All right. Good evening, everybody. So nice to see a lot of people here.
Welcome to the guest lecture, which is part of the module introductions to study, design and research.
Welcome. And then I'd like to introduce Professor Paul Aviat,
who is Professor of Behavioural Medicine in the Nuffield Department of Primary Care Health Sciences,
and he's going to talk to us today about how we change behaviour and what each school thinks about it.
Thank you. Okay. Hello everybody.
Thanks for coming along today. And if you want to ask me things as we go, that's okay too.
Otherwise, I will try and leave some time for questions at the end as well.
Right. So just to say, we do work with commercial companies.
We have no personal financial entanglement with these companies.
That was we don't profit from this work, but we do work with them now.
When my mum was at school, this was in the 1940s.
And what was that in the girls grammar school? She On the wall of the classroom, it was this kind of map, a map of the British Empire.
And she used to look up at that and feel terribly proud about, you know, look,
there's little old Britain here and it kind of has got all that sort of land.
And we wouldn't necessarily look at that sort of map today with that kind of ethos.
But back in the 1940s, that's how people looked at it. This is a map of contemporary British colonisation.
I don't know if any of you can guess what it is and I'll tell you about it in a moment.
But while we do, I want to just tell you a story. I was giving a public lecture in Oxford.
It was about smoking, smoking cessation.
And as part of that, I went to Radio Oxford and was chatting about the lecture to the presenter and what it was about.
And we had one of our patients, as we tend to call them, in our smoking cessation research,
come along and talk through what it was that they, you know, why did you suddenly stop smoking?
This is a man who'd had cancer.
And of course, what you said to me was, you know, what made the difference was, you know, getting the support from the nurse, using the medication.
But when the presenter asked him, you know, so you've tried to stop smoking before, what was it that made the difference this time?
He said, This time I really wanted it.
And that he's not alone in that. If you talk to people who stop smoking, they say, Well, yes, of course,
I tried to stop lots of times before, but the last time was the time that I really wanted it.
And that brings me back to this map, because I don't know if you know,
but all the countries coloured out of blue or turquoise have all taken the British TV show The X Factor.
We can all be very proud.
So and that reminded me of that when that patient said that because and actually what happens in the early rounds of X Factor,
I used to watch it with my kids because they were young teenagers once and they said, you know, everybody watches it.
So we all watched it. And what they what you see in the early rounds is the hopeful presenters come along and they say to,
you know, whoever was presenting and say, you know, I really want this, I really want this.
And when they open their mouths to sing, you realise that wanting it is not always enough.
And that's really the lesson that we learn from science of behaviour change.
We think that motivation is the main story involved.
It's that that drives people onwards. It's the story so kind of leitmotif of our society and we might ask ourselves if we were clever sociologists,
we might say, Well, where does that belief come from?
Maybe it's from the kind of as a clever sociologist who might want to wonder whether this belief that wanting
it is enough is sort of sustains and reflects the kind of neoliberal economic society that we live in.
You know, people will say, well, it was all out there for you, but you didn't want it enough.
And maybe we can speculate that, but we're not clever sociologists.
So I'm going to move on and go back to our story and remind you about the British cycling team,
because they've come from nowhere to world beaters over the last few years, last ten years or so.
And why was that? Well, it was the law of aggregate marginal gains, as David Brailsford said.
He said, in other words, if we can make small improvements in every aspect of our preparation,
then we can get the world championship and the Olympic medals and so on.
And so it proved and the science of understanding behaviour change is very much like that.
We can learn to make small. I could get gains across a range of things and not rely on this belief that you've got to really want it to achieve it,
because that's not what science tells us. All right.
So I'm going to tell you now about one of our trials. And in a way, I'm just going to recreate this trial here.
This is a trial from the 1970s. It was published in 1980, 1979.
It's the citation classic, meaning it's been cited more than a thousand times.
And in this trial, what doctors.
What happened was researchers went along to the waiting room full of patients waiting to see a GP and they recruited them into a study.
