn’t change as much as might be expected – it’s about getting healthy and getting your mind right.
personal development. Some guests describe being initially “clueless” about proper nutrition and so, for them, advice, such as how to “make conscious decisions” like controlling portion size, and monitoring sugar or sodium intake, is invaluable. One guest said eating right is not “just willpower, it’s good planning.” A wellness stay can also constitute a time in which guests “regroup mentally” and address bad habits. Another guest described a new level of “self-awareness” through the self-development lecture series. These, by extension, help manage the emotions and mindsets that encouraged weightgain in the first place – “getting to the root of why you eat.”
In terms of physical improvements, despite consecutive fitness and activity sessions on an intake of between 1,200 and 1,800 calories a day, actual weight-loss is fairly modest. By Martin’s estimation, guests average a 1-2 percent reduction in body mass per week. More rapid weight-loss is not, however, the primary aim of Hilton Head Health which bills itself as “more than a fat camp.” Martin said, “The weight doesn’t change as much as might be expected – (but) it’s about getting healthy and getting your mind right….that’s kind of what our program is about.”
Guests may visit Hilton Head Health due to health concerns ranging from minor to more severe. They may have had a “wake-up call” that prompted them to seek out a destination like Hilton Head Health. More severe health concerns may include hypertension, morbid obesity or advanced stages of diabetes rendering guests, according to Martin, “ticking timebombs” by check-in.
Good news for these guests is that with changes in diet and activity levels, physical improvements are typically rapid. Within an average stay of two weeks, changes in lipid profiles that Martin routinely witnesses include reductions in blood pressure by 10-20 points and cholesterol levels by 20-30 percent, in addition to general increases in flexibility, endurance and strength. The seriousness of such health concerns is not lost on guests. Some people, said Martin, “view this as their last opportunity to change.”
Hilton Head Health employs self-determination theory (SDT), a motivational practice within the positive psychology tradition, to gain deeper understanding of the benefits guests derive from a stay at a wellness facility. In recent years, SDT has gained considerable currency in applied research fields, such as health and leisure sciences. A crucial distinction relative to other theories of motivation is that in SDT, well-being may be predicted to the extent that three universal and fundamental needs — autonomy, competence and relatedness — are satiated or thwarted.
In SDT, an autonomy supportive environment is one that fosters basic need fulfillment through encouraging autonomous motivation, as the term suggests. An individual also behaves autonomously when intrinsically motivated rather than performing behaviors out of duress. Hilton Head Health was described as a “very safe place” and instructors as “non-judgmental.” Guests also stated that in contrast to other facilities, Hilton Head Health was structured without being regimented. Attendance in exercise and self-development lectures is voluntary. As one guest said, “You can do whatever you wish, whenever you wish,” while progress within these sessions is entirely “at your own pace.” This approach was clearly appreciated by guests.
“It really is a good way to go compared to other places where there is a personal trainer barking orders,” said one. The approach reflects an emphasis on active experimentation rather than pursuing a physically punishing routine. Another guest said, “It’s about being active” and “learning the things that work.”
Intrinsic motivation, which is natural and spontaneous rather than forced, may be nurtured given the right conditions. One participant said, “all the trainers are very positive, not negative…so they are not very strict with you unlike coaches I have had in the past….therefore, you push yourself to be motivated to do the classes….to go to that next level.” Another said, “They bring out the inner spirit in you.”
The second basic need, relatedness, defines a universal desire to feel connected. The friendly banter and camaraderie among guests was described as central to the wellness experience. As one guest said, “We are all in this together…. (and) it’s a whole lot easier to go about this when you know you have a buddy.” Another said, “We are going through the same things together,” which in itself is “very therapeutic.” Beyond the services and activities they offer, a wellness facility may inadvertently support well-being through facilitating this primary need.
At Hilton Head Health, community tables in the dining room encourage conversation and first meetings. Another guest explained that the sense of being is “so connected” and a “family atmosphere” also “starts with the staff.” Social media, emails, and an interactive website help to sustain relationships post-visit. Said another, “I’ve made friends here that I can see being friends with for life,” and “that’s not something you expect to go home with.”
The third basic need, competence, defines the human propensity to feel effective. Although guests maintained that the emphasis is on “trying different forms of exercise” rather than “mastering them,” a sense of pride in even modest accomplishments was evident. One guest said that within less than a week of stretching and flexibility training, “I can actually touch the floor!” The lecture series also provides information that guests can apply in daily life. Guests gain “tools” and learn “to make conscious decisions” with respect to their health. “Education here is a huge part of it,” said one guest, while another commented, “the focus is on the fundamentals and that is something that stays with you.”
As suggested in focus group sessions, the most valuable benefits may not stem from activities directly. Consistent with wellness tourism studies that highlight stress reduction as a primary motivation for attending a wellness facility, an enhanced capacity to cope with life’s pressures post-visit may be the key to the popularity of wellness vacations. One repeat visitor said, “I feel like I’m defragging my drive whenever I come here.”
An increasing number of wellness facilities are responding to global demand, catering to the physical and psychological needs of guests while promising enhanced well-being – benefits that visitors can take home when the holiday is over.
A far cry from more traditional vacations spent lounging on a beach or pool-side chair, the question remains for wellness facilities: how to go about supporting well-being beyond traditional relaxation? Our research to date provides tentative insights into the manner in which psychological well-being is facilitated. Results of this preliminary study suggest that given a well-designed program, psychological need fulfilment is, in fact, supported.
A chief consideration for program design may be striking the right balance between flexibility and structure. For guests, it may be that in the never-ending cycle of work, family and social pressures, a chief benefit from taking a wellness vacation may be an enhanced sense of self-efficacy. One guest summarized the experience: a wellness facility “enables us just to step back and let some-one else take the reins for a little bit, to give us the strength or the abilities to move forward. I think all of us will feel a lot more confident when we step out of here, that we have the tools to take on another challenge.”
In this light, the extra money, individual effort and apparent popularity may actually be warranted. A wellness vacation is clearly not a stroll on the beach, but what more could be expected of a holiday than an enhanced ability to meet ongoing challenges of life?
A wellness facility enables us just to step back and let someone else take the reins, to give us the strength to move forward. Much as might be expected – it’s about getting healthy and getting your mind right.