Doris Behrens, Enzo Di Battista (ABUHB) and Daniel Gartner (Cardiff University)
Aneurin Bevan University Health Board and Cardiff University
This Bevan Exemplar project aims to tackle obesity and obesity-related illnesses by explaining the health benefits of small weight loss through a digital app.
Background:
Aneurin Bevan University Health Board (ABUHB) established the Adult Weight Management Service (AWMS) in 2014 in Gwent, an area that has some of the highest obesity rates in Wales (approx. 29%). The service aimed to support people to achieve clinically meaningful weight-loss (i.e. above 5%). However many patients have more immediate weight-loss expectations, and these unrealistic expectations often hinder motivation because patients do not achieve the weight-loss they desire, become frustrated and drop-out from the service.
A key challenge is keeping patients engaged and motivated. The focus towards health gains as opposed to aesthetic weight loss has been reported to enhance ‘intrinsic motivation’ (i.e. acting for the inherent satisfaction of the activity itself) which is associated with weight-loss maintenance.
Aims:
The main objective of this project was to bring together dietitians, mathematicians, hospital staff and patients to, step by step, develop a mobile phone application that can demonstrate the health gains that people achieve from relatively small amounts of weight loss. The app is built to be deployed on Android, iOS or Windows-based mobile devices and can also sit alone on a Windows or Mac computer.
Challenges:
Initially, the team had no funding to compensate an external industry partner for converting their mathematical model from an Excel Spreadsheet tool into an application for smart phones and no time to do the translation in house.
Other issues arose around the storage of user data but was resolved for patient interventions within the ABUHB Adult Weight Management Service.
Outcomes:
The patients involved in the creation of the smart phone application reported that the app had improved their understanding of how small amounts of weight loss (i.e. 1-5kg) can improve their health. Larger-scale evaluation will have to analyse how the enhanced motivation reduces early ‘drop-out’ or missed appointments in the ABUHB Adult Weight Management Service and thus generates the weight-loss related health benefits. As a side-benefit, the app also computes the cost savings associated with the acquired health benefits. For any pre-diabetes patients losing 2 kg over two years without instantaneously regaining it, we save at least £5,000 treatment cost over the next 25 years.
Next steps:
The team’s next steps will be to carry out a wider analysis with more patients and follow a Quality Improvement approach to evaluate the motivational effect of the app. The team will publish the tool on the App Store and on Google Play so that people with smartphones around the world can access it.
To enable clinicians to monitor the patients’ motivation and health outcomes, future work will include the development of an integrated information system with the app. The longer-term aim for wider app implementation across the weight management service is to lead an evaluation of the effect on patients’ weight loss related health improvements and appointment needs.
“Experience with our patients was worth the effort; the support given by the Bevan Commission team was brilliant.”
Dr Doris Behrens
“I would have never believed that such a tiny weight loss has such a huge impact on my health!”
Patient