And then they went to see the doctor and the doctor. These were all people who smoked.
And the doctor said, Either you really ought to stop smoking, it's terribly bad for you, or they didn't.
And then when they were followed up a year later and Lo, it showed that that sort of thing was effective.
Now, what we did in this trial was went to recreate it.
And you can ask yourselves and when I present this to GP's they say to me, well why, why did you do that?
Really, because you're just putting the responsibility. So in our trial we did it on weight loss for people who were overweight.
I said, You're just putting the responsibility on society. Now, I wanted to.
It made me think as I looked at this 1970s trial about my life.
So I was born in the 1960s and lived and grew up through the 1970s, and that's where I spent most of my time.
That was my primary school there at the bottom. Is this a pointer?
It doesn't work. It doesn't work on there. That's that's my primary school.
I was going across the road here. There's a little corner shop and we used to go out after school if we had some money and buy some sweets.
One of the things that we used to really love to buy were these, and these were not banned until the 1980s.
This is 1970s. TV famous actor Richard Burton talking to Michael Parkinson.
Those who are much younger and live in Britain will recognise him.
Now he sells insurance for funerals.
But the thing that you might notice on here is that he's smoking away.
BBC One Prime Time TV The time when there were only three channels on TV.
Lots of people used to watch this show and there is smoking.
Unthinkable today. Life has completely and radically changed.
We've got to a situation that looks like this where you queue for tobacco that sold in ugly plain packets behind closed doors.
How did we go from a society where smoking was normal to one that was looking like this?
And how, for that matter, might we get to a society that also looks like that?
Well, I want to suggest that part of the rationale for these kind of far reaching reforms that encroach
on personal freedom is the fact that we all accept that smoking is terribly bad for us.
And if we can accept that being overweight is also bad for us and the things that we might be doing about it personally that might
support and sustain those rather more wide ranging types of policy changes that I think we need to see in the world of tackling people,
tackling obesity as a problem. Right.
So let me tell you now about the trial itself. So we we we did exactly what they did back in the 1970s.
We replicated their methods more or less entirely. And we went along to waiting rooms.
We waited and measured people. And if they had a BMI over 30 or 25, we tried to enrol them in their trial and then they went to see the doctor.
And the doctor did one of two things.
Either they said at the end of they treated them for their sort of a cough, whatever it was they saw the doctor for.
At the end of that, they said the doctor said, well, you know, in the control condition,
the doctor said it really helped your health if you could lose some weight.
So why don't you give that a go, something like that. And in the active intervention, they did three things high.
They they said, you know,
the best way to lose weight is to go along to something like Slimming World or Weight Watchers and that's available free on the NHS.
Why not give it a go? And then they said and then the person would go, Yeah, okay.
And then they walk and the doctor would say, Great, what I want you to do is take this form,
give it back to the person who weighed you and then book you into a support group right now.
But come and see me again. That's the third part. Come and see me again in a few weeks, because I know it's tough to lose weight.
I want to see how you getting on. So that's what we asked them to do.
And the idea was that in both cases, the doctor could do this within 30 seconds.
The reason one of the reasons, many reasons that doctors say they don't talk to people about being overweight is because it takes too long.
So we aimed for this to be done in 30 seconds. What I explain to you is what happened now?
Why did we do that? Well, we did it. When you design interventions, you do it for a number of reasons.
But one of the things that you meant to do is look at what if?
Of things that we know already. And so we've done this review already.
This was on smoking, for which there are now lots and lots of trials of these what's called brief interventions.
And we contrast the two types of interventions, one where the doctor said, you know,
smoking's really terrible for you but will help your health if you gave up with the ones where they said and there's lots of great ways to give it up,
why not try one of them? So and it turns out that that second one,
that offering support why actually is more effective in motivating people to have a go and supporting them to stop smoking.
The second thing we did was the doctor said, take this form outside and we'll book you into a clinic.
Right now, what most people will say to me is I'll say, you know,
if a person's not prepared to go and book their own appointment simply by ringing up a weight loss program,
there is no way they are motivated enough to lose weight.
