Maximising the appeal of weight management services: Qualitative research
Summary of findings
Commissioned by COI / Cross Government Obesity Team in November 2009, ESRO’s research on maximizing the appeal of weight management services took us to all corners of England. From Newcastle to Brighton, Norwich to Bristol, ESRO researchers met with numerous individuals, conducted workshops, and visited several weight management services producing case studies, films, and ethnographic narratives exploring the complex and emotive issue of weight management. The research included a diverse range of demographic groups, including men, women, young people, and individuals from different ethnic backgrounds and of different income levels.
The research highlighted that weight remains a difficult and personal issue, made more complex by the interplay between long-term health issues (such as diabetes or arthritis) and key life events such as divorce, bereavement, job loss, accident or injury. Equally difficult for some, was a gradual increase in weight over long periods of time accompanied by the realisation that whilst they once had been a ‘healthy size’, their weight had now reached unacceptable levels.
Weight management was often described as a never-ending battle, exhausting, and painful. Yet whilst acknowledging the deep seated concerns around the reason for weight gain, all of the respondents pointed out that weight loss, healthier living, and better eating acted as confidence boosters, empowering and enabling further change and better life choices. Such choices reinforced the respondents’ sense of self worth, enabling them to move past their own personal difficulties.
The full report highlights the level of motivation that exists amongst overweight and obese people to lose weight. It also highlights the complexity of the barriers surrounding engaging with services. Key findings include:-
· For the majority of overweight people there is a strong desire to ‘be less fat’
· Weight is an emotive issue and language used around weight and obesity can be a particularly sensitive area
· Whilst measures such as ‘weight’ and BMI are useful in clinical settings they can lack personal relevance
· More meaningful and empowering framings of ‘fatness’ include overall health, fitness, size and shape
· It is clear that ‘one size does not fit all’ when it comes to weight management services
· When designing and commissioning weight management services, it is important to take into account the motivators and barriers experienced by different population segments or user groups
· Appealing weight management services need to find an appropriate balance of nutritional advice, exercise and support (different segments find different ‘components’ more spontaneously appealing)
· Tailoring support around an individual’s ‘readiness to change’ is important in getting buy-in and ensuring that messages aren’t felt to be patronising or overwhelming.
People Segments
In the full report, we highlight that individuals often express frustration at the current services on offer, which they describe as unappealing, ‘for someone else’ and unreflective of their needs or experiences.
More specifically, broad differences of appeal emerged across different socio-demographic groups:
· Male and female
· Older and younger
· More and less affluent
· Size (e.g. overweight – morbidly obese)
In order to capture these differences more clearly, we have devised nine ‘People Segments’. Each segment outlines the broad differences between groups, highlighting a diverse range of motivations, barriers and ideals in terms of weight management services.
The tables overleaf represent an overview of the nine segments.
Women
Segment |
Young Women |
BME Women (traditional role) |
Older Women (more affluent) |
Lower Income Women (just coping) |
Motivations |
§ Physical attractiveness § Fashion § Clothes size |
§ Health and well being § Energy § Vitality |
§ Physical attractiveness § Long term health issues § Mobility |
§ Physical attractiveness § Being a good parent § Self-esteem |
Barriers |
§ Tendency to overemphasize impact of diet § Prone to quick fixes |
§ Too little information § Care giver for extended family |
§ ‘Weight management’ fatigue § Snobby about public leisure facilities |
§ Cost of services, childcare issues § Self esteem § Physical limitations |
Ideal Service |
§ Glamorous, aspirational service § Combining nutrition and exercise |
§ Culturally tailored § Basic nutritional info § Female only service |
§ Need motivation and support § New innovative services § Run by experts |
§ Family based activities § Affordable § Fun |
Men
Segment |
Younger Men |
Physical Men |
More Affluent Men |
Lower Income Men |
BME Man (traditional role) |
||
Motivations |
§ Physical attractiveness § Health |
§ Strength and fitness § Physical prowess |
§ Long term health concerns § Managing health issues |
§ Desire to be fit and healthy § A second chance... |
§ Strong connection to cultural identity § Fitness and strength |
||
Barriers |
§ Lack of confidence, poor § Adjustment to life changes |
§ Want to remain a ‘physical presence’ § Not interested in being ‘smaller’ |
§ Not responsible for food preparation § Lack of time |
§ Unhealthy lifestyle patterns § Lack of awareness |
§ Poor knowledge of nutritional information § Reliance of others to prepare food |
||
Ideal Service |
§ Focussed on fitness § Competition |
§ Health check MOT § Support of active lifestyle |
§ Professional, expert advice § Actionable goals |
§ Designed for men § Nutritional info § Basic intro level exercise |
§ Whole household solutions § Basic nutritional information |
||
Research objectives
The primary internal audience for the research is commissioners in Primary Care Trusts with responsibility for commissioning weight management services. The research will assist commissioners in understanding the needs and preferences of potential service users and helping to procure services that will meet those needs. Weight management support includes a number of approaches or interventions to deliver healthy eating and physical activity advice and information to those who are already overweight or obese, in order to enable behaviour change – this research needs to identify which services are most appropriate to which audiences
Background
The aim of the research is to increase understanding of how weight management services that aim to support people in making lifestyle changes can be designed and delivered in a way that maximises uptake and retention of potential service users. It is crucial that findings relate to the full range of population groups and that, as far as possible, they highlight differences or similarities in terms of age, gender, ethnicity, socio-economic status, weight status (perceived)
Quick summary
Weight management and engagement with services is a complex issue. Key findings from the research highlighted that: • For most overweight people there is a strong desire to ‘be less fat’ • Weight is an emotive issue • Measures such as ‘weight’ and BMI can lack personal relevance • More meaningful and empowering framings of ‘fatness’ include overall health, fitness, size and shape • It is clear that ‘one size does not fit all’ when it comes to weight management services • When designing and commissioning weight management services, it is important to take into account the motivators and barriers experienced by different population segments or user groups • Appealing weight management services need to find an appropriate balance of nutritional advice, exercise and support • Tailoring support around an individual’s ‘readiness to change’ is important
Audience Summary
Gender
Ethnicity
Mixed
Age
18-74
Methodology
Methodology
Stage 1: 30 x executive interviews with experts, academics and commentators on obesity or weight issues and the frontline providers of services; Literature Review of data pertinent to the appeal of adult weight management Stage 2: 12 x 1-day ‘service ethnographies’ with service providers engaging ‘difficult to engage groups’; 5 x 1-day ethnographies with difficult to engage overweight people Stage 3: 5 x 2.5 hour co-design workshops with women, men, young people, lower income and BME groups.
Data collection methodology
Detailed region
Fieldwork dates
December 2009 to February 2010