By DAVID SHAYWITZ
Agency — the conviction I can shape my future — is a vital driver of human health and human potential.
It is also the factor overlooked by most digital health platforms.
University of Pennsylvania psychologist Martin Seligman, who has spent decades studying this, says agency boils down to the belief “I can make a positive difference in the world.” People with high agency believe there is something they can do next that might help – and then they actually try.
As Seligman emphasizes, the moments when we “try hard…persist against the odds…[and] make new, creative departures” are precisely when agency is at work. That extra effort and sustained determination — not just the mindset — shows up as improved performance, greater achievement, and enhanced health. It also manifests as resilience, enabling us not only to recover from adversity but (ideally) to bounce back as an even better version of ourselves.
GLP-1s highlight the power and promise of newfound agency. For many living with obesity, past attempts at weight loss reinforced a “cycle of despair” – trying harder mostly meant failing again. With the advent of GLP-1 medicines, many found that their weight would come down — and stay down. Oprah Winfrey called the feeling “a relief, like redemption, like a gift.”
The deeper change is psychological: for the first time in years, effort feels rewarded. GLP-1s unlock an agentic dividend: the motivational boost that comes from finally being able to take control of your health. That surplus sense of possibility can be channeled into the familiar health basics — moving more and sleeping better — but also, often more importantly, into how we show up in our relationships and communities, in the enthusiasm we bring to our hobbies and pursuits, into the totality of experiences that make life so meaningful.
Agency is the motivational currency of health, the ATP of behavior change – it lets success in one domain drive progress in others.
Connected fitness platforms have a similar opportunity. Each discrete achievement — finishing a class, riding three times in a week, noticing that the stairs feel easier or the back hurts less — is a small proof of “I can do this.”
In fixating narrowly on performance metrics, platforms like WHOOP, Oura, Peloton, and Tonal are leaving agency on the table. The opportunity here is to help people recognize, name, and bank their achievements, compounding the agentic boost that comes from each small win and making it easier to translate that confidence into the rest of life.
There are techniques that seem to support agency – cognitive reframing, elements of motivational interviewing, healthy conversation skills that help people generate their own plans, positive-psychology exercises that increase a sense of control and possibility.
But there isn’t a well-validated playbook. The 2021 Duckworth–Milkman exercise megastudy and a 2022 review by Feig and colleagues both point in the same direction: many thoughtfully crafted interventions, when rigorously evaluated, have disappointingly yielded only modest, generally short-lived changes in behavior; in the case of the megastudy, the effects observed were on average nearly ten times smaller than expert forecasts. Cracking this nut remains one of the biggest opportunities in health and technology.
Moreover, as public-health thinkers like Michael Kelly and Mary Barker, and Angela Duckworth in her emphasis on “situational agency” remind us, behavior is always embedded in social practices and daily routines, not floating in individual headspace. Kevin Hall’s work on obesity underscores the same point from a metabolic angle: in environments saturated with ultra-processed, hyper-palatable, calorie-dense foods, many people will overeat and gain weight. Our environmental defaults can make it much harder for individual agency to gain traction.
Powerful emerging technologies — from AI to connected devices and “health OS” platforms — now give us a new lever on this problem, but only if we use them thoughtfully. So far, most effort has focused on treating people as objects to be managed, with platforms competing to instrument every moment and compress our lives into ever more granular scores and rankings.
The real white space, I’d argue, is a platform that can reliably cultivate agency at scale. Building something like that would mean putting our most sophisticated AI and connected-health tools in the service of scaffolding human agency — helping people see real options, notch early wins, recover from lapses, and let small successes accumulate into a lived identity of capability.
None of this — from GLP-1s to digital health platforms — makes behavior change easy, but it does make sustained, structured support more possible than before, for patients, for consumers, and for employees trying to stay well while they work.
While we don’t have all the answers, designing for agency will likely emphasize:
- Early, undeniable wins that are small but meaningful (“I hurt less,” “stairs feel easier”).
- Guided choices instead of scripts or chaos, so people experience themselves as choosing, not just complying.
- Feedback that links progress to individual effort (“because you did X, you’re now experiencing Y”), rather than to the brilliance of algorithms or the wisdom of clinicians.
- Ways to bank progress so actions add up to a lived story: “I am someone who shows up.”
By focusing technology on enhancing our intrinsic potential rather than just crunching our extruded numbers, we can strengthen our agency and with it, our capacity to live healthier, more fully realized lives.
In a year when tech-forward health platforms are vying to incorporate the most agentic AI, our greatest challenge, and most important opportunity, may be figuring out how to leverage these ever-more powerful emerging technologies — with wisdom, humility, and humanity — to nourish the development of the most agentic people.
Dr. Shaywitz, a physician-scientist, is a lecturer at Harvard Medical School, an adjunct fellow at the American Enterprise Institute, and founder of KindWellHealth, an initiative focused on advancing health through the science of agency. This piece was previously published on the Timmerman Report
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