This is a trial of actually smoking cessation now, not our trial,
but the reason we involved this was based on this sort of study where actually people were randomised to two conditions,
one where the patient, the doctor said Great, you want to stop smoking, go and ring the quit line, that's that condition.
Or the doctor said, It's great, you want to stop smoking.
I'll get the Quitline to call you. And this is looking at the proportion of people that enrolled in a treatment program to help them stop smoking.
And it's much higher in that second condition. And thirdly, we said, come and see me again soon.
And that's because lots of reasons to think that just somehow being responsible to
another person for what you're about to do boosts your motivation and keeps you on track.
All right. So we went to all of these different surgeries.
There were 137 different doctors involved in the trial, each of them delivering these brief interventions, much as I've told you.
And we weighed and measured 8403 people.
That's that lot. And this group here, about a third of them had a BMI in our category, which we classified as obese.
We didn't use that word when talking to people and we asked them to take part.
And the people in blue said, no, thank you very much. And all of the rest said, Yeah, I'll take part.
And we excluded that group, doctors excluded that group, and we enrolled that group.
And I'll just press on, except to say that the main reason we excluded people was because they were already doing something about their weight.
We were after the unmotivated majority of people, not those who are already being active.
Who did we enrol where we enrolled? People who were just waiting to see a GP.
So an average there, their age was in their mid-fifties, their BMI was about 35.
There were slightly more women than men because more women than men go to the doctors, that kind of thing.
But there is an exceptional group of people.
Now, the other reason doctors say I can't possibly talk to people about their weight is because they worry that it will be upsetting for people,
that if you go in with a sore tone, the doctor says, Oh, while you're here,
can I just talk to you about your weight, that that might be intrusive and unwanted.
And so we were careful to assess that in this trial.
We asked people, you know, fill in a short questionnaire, and we asked them two questions.
How appropriate was that or how inappropriate and how helpful or unhelpful was that on a
scale from very unhelpful to very helpful and very inappropriate to very help appropriate.
Come in. So here we are in the next two slides you'll see the graphs and green is helpful or appropriate and red is unhelpful and neutral is amber.
And for those a red green colour band, green is at the top.
So that's appropriate. And us, you see the red band is quite small and that's helpful.
The Red Band is quite small. And what's surprising to us was that just telling people that they ought to lose some
weight was had quite this was seen as helpful as offering them help to support weight.
Now most people who thought this is inappropriate thought it was helpful and vice versa,
meaning that only one in 500 people thought it was both inappropriate and unhelpful and no one thought it was very inappropriate and very unhelpful.
So surprisingly positive results there, while more than eight in ten thought it was both appropriate and and helpful.
All right. So the 2000 $64,000 question, of course, is what effect did that have on people?
And we weighed them at three months. This is the difference then.
So the people who heard the message, this is not people who went to the weight loss coach.
Remember, the the intervention was the best way to go. And then they were referred for 12 weeks to Slimming World or Rosemary Connolly.
That's not necessarily people who go that's everybody who heard that message and that's everybody who heard the advice message.
So you see a 1.8 kilo difference. So at that point and then at 12 months, this group had more effectively there was less weight loss here,
as you can see, but still a highly significant difference.
It's not massive weight loss. It's 2.4 kilos versus one kilo, not massive weight loss.
And you say, well, why is that any good? And that's just showing five and 10% weight loss.
Why is that any good? Well,
one of the things that we've done is done some modelling of this to look at what would happen to the population if GP's were to do this as a routine.
Let's suppose that once a year so anybody who came along who was suitable, they did a brief intervention of the kind we proposed suggesting advice.
Now in the first bit of modelling, I'll show you that's not happening.
All we're doing is looking at trends in the prevalence of obesity, a BMI over 30 without any intervention.
And what we think will happen over the next 20 years if current trends continue, is the prevalence will go from that 25% to just over 30% in the UK.
So that's what the prevalence of obesity is set to do over 20 years and that will add of course to increased pressures on the NHS.
