What The System Saw

Short Term


Being overweight is a significant risk factor for a number of long-term health conditions. Through this blog, you have probably gathered I’m not a huge fan of making the headlines about the risks, because we are pretty poor at understanding them. However, at a population-level, when you have millions of overweight people to consider in the health system, finding a way to help as many of them as possible to lose some weight starts going up your list of priorities. Hence why in almost all parts of the UK there are NHS-commissioned weight management services designed to help people lose weight.

I spoke to a woman who had been a participant in one of these services in the North West of England. She’d been to see her doctor who had suggested she would benefit from losing some weight. The doctor was able to refer patients to the local weight management service, a 12-week programme delivered by the local leisure trust and designed to offer a range of fitness activities and advice on healthy nutrition to participants who start with a body mass index (BMI) of 30 or more. This lady’s BMI was “high 29 something”, so pretty close to the cut off, just a little under but only by about 1lb. It was close enough and the doctor made the referral but reminded her not to lose any more weight before it starts or she would be “too light to take part”.

One of the coordinators from the weight loss service called her up to confirm her spot on the next 12-week programme. But there was going to be a wait of several weeks before she could start because the 12-week programme that was running before hers was only on its 3rd or 4th week. It would be another 8 or 9 weeks before she could get started, but at least she had her place confirmed.

What happened next is what you might expect… She spent the next 8 weeks or so knowing she was about to embark on a weight loss journey and fell into “free time”, where she was free to eat and do as she pleased because she felt it it didn’t matter – soon she would be fit and healthy and on a diet and could therefore undo any extra weight she gained in this time. By the time her 12-week course started she had gained several more pounds. At least she was over the 30 BMI starting criteria.

Over the following 12 weeks she participated in the programme, ate well, took part in lots of activities and successfully lost just over 5% of her body weight. The final result? She weighed about the same as she had weighed at her original appointment with the doctor. And about half a year later!!

Here is what the system saw:

• The doctor made a successful referral to the weight loss service.
(Doctor gets points for this.)

• The weight loss service called the woman and booked her into the programme.
(Service gets points for this.)

• Woman started 12-week programme – she started with a BMI of 30+
(In the high-risk target group the service was designed for.)

• Woman completed 12-week programme.
(The weight loss service was incentivised with further income by the NHS commissioner to have participants complete the programme, so they get more money.)

• 5% body weight loss was achieved.
(Yay! success.)

• The weight loss service had a success and they were happy.
(And paid.)

• NHS commissioner was happy.
(Because they paid for success.)

Here is what the customer saw:

• She wasted 6 months of her life, getting to about the same place she was at the start!

These are the kind of stories you can only find out by asking customers. You might have a service where all the data and indicators are telling you you are doing a great job but there may be a whole layer of other things going on making it hard for customers, wasting their time, or worse, causing them harm. It’s worth a few conversations to find out.