wellness has also been criticized for its focus on lifestyle changes over a more general focus on harm prevention that would include more establishment-driven approaches to health improvement such as accident prevention. petr skrabanek has also criticized the wellness movement for creating an environment of social pressure to follow its lifestyle changes without having the evidence to support such changes. some critics also draw an analogy to lebensreform, and suggest that an ideological consequence of the wellness movement is the belief that "outward appearance" is "an indication of physical, spiritual, and mental health."