If doctors were to do this once a year, we think it will get less than half that prevalence.
So dramatically drop. This assumes this model that people who have been will regain the weight back
to zero unless they happen to go again for a second time over five years,
which is what we think is is the natural course of events.
So and that will save about half a percent of the NHS budget.
So as far as we can calculate over this period.
So a substantially it's cost saving and improves outcomes in quite a dramatic way from small changes delivered at scale.
Of course the key will be to get GP's to behave and that is another question.
Right? Where did this idea come from? Well, I don't know if you've seen these these type of characters around.
These are chokers, as we say in Britain, charity muggers or people who work for charities.
More charitably, and I don't know about you, but I'm pretty immune to sugars on the street.
That's because I give regularly through my various direct debits and so forth.
But when they come to the door, then I find that a difficult encounter because I feel like I'm trapped by that.
And the idea for this intervention sort of came from my experience of being chucked on my doorstep by the British Heart Foundation.
It happens. Now, I actually gave most of my all my or almost all of my giving.
As you'll hear in a minute, is to charities that work in low and middle income countries like Oxfam and so forth.
And and this is British Heart Foundation.
So I didn't wasn't inclined to give them my direct debit.
But of course, the conversation proceeded in such a way that in the end, I was there signing the direct debit.
And it's gotten me to thinking that there's something in the way that those
conversations are structured and managed that leads to that kind of outcome.
And also, I said, I showed you this early, and just as the facts look compared with advice, offering support is more effective.
P values and whatnot on there. But take it from me that there, there.
But why? What is it that's happening?
And so over the once we did the trial, we not only did we, we measured the outcomes, we also recorded the consultations.
And I didn't know why at the time, but I've now got a student whose picture I meant to put up there called Charlotte Albury,
who's working with me looking at these consultations and using this thing called conversation analysis,
where essentially she's looking at how that consultation is going, the flow of the consultation,
and you can tell whether people are responding to you in a positive way or not so positive if you listen to that consultation.
So, for example, if the person says, oh, do you want to go to Weightwatchers or Slimming World or something like that?
And there's a longish pause and then they go, Yes, that's generally means no.
Right? So that's that's what conversation analysis is.
Whereas if you said you want to get to slimming world, yes, that means yes.
So that's sort of what she's been doing.
But I've oversimplified it to make a point, I think because it's taken her three years, I hope she's done a bit more than that.
So that's what she's doing.
And this is some of the things that she's found that are consistently associated not just with positive signs in the consultation,
but from what we know about what happened to the patients, because we followed them up to see whether they actually went and so forth.
And these are the things that are associated with success, as in you offer people a weight loss program and they go, that's what she means by success.
So and the key thing is it's this good news thing.
It's fairly obvious when you put it like this,
but it's amazing how commonly the doctors in this thing would give it a kind of, well, you're not really a bit overweight.
And what we normally do is send people to this, you know, not give it a thing.
Like I'm pleased to say it's a good opportunity.
It's fully funded on the NHS, some good news delivery,
somehow just getting across the fact that you're pleased to offer them something is associated with a person taking action.
Secondly, in this context, people I think think that things like weightwatchers and slimming world are expensive.
They're not particularly expensive. They're about £5 a week.
But note saying that it's free was absolutely crucial.
If you if if you said, oh, what, you can go to slimming world and they say,
oh no, then then saying it's free later on in the consultation didn't rescue it.
You've got to say upfront. Right delivering successful asking the question there's all sorts of ways you can crunch claim.
You could say would you be willing to give it a go?
And if you think about that for a moment, why would that work better than saying, do you want to go to slimming world or why not?
What about giving it a try?
The reason that would you be willing is such a powerful construction is because it creates this expectation of a person saying yes,
what sort of person would be unwilling to give it even a go like that?
So that's why that you get more people saying yes and more people turning up.
It's not just that they say yes, but once they say yes, they're kind of half locked in collaboration.
There's a lot self consultation styles.
