Making weight management work through behaviour change Monday 17 th May 2010

1. Making weight management work through behaviour change Monday 17th May 2010

2. Why? • Potential to save cost in traditional patient pathways has met the law of diminishing returns. • Disease costs are calculated in silos of clinical speciality • Yet all key lifestyle choices, about what we drink, smoke, eat and our exercise are made in private, in our personal ‘Circle of Care’. • Reducing obesity will mean changing behaviour in the COC.

5. Can we meet policy objectives with products and services offered commercially? • Working in partnership with industry produces a win-win situation • But it may not happen because industry organised in factions, each represents an individual element of behaviour change matrix • There is plenty of technology out there • So it is up to health provider to develop a coherent strategy

6. Recent DoH seminar concluded ‘we don’t know how to successfully drive behaviour change’. • Some things worked others didn’t, ‘ • Completing this research may take 5-10 years and that’s too long • Net.Weight has shown potential of IT to drive behaviour change • Clearly we are unlikely to find one BC strategy that fits all • We need the help of industry to provide devices and services • Making behaviour change work means working by a new set of rules

7. Issues key to successful behaviour change 1 • Some health information will move back and forth between commercial organisations and NHS. • But the sharing of information needs trust, confidentiality and privacy • The ‘wellness transaction’ • The ’significant other’ could be highly important • IT and social networks will be crucial tools in the future

8. Circles of Care 2 research • Builds on earlier research called Circles of Care 1. • Uses best practice consumer health methods to explores behaviour change issues. • It will invent, develop and then test a range of ways to engage with the individual, the significant other and a variety of social groups. • Uses a multi pronged approach to test behaviour change interventions. • Will be used to build an algorithm that connect lifestyle to morbidity • That will produce a way for the DoH to assess commercial offerings

9. Conclusions • There is a ‘pot of gold’ if we make behaviour change work • But we need an armoury of behaviour change interventions first, • We are entering fresh territory. • We need feedback mechanisms that help demonstrate savings. • And aim to build the vision that encourages industry to engage. • Use this to develop the policy framework that endorses change.

10. Ron & Sharon, a worked example Ron is a bus driver, Sharon a part-time council worker. They have 3 children a small mortgage, joint income of£26,000 and no history of sport or exercise. At 48 they are both reaching 29% BMI and soon to be clinically obese. Ron smoked until last year and still has respiratory problems, high blood pressure and incipient type 2 diabetes. Sharon is fitter but does no exercise and is suffering from lower limb joint problems due to overweight. Their drain on primary health care resources is growing and this will soon move to secondary if Ron develops diabetes and needs to control his diet and insulin. They do one big fortnightly shop at a supermarket and buy the rest in the local corner shop. Their GP tries to impress on Ron the need to change his behaviour but her influence only lasts a few days. Husband and wife Rajid and Sanita have both become a health champions. Sanita runs the corner store where Sharon shops and Rajid is a bus driver with Ron. In the mornings Rajid walks round to meet Ron and David who is also a bus driver. By leaving 20 minutes earlier they can walk to work together and in the three months they have been doing it they have never been late for work. They are all beginning to look forward to their chats about last night’s TV and football on the way and after just 3 months they have each shed 3lbs and cut the walking time to 17 minutes. When they started Rajid gave them an activity monitor to wear (www.milife.com) and every time they go into Rajid’s shop and stand near his health console it automatically uploads their activity profile via Bluetooth. Rajid monitors the feedback for the three of them and in the mornings passes on the suggestions it makes on ways to improve activity. They agreed to wait until the end of each month before deciding whether to pass these results on to their employer and GP. The GP is providing the system on prescription at a cost to her practice of about £10 a month for the first 3 months. If they meet an agreed target this is extended to 6 months and half price from then on. Their employer is offering a half day holiday per month extra if Ron meets his agreed target in 3 months and will take over the entire cost of the service after 6 months if he meets a second target. If they meet their annual target their employer will give them each a free bicycle (the cost of all this is paid for because Ron takes less time off sick and has fewer doctor’s appointments).

11. Sanita giving Sharon free ’Good to Cook’ recipes when she comes in the shop and keeps all the necessary ingredients. Because of this creates a known demand Sanita can afford to stock more fresh vegetables, and when the shop is quiet she will part prepare them into packs ready for Sharon and the other 25 mums to whom she has become a ‘significant other’. Sanita has been able to book GP appointments for Narooda who only arrived from Sengal last month and will only see a female doctor. She can link to the local surgery booking schedule from her health console and make sure she selects the female GP. She makes the appointment there and then when Narooda calls in. She asks Narooda some intimate questions and with her permission logs the answers under Narooda’s name on the website for the GP to see during the appointment. This helps because Narooda doesn’t yet know the technical English words for the things like thrush or Chlamydia and it saves both her and the GP a lot of time and embarrassment during the appointment. Narooda approves the data being sent to the GP with her finger print. After the appointment the prescription is sent to Sarita’s shop and she goes and collects it for Narooda with prescriptions for another 10 customers. This way Sarita is able to quietly monitor drug compliance. She is paid a small fee for this service. Narooda’s husband has a nasty chest. When he came in with Narooda, Sanita ran the over-the-counter CRP test on her console, and was able to tell him there and then it was a virus not an infection. So she sold him some Nightnurse, advised him to go home and stay in bed. Before leaving she suggested it would be best for him to log the situation with the GP just in case and he was able to approve the information being sent by means of their finger print reader. Sanita is keeping an eye on him whilst Narita works in the mornings via one of their remote ‘Nanny’ boxes. This box is lent to them for £1 a day and has an emergency call facility and a wrist band which monitors the basic parameters of temperature, hydration, galvanic skin response and blood oximetry. If any of these alter significantly Sanita sees it on her health monitor and can send her son around to check or alert the appropriate services. Sanita is providing food advice to the local Bismati community. Together they are trying a low fat ghee. Their husbands are complaining about it, but acting together they think they will make them accept the change.