Fit Fans

Target audience

Men aged 40 to 65, particularly those from lower socio-economic groups, were chosen as the target audience, since they were identified as less likely to participate in weight management activities overall and more likely to fall into the categories of overweight or obese.

NHS Hull data indicated there were 42,400 men in the 40 to 64 age range registered with a GP in Hull in 2007. Given that approximately 75 per cent of these men are overweight or obese, the target group comprises around 32,000 men in the city who could be eligible to access weight management services. Encouraging these men to adopt a healthier lifestyle and lose weight would bring significant long-term health benefits and increase life expectancy in Hull.

The target audience was segmented according to demographic and behavioural variables:

• Male, aged 40 to 65, and overweight or obese
• Routine and manual workers, low paid or unemployed
• Living within the most deprived wards in Hull, where there is a high prevalence of heart disease and smoking
• Have an unhealthy or poor diet and excessive alcohol consumption
• Participate in little or no physical exercise
• Significant family history of heart disease or diabetes
• Reluctant to attend GP or other health services when in poor health (have not attended GP within the past 12 months

Research

NHS Hull commissioned external research and evaluation agency Information by Design to carry out extensive research to understand the target audience and provide insight into their characteristics, motivations and behaviours. This comprised of four main elements:

1.  Literature review

This drew together evidence from the commercial and public health sectors around approaches used to target men in marketing campaigns (rather than on the effectiveness of obesity interventions, which are well documented by the National Institute for Health and Clinical Excellence). 

2.  Stakeholder consultation

Depth interviews were held with a number of key staff in NHS Hull (like GPs, pharmacists and nutritionists), and with other staff who had an interest in weight management initiatives (like local leisure clubs, community centres, employers and occupational health). A fact-finding exercise was also carried out with local companies on shift working patterns.

3.  Qualitative research with residents

Focus groups and depth interviews were held with local residents, including men and women who were, and were not, engaged in weight management initiatives in the city.

4.  Quantitative research with residents

A survey was undertaken with almost 300 male and female residents in Hull, either face-to-face or over the telephone. A structured questionnaire was used to provide quantitative data on:

• Self-assessed health and limiting illness
• Perceptions of weight
• Attempts to lose weight in the past and current status (in terms of weight loss)
• Barriers to losing weight and motivations to lose weight
• Likely involvement in possible NHS Hull interventions, influences on involvement and referred types of intervention
• Effectiveness of potential links of weight management intervention to Hull City Football Club

The survey also collected claimed data on height and weight to allow the Body Mass Index (BMI) of male respondents to be calculated.

Key insights

1.  Carrying a bit of weight is more manly

“Overweight men still see themselves as more attractive than a skinny bloke”

Being overweight is more acceptable for men than it is for women. In Hull, the culture of rugby and associated activity of drinking entrenched the view that it is ‘normal’ for men to be overweight. To some men, being overweight represents masculinity and is a sign of ‘good living’ or of being able to ‘provide’ enough for one’s family. 

Overweight or obese men involved in the qualitative research did, however, have aspirations to reduce their weight and improve their health. Reducing the risk of illness and feeling fitter were key motivators for weight loss. They also recognised the importance of exercise in achieving these goals.

2.  Dieting is for women

“Men won’t go to sessions where there are too many women”

Men tend to consider their ‘fitness’ levels rather than their ‘weight’, and frequently use the terms ‘getting into shape,’ ‘getting fit,’ or ‘in training’. Findings from the literature review also suggested that men respond to status, power and humour.

Some men would not consider attending weight loss groups, because they were viewed as female oriented, having high associated costs and using unappealing ‘methods’. Some men did feel they would be encouraged by men-only sessions. Some key stakeholders felt that men prefer a scientific approach to weight management and any weight loss programme would need to be simple and more masculine – such as a ‘wild boar’ low fat microwave meal. Weight management for men needs to be informal and activity based, and not about ‘counting points’.

3.  It needs to fit my lifestyle

“I can just about cut out chocolate and a fry up, it’s booze that’s the killer”

Many men in Hull have a strong identification with sport and may be passionate fans of the three big sports clubs in the town. Sport is a major ‘pull’ factor for men and is commonly used in marketing to men. Sport appears to represent masculinity – power, control and indestructibility – and is undertaken for enjoyment and ‘having a laugh’. Men do not always make the direct connection between sport and health, which is commonly thought to be a result of genes or fate.

Many men involved in the qualitative research felt that a ‘gym’ was inappropriate, either because of their age or weight. Key stakeholders also emphasised the timings of any service delivered needed to be appropriate for working class men, who work shift patterns that can be unpredictable and change week by week.

4.  Health professionals and family members are key influencers

Despite the fact that men do not traditionally access healthcare services, GPs and nurses are seen as important providers of support in losing weight, and a referral from a GP could be used as a powerful tool to promote men’s involvement. However, as men are not traditional users of health services, it was therefore key to find different pathways for men to access services.

The majority of men surveyed mentioned that their wife or partner would have an influence on them in considering a service to help them lose weight. Sons and daughters were also commonly highlighted.

It became clear that there are many barriers and motivators that men face in their approach to weight management:

Exchange

Practical barriers:

• Lack of time: Labour intensive to cook from scratch; eat out regularly and drink alcohol; too busy to exercise
• Costs: Affordability of healthy food choices; expense of joining weight loss groups; cost of fitness facility membership
• Shift working patterns: May need to attend at different times each week
• Someone else takes care of household cooking

Attitudinal and perceptual barriers:

• Lack of willpower or motivation: “It’s willpower, that’s what it boils down to, everything else is nothing really, if I want to do it I’ll do it, like when I quit smoking I did it and I mean losing weight will be willpower.. Maybe if I could go in and get help focusing on my objectives, maybe that would help.”
• Perceive weight loss groups as being female oriented and put off by ‘methods’ used to lose weight, like being required to purchase speciality food items
• Belief that it is ‘okay’ for men to carry extra weight
• Change of lifestyle seen as too significant
• Losing weight can be lonely and boring
• Denial of problem or potential problem

Motivators:

• Improving overall health
• Feeling fitter
• Reducing the risk of illness

Potential competition for a new weight loss programme:

• Trying to lose weight independently
• Apathy
• Current services in the local area
• Peer and social norms
• Accessibility of cheap fast food and alcohol