Motivational interviewing is the most classic example that people think you should use in this thing, which is about collaboration with your patients.
Obviously, you can't tell people what to do, and I none of us want to do that.
But actually what we're talking about is just paraphrasing the patient saying, you know,
you were telling me earlier on about your knees or as you were saying and just using these idioms.
And phrases in the way that you're talking. When you're talking about this, you're sort of drawing the person in.
If you notice, when I did my little spiel, I probably said, Did you know?
You sort of again, it's just that did you know that the best way to lose weight is to go, too?
So it's sort of drawing them in as their partners in this.
But you're sort of providing information.
You're not necessarily asking them what their ideas are about ways to lose weight, which is sort of the approach in motivational interviewing.
One of the things that we noticed in the consultations with doctors were at pains to distance themselves from what they were saying to the patient.
We asked them, Make it sound like it's coming from you.
What they did was they would say, The trial thinks you should go to slimming world, right?
These folks out there, they're nutters who go on about obesity all the time.
They want you to go. But actually, if they said if they got resistance and they said, well, actually, I think this would be really good for you.
That sort of phrase was a powerful sort of thing that they could use to overcome resistance in the consultation and was associated with attendance.
All right. Here's some things that they should not do based on Charlotte's research.
And the first is rather on a rather surprising, which is to link weight and health.
There are ways to do this. If you use that collaboration frame that I talked about earlier, some of those phrases, you can do this successfully,
but it is a high risk thing to do both in the case of people doing this in smoking cessation interventions and with weight loss interventions,
linking weight and health from a doctor, strangely enough, tends to lead to resistance.
So it might be a good idea. Some obvious no no's don't say obesity or obese.
It has a lay meaning and a technical meaning.
Doctors clearly meaning it technically, but it's understood in a different term don't sound hesitant or negative, obviously.
But again, because doctors would do things for the first few times in their lives, they often did so.
And that was associated with a very bad outcome.
So that's just a summary slide. Okay.
The final thing I want to draw your attention to is I mentioned this already with this other trial.
This isn't one of our trials. This is a trial in Denmark, but it's a forum randomised trial.
And these two arms here, these are the crucial ones I want you to think about.
The first one, they were these were people who were somewhat ambivalent about stopping smoking involved in this trial.
And they were randomised to two types of interventions.
Either the clinic would phone them up or the counsellors would phone them up regularly every week for a course of let's say five sessions.
I think it's five sessions. You have five sessions of support in to make a quit attempt, right?
That sort of like if you went to a smoking cessation clinic in Britain, that's what it would look like.
This group here, they were left to make their own calls. They could ring up for help and were told, oh, yeah, well, why don't you bring in next week?
And what we're looking at in the grey bar here is the proportion of people that did one call, at least 74% plays 9%.
And this is the number of people who completed treatment, 25% or a quarter versus nobody at all.
And most crucially of all, this prolonged 12 months of abstinence.
So long term cessation, four or five fold higher.
As I said, what people say is, well, if you can't be bothered to make your own appointments, you surely won't be able to stop smoking.
But actually, the reverse is true.
Somehow or other, we as humans can accomplish marvellous things for ourselves if only somebody makes the arrangements for us to do so.
Oops. What happened there? Right.
Okay. And the reason I'd want to draw your attention to this is because in my world behaviour change world, we have a thing called a taxonomy.
It's like the atoms of what counselling or support or other sorts of behavioural interventions,
including policy interventions, look like the kind of micro micro components.
And there's one which is this one called social support, which is I'm going to arrange for you to get your, your weight loss supports.
And that can either be advice on, such as what you should do is give them a ring or arrange.
Those are considered as the same thing. But actually, if you go back to this slide here, the difference between those two two strategies is immense.
And if there's one single thing you take away from this lecture as a sort of single Best Buy in behavioural
behavioural interventions is probably this just somehow organise for people to do things for themselves.
Right. The upshot was when the doctor said wine, you know, the best way to lose weight is to go to slimming world.
