Effective clickbait doesn’t just happen. It’s carefully crafted.

Take this wildly misleading article from CNN: Not exercising worse for your health than smoking, diabetes, and heart disease, study reveals.

It’s one example — among many generated daily by various news outlets — of how a mundane observational study can be transformed into viral internet gold. In the days after it was published, this story was liked and shared hundreds times and sparked dozens of copycat articles.

We’ve dissected the methodology behind this story to create a step-by-step guide to making health care clickbait. Please note that this is intended for educational purposes only. It’s not recommended that you try this at home.

1. Find an observational study on a topic that will grab readers

Observational studies often deal with actionable things people love to obsess over — nutrition, exercise, sleep, sex, etc.

They use observational data, such as a survey or a database of medical records, to find statistical associations between two variables.

Research based on observational data is also in abundant supply. Many institutions are eager to promote such studies even though – as we’ve pointed out over the life of this 12-year old project – they can’t prove cause and effect.

In this case, CNN reported on a study from the Cleveland Clinic that explored the connection between aerobic fitness and long-term mortality.

Researchers examined data from 122,009 people who took a treadmill stress test at the clinic over a 24-year period. They also looked at Social Security data and medical records to determine how many subsequently died.

The study didn’t actually look at any data on exercise, even though “exercise” ended up in the headline.

2. Distort the heck out of the findings

Such was the case here, where the clinic issued a news release that disregarded that pesky fact that observational studies can’t prove cause and effect.

The study found the greater a person’s aerobic fitness, as measured in a single exercise treadmill stress test, the lower their mortality risk.

The study did not show that poor fitness causes death — only that the two factors appear to be related based on this treadmill data.

Yet the news released stated researchers found better fitness “leads to longer life.”

If you click on this link, you’ll see that the clinic also provided video, audio, and a script that reporters could follow – huge elements for broadcast clickbait. It’s like instant news; just add water, or in this case, your own reporter’s voice.

Press materials further distorted the findings with quotes like this from lead researcher Wael Jaber, MD:

This research shows that going from being sedentary to starting an exercise program – and increasing aerobic fitness – translates into a benefit that is similar to that seen from taking medications for high blood pressure, for high cholesterol, or not smoking.

That’s quite a leap. By suggesting a “benefit” Jaber, a cardiologist, seemed to ignore his own study’s caution that a statistical link between fitness and mortality in his study “does not prove causation.” As his journal article explained, “there may be many measured and unmeasured factors that contribute to this association.”

That statement is also a leap because nowhere did the study examine how much people exercised. So how could researchers conclude that starting an exercise program is as beneficial as taking high-impact steps like quitting smoking?

Clearly, they can’t — not  based solely on measuring what’s called peak metabolic equivalents, or METs, from a single treadmill stress test.

“The spin here is that they’re assuming that if you increase exercise, you’ll get your METs up and then have a lower mortality rate,” said Steven Atlas, MD, MPH, a primary care physician at Massachusetts General Hospital, in an email. “This may be true, but it is also possible that people with lower METs aren’t able to exercise more because they are less well.”

Going from a single treadmill stress test to claims about an exercise program is, to put it mildly, a stretch.

3. Add sensational quotes from a researcher

CNN boosted the drama with a quote from Jaber calling his study’s findings “extremely surprising.”

Jaber also provided a bevy of other misleading and dire-sounding comments, like this one:

Being unfit on a treadmill or in an exercise stress test has a worse prognosis, as far as death, than being hypertensive, being diabetic or being a current smoker,” Jaber told CNN. “We’ve never seen something as pronounced as this and as objective as this.

And this one:

Comparing those with a sedentary lifestyle to the top exercise performers, he said, the risk associated with death is “500% higher.” (See our warnings about using relative – as in this case – versus absolute risk reduction statistics.)

And this one:

You should demand a prescription from your doctor for exercise.

Reached via email, Jaber said he did not think his statements were misleading. He wrote: “We always talk about association and not causality in our reports. … You are asking me to fix the media, and that is an impossible task.”

4. Concoct a provocative headline

Clickbait requires an alluring headline. To achieve maximum shock value, this one reached beyond even the misleading message of the news release.

In a master stroke, CNN distorted another of the study’s findings — that a reduced fitness level appeared to be at least as good a predictor of mortality as traditional risk factors like heart disease, diabetes, and smoking.

The study did not show that skipping exercise is more harmful than having heart disease, being diabetic, or smoking.

Yet the lead and headline mangled that to say that lack of exercise is actually “worse for your health” than all of those things.

Of course, that’s not at all what the study said. But it certainly grabs your attention.

5. Watch other news outlets scramble to copy

Clickbait is a competitive business, with little incentive for actual reporting. As a result, copycat stories are rampant.

Two days after CNN’s piece, TIME regurgitated CNN’s reporting.The website Newsmax ran its own hyperbole-filled rewrite: “Just Sitting Around Deadlier Than Smoking, Definitive Study Finds.” 

Women’s mag Bustle teased readers with what appeared to be a fresh angle: “How Bad Is Not Exercising? A New Study Says It’s Worse Than Smoking, But Here’s Why You Shouldn’t Worry.”

But rather than clarifying the limitations of observational studies, Bustle made vague statements like this: “Exercise habits are unique to each person, and there are many factors that determine whether or not someone is healthy.”

CBS later came out with its own coverage, as did USA Today and Men’s Journal.

None of these articles — if we can call them that — advanced the reporting in a meaningful way. They all repeated the same mistakes.

Yet a Google search showed the story soon made its way to dozens of news sites around the world, translated into multiple languages. We can only wonder what people in places as far flung as Helsinki and Bangkok made of it.

Mary Chris Jaklevic is a reporter-editor, HealthNewsReview.org, and can be reached on Twitter @mcjaklevic.

Image credit: Shutterstock.com