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20 March 2024
Traditional weight management approaches are not meeting the needs of their target groups. Could a truly co-produced service be more successful in changing lives (and waistlines)? In this blog, Rowan Brockman discusses the findings of our recent study on co-designing weight management programmes.
Co-production (or co-design or co-creation) is having a moment in public service delivery. The idea of engaging local people and communities in designing services that will meaningfully improve their lives is extremely popular.
Peer-reviewed articles on co-design and health have burgeoned in the past two decades. Numerous guides and frameworks have been written. Co-production is described as “intuitively appealing”, “beguiling”, “a hot topic”, an idea whose time “has arrived”.
At the same time, taking a more compassionate approach to weight management is growing in popularity. This is about recognising that weight is a complex issue rather than a lack of knowledge or willpower. Commissioners and providers are calling out for evidence on alternative approaches, recognising services just aren’t meeting people’s needs.
In our research, we looked at a truly “co-created” (their term) service based in rural Gloucestershire. One that started on paper as a weight-management service but then morphed into something that looks quite different. Yet it has, potentially, more power and wider reach to improve weight management for target groups in the long-term, than traditional approaches.
Through a working partnership between NHS commissioners of weight management services, and a local charity with a strong ethos of building connections in the local community around food and mental health.
The commissioners knew there was a population problem around levels of obesity. They also knew their community-based weight management services were not meeting the needs of some sectors of the local population, including men. Taking what they knew about working with the voluntary sector, together with their knowledge of developing, commissioning and delivering weight management services, they decided to try something a bit different. They developed a six-week programme known as the Men’s Table.
“We’ve been in that space for a long time of trying to build the understanding around weight management and move away from this idea that it is ‘move more, eat less’…when you understand … inequalities and how that influences people’s decisions and choices in terms of health behaviours, it’s definitely not that simple!” (Commissioner)
“The NHS hadn’t seemed to find a way to successfully connect with middle-aged men with regards to health and wellbeing and they asked us if [we] would be up for using our approach to finding something that men might be interested to join in with, that would have the kind of outcomes that keep men from being patients I suppose, a preventative thing.” (Charity)
The NHS commissioners and the charity had an existing relationship, having worked together during the pandemic. For the commissioners, they liked the ‘community connection’ ethos of the charity and the emphasis on food. For the charity, they were drawn to the idea of men being involved in the co-design of the project, so they could have ‘skin in the game’.
“We were going to do something experimental, so [we] needed somebody who was prepared to jump in, in an uncertain space, and there needed to be a degree of trust there…and …they were involved in food, and food seemed to have a strong connection to the whole issue of weight etc. So, their mission seemed to fit with what we were doing.” (Commissioner)
“The thing that really kind of made us say yes to exploring it was the idea that it was a co-generative co-design piece, not only alongside us but with the men itself and …it meant that … the men kind of created what was important.” (Charity)
The target population for the project was men living in the local community. The programme facilitators used a range of techniques to get the men’s input, including community planning meetings, social media surveys and focus groups.
But the actual sessions themselves were also co-designed with the men. So although there was a rough framework for the six sessions (activities, talking and goal-setting), and a theme for each week (based on the charity’s ethos of ‘food as connection’), it was up to the men to steer the focus of the sessions.
At the end of the sessions, there was a follow-up one-to-one with an NHS facilitator, to discuss goal achievements and reflections. Finally, there was a meeting with the men about next steps for the group, to connect them to further support via the charity and to recruit them as peer mentors for the next group of men.
“A lot was done by kind of consensus and by the feeling of the group and the mood of the room.” (Participant)
Although the funding for this came from weight management, as a fully co-designed project the men determined its focus. For them, the most important things were about mental health, loneliness and connection. So, it ended up looking quite different from your standard weight management approach. This was welcomed by all parties in the project:
“It was a coming together of people in a space that they made into a safe space, and they could talk about health under the guise of learning to cook or whatever it was that they were doing.” (Commissioner)
“The goal isn’t ‘I want to lose weight’. That may be what your goal is but actually that might be 100 steps down the line….it doesn’t matter whether you can’t stop eating or you don’t do your rehab for a sports injury, the drivers are the same quite often, you know? … So, being able to talk around your problem with someone who’s got a different problem but similar reasons why it was happening, I think was really effective.” (Charity)
“There was a lot about identity and a lot about health and a great deal about people speaking or not speaking, how much people reveal, how it’s better to go on a walk with someone and when you’re walking and looking straight ahead, you might go, oh by the way this and this is bothering me.” (Participant)
Such an unconventional, experimental approach meant that it was difficult for commissioners to establish if the project achieved what they wanted it to:
“I think in terms of weight, if you were going to be reductive about it and say, how many kilogrammes did those men lose, I think you’d probably say that it hasn’t necessarily had that immediate impact on men.” (Commissioner)
However, it was a more obvious success in terms of service delivery:
“Because it set out to be something that was really driven by the co-design and kicked out something that meant something to those men.” (Commissioner)
Participants shared the commissioners’ views, that the metrics of success weren’t as tangible as weight change:
“There’s been various attempts at trying to measure the benefits and things, but there’s a load of stuff we’re not even trying to measure that’s been positive for people as well.”
“If you want to look purely at health and wellbeing benefits, there are people now doing activities they didn’t used to do.”
However, commissioners were keen to point out that the project took place in a broadly white, middle-class, rural community which limited the diversity of their sample:
“I think the men themselves said, they’d be a little bit concerned about the reach of this to the people that really need it…they said, ‘We didn’t feel there were people in our group who were really struggling with life, in terms of finances etc, or came from BAME backgrounds or anything of that nature’, and I think it is an issue.” (Commissioner)
It would be interesting to see how effectively the Men’s Table could be replicated with groups of men from different geographical, socio-economic and ethnic backgrounds.
Courage and being comfortable with uncertainty were qualities needed in this novel approach to commissioning:
“Be brave and trust the process.” (Said by both the charity and a participant)
“I’d say be openminded, be prepared to be flexible, and possibly not to achieve what you thought you were going to achieve at the beginning.” (Commissioner)
It is less about measurable outcomes, and more about creating “the context that enables people to make choices around their weight at a later date” (Commissioner).
It was vital to recognise the value of giving participants “skin in the game” to increase engagement, whilst also finding “the right partner organisation, both in terms of their style and the level of trust that exists in their community for their brand” (Charity and commissioner).
A final key message from both the commissioners, the charity and the men themselves, is the need to reframe what success looks like, and take a more upstream, holistic and longer-term approach to population health, working in partnership with local communities.