SANDY — Zoey Welsh remembers in great detail her epiphany — "my wake up call, I call it" — about needing a lifestyle change in the summer of 2015.
"I started noticing rashes all over my body and I thought I had diabetes, so I went immediately to my doctor and asked them to test me for that," Welsh, 24, recalled.
"That was my motivation to get healthy," she said, "because it kind of made me realize sickness is real and I'm not exempt, and I could definitely get diabetes if I kept going the way I was going."
In the nearly two years since that experience, Welsh has shed about 75 pounds. The Bluffdale woman credits working out at least five days a week, as well as preparing nearly all of her meals. She also completely cut fast food out of her life.
"So much has changed. I'm so much happier in my life," Welsh said. "It's definitely a lifestyle, so I've still been working at it every day."
While Welsh saw the writing on the wall and did something about it, it turns out many Utahns are eternal optimists when it comes to perceptions of their own personal health.
The reality of their well-being is less rosy than their own estimates, according to researchers who recently unveiled an extensive Utah health values study.
"Pretty much everybody in Utah thinks they're in good health," said Dee Allsop, chief executive officer and managing partner of Heart and Mind Strategies, a research-led consulting firm that partnered with Envision Utah to conduct the study.
"It's this classic situation in which (people say), 'I'm doing good, but everybody else has got a problem.' There's this denial issue going on," Allsop said.
Envision Utah spokesman Jason Brown said the study, conducted by surveying 1,012 Utahns in January and February, is the first to take a deep dive into what people in Utah think about their own health.
The findings were presented last week to various health care providers, educators, religious leaders and government officials during a Get Healthy Utah retreat at Salt Lake Community College's Sandy Campus.
Even a person's basic assessments about their own weight can be skewed, Allsop said. While only 11 percent of participants in the study said they believe they are very overweight, about 30 percent actually are, according to measurements conducted as part of the study.
The study found that 54 percent of respondents said they are at least slightly overweight, when the actual number was 62 percent. Separate research indicates about 60 percent of Utahns are overweight or obese. On average, participants in the study estimated that number would be 45 percent.
"All of us might be a little inaccurate when we guess how healthy we actually are," Brown said. "What it says to me is that, in order to help people be more healthy, (the first step) is helping all of us to understand where we actually are in regards to our health."
The buzzword at the Get Healthy Utah conference was "messaging" — or persuasively explaining the reasons behind efforts to improve Utahns' health. Strong messaging answers the "why" of health campaigns and can dramatically increase their effectiveness, said Heather Borski, director of the Utah Department of Heath's Bureau of Health Promotion.
"One thing we don't do a good job of in public health is connecting the message with any of the storytelling or values behind it," said Borski, who is also a board member at Get Healthy Utah. "We say, 'Get active, it's good for you,' and leave it at that."
The study's respondents were also asked about the warmth of their initial reaction to several health-related terms. For example, 88 percent reacted positively to phrases such as "eating right," while only 51 percent had the same response to "low-fat diet" and a paltry 29 percent felt positively about "diet" on its own.
"Words matter. And the way we refer to things evokes emotional responses," Allsop said. "How we're talking about diet makes a difference. There are ways we can talk about it that are going to get a more significant positive reaction."
About 83 percent of respondents reacted positively to the phrase "family mealtime," which is a telling response, he said.
"Connecting food with family — what a significant positive insight that is," Allsop said. "(There is) value making that connection."
There were also some negative phrases that appeared more motivating than others. The word "sedentary" garnered negative initial reactions from 71 percent from respondents, but the less formal phrase "couch potato" did the same among 86 percent of them.
Health improvement messaging needs to be more nuanced than all-negative campaigns aimed at reducing other harmful behaviors such as texting while driving, or different issues that focus chiefly on positive motivators, Allsop and other presenters said.
They cited fairly even division between respondents who say they react more strongly to aspirational ideas about their health (58 percent) and those who are more motivated by receiving messages that cause them to worry about negative consequences (42 percent).
"The most intriguing thing for me is just how powerful the emotional levers are," said Robert Grow, president and CEO of Envision Utah.
For Welsh, it was the dread of a possible illness in the future, combined with the realization that such a future could be sooner rather than later, that sprung her to action.
"It was the physical appearance of the rashes that made me realize the way that I was going," she said. "Diabetes was one of the things that really scared me because it's so serious and life-changing."
Respondents were also asked which positive life outcomes were "very important" or "absolutely essential" that would motivate them to want a healthy lifestyle. Only 4 percent of respondents answered that a better appearance was a "very important" or "absolutely essential" goal, running counter to the perceptions of many in the health care industry, Allsop said.
"A lot of the smarter weight-loss programs are connecting weight to health," he said. "(Physical appearance) is one direction we clearly don't want to be going."
Avoiding chronic disease (23 percent), improved physical abilities (18 percent), better mood (16 percent) and feeling healthier (11 percent) were all among the categories that more respondents said were "very important" or "absolutely essential" healthy lifestyle objectives.
In general, middle-age respondents tended to value those lifestyle advantages for the purpose of better taking care of their family and enjoying more time with them, while seniors and young adults generally valued them more for the purpose of self-improvement and increased productivity, the survey found.
Welsh appreciates her new physical appearance — "I love the way I look," she acknowledges — but what she's cherished most is what the change has done for her social relationships and family life.
"I was definitely depressed, and my mind wasn't healthy at all. I didn't really have a social life. (Now) I make a lot more friends. I've been dating for the past two years," she said.
Welsh says her improved lifestyle means she's more capable of making a positive difference in the lives of her loved ones.
"It would've been selfish for me to carry on the way I was," she said, "because I would've become a burden at one point. I did it for me, but I also did it for my family."