Why not give it a go? Well, when they said that to.
Almost all comers. These are just all people who turned up nearly well more than three quarters.
Nearly 80% of people said, yes, I will do. Dr.
Amazingly high proportion. You think about why that is.
I guess if you were just talking to your friend, that wouldn't be the case.
Know if you turned around to your friend and said, you know, the best way to lose weight is to go to slimming world.
Why don't you go? He or she would likely not say yes, but because it's in the context of consultation.
That's what patients do with doctors. They tend to say yes.
And of course, in real life, they don't always mean it. They take their prescriptions and they think, screw it up and throw that away outside.
But they don't say that. That's an idiotic idea to give me that prescription.
But of course, they then we ask them to make an appointment.
This little group here, they forgot their diary or made other excuses as to why they weren't making their appointment.
This little group made an appointment but didn't turn up, and this group actually turned up.
And this group completed the treatment course this group didn't.
Now, this ratio between completers and non completers is the same as we see in motivated populations.
It's as though motivation was enough to get them through the door and what happened next depended upon what was behind the door.
In this case, the door was the door of the slimming world or Rosemary Connolly group that they got referred to.
So that's what takes over. So it's not this intrinsic motivation that's carrying people through,
but simply whether they got on with or did not get on with that form of support to lose weight.
Right. And this is why the treatment works.
If we look at the control intervention, here are the people who did nothing at all and a slightly higher proportion than in the group who were given.
They suggested a referral. But the main difference is this group here who tried to lose weight on their own is very much larger than that group.
And what we've done primarily is take this group of people who would have tried to lose weight and given them a more effective way to do that,
which was to go along to the slimming world or Rosemary Connolly group.
And that's primarily why it worked. It's that high uptake of that support that drove it about four in ten people who heard the message.
Why not go along to Rosemary? Connie or Slimming World did so. And that's what's driving that.
Okay. One of the things that we think of in our society, particularly over the last 15 years, has become a sort of political mantra.
Is choice, right? No. Know in lots of areas, we think that choice is really important and surely to goodness it's importance in behaviour change.
But I want to suggest to you that it probably is a lot less important than you imagine.
This was one of the trials we did quite a few years ago is one that shows that the best
way to lose weight is to go along to one of these commercial weight management groups.
This is a trial that shows that you can see these are highly significant differences for those who worry about that kind of thing.
And here are some NHS owned brand alternatives.
No better than no intervention there. And here's the Choice group, which did a bit better than everything else.
But the reason it did so was because most people who were given a choice chose that.
And to the extent that they didn't, they did worse.
But if we if we look at the difference in people who chose that treatment compared with people who didn't choose that treatment,
we just allocated it at random. This these guys, they did just exactly the same.
There was no evidence of a difference. Choosing your treatment does not improve somehow commitments or carry through.
Here's another trial that I came across where they were randomised to a diet they chose.
In other words, do you want to go on a vegetarian diet or a standard diet or the diet?
They did not choose the opposite of what they chose. That's what they were randomised to.
And here is what they outcomes were.
So if they got that preference, that's the blues.
And if they did got that the one they did not want and they didn't know they were going to be given the choice they didn't want.
They, they, they did better. So choosing here is actually worse.
And the outcome for people, when you get what you choose, you do worse than if you get.
When you get what you choose, you do worse than if you'd get the thing you didn't choose.
All right. Where are we? Okay. Just to show how malleable choices can be,
here's a randomised trial of some different types of nicotine replacement treatments for people stopping smoking.
This is what people's preference was at the beginning. But if we look at one week into it, you see very little difference in preference.
People who got gum, which was the least preferred choice. Their ratings of how good gums have shot up.
You know, Patch remained the most popular treatment choice in that trial, but it choices were modified easily by experience.
Now, here's a trial. We did a smoking cessation trial where we randomised people to two ways to stop smoking,
either to cut down first or to stop back like that without cutting down at all.
So we asked people at the beginning, Which do you prefer?
These groups had no preference. That group said, I want to quit.
Bang like that abruptly. Or these people said, I want to cut down first and sort of more natural way of doing it.
On the whole, if you're building up your training, for example, you build up, don't you?
Don't you don't you don't do it all in one lit. So it seems a natural thing to do.
It turns out. Oh, just to say the trial was funded by British Heart Foundation and thanks to my direct debit also by me,
it turns out across the board doing it gradually was worse.
I haven't shown you the overall trial results. These are 95% confidence intervals here.
You can see they're all crossing the one line. But if we take this group as a whole.
This is by split by baseline preference, then you'll see a significant improvement of abrupt over of a gradual.
But you see absolutely no difference whether you get what you choose or you get what you don't choose.
You have the same as it were, worse and outcome regardless of.
Type across, whether you've got preference or not. But nonetheless, people who quit that way, it became really a popular choice.
So what I want to try to suggest to you is that choices can be, you know, beguiling thing,
but actually there's very little evidence that they make a difference to
behaviour change and some evidence in some cases that they worsen the outcomes.
Now if there's one area that surely makes a big difference is gender.
You would think that choice is based on gender, a highly resistant to changing, as based as they are on sort of marked parts of our identity.
And the classic example, of course, is weight loss.
So I've been saying the best way to lose weight is to go along to weight or slimming world.
And if you do that, you will find that if you go as a man, you'll be one of very few men almost.
This is the people who just choose to go by themselves. But 95% of women and 5% of men.
So one in 20 men and 19 in 20 women of their own volition go there.
If instead you look at what GP's naturally do, then you can get that up.
So about one in ten men and nine in ten women.
That's what those two right hand columns represent. And if you look at the websites of these organisations, this is weightwatchers.
This is what at the time I put this slide together, that's what it looked like.
And slimming world, you say, well, no wonder women go and men don't go.
This does not look like something that men are interested in. And this is, of course, this and more generally,
any kind of weight loss intervention that consists of sort of behavioural support is a cause of anxiety and stress to those people in public health.
Here's a big commissioned report saying, you know, look, we've got this problem.
Men don't go for support. We know that support really makes a difference to weight loss success.
But men aren't going, what can we do about it? And we do sort of, you know, focus groups and all sorts of things.
Men like what men like. So what they want is sort of banter and sort of fun and some exercise and not at all like the Weight Watchers and stuff.
Right. That's what they say. And that was just a commissioning brief.
Now, this is as I said, I've showed you that already.
That's what we achieve naturally. And we did a trial where we wrote to people and said, Well, why not go?
We wrote to everybody, men and women alike. Same letter. And actually, when you do that, you get a ratio of about 2 to 1.
So instead of being 9 to 1, we get down to 2 to 1.
And if we look in our trial, the brief interventions where the GP was offering support, this ratio of what these are,
men versus women, you can see that about three in ten men take up the offer in about five in ten women do so about 1.6 to 1.
And that's sort of what it looks like. And if we say, well, look this, where are we?
That's sort of gender, the slipped a bit, but that's gender neutrality.
If you look at it simply by, say, a GP saying, you know, why don't you just give that a go?
That's what you can get. You can get most of the way towards gender neutrality by that simple expedient.
And maybe there is something to do with cultural adaptation towards men that can get the rest of it.
Maybe that's that's something that we need to do.
But actually, the reason men aren't going in this country to support us is because nobody's suggesting that they do.
And men are men. And maybe we just don't get off our own bottoms and go ourselves.
But if only somebody suggested to us to do so, we might.
What happens to men when they get to these programmes? Or. This is a large trial that we've recently published which splits the outcomes.
These were people referred. So these were brief interventions down here.
This is 12 weeks of Weight Watchers and 52 weeks of Weight Watchers.
No evidence at all that men and women were doing differently in these weight loss programs.
When they get to Weight Watchers or slimming world, they do just as well as women do, and perhaps in broader literature, even slightly better.
But in our trials, certainly no difference across the range of several of these sorts of trials now.
So that's all I wanted to say to you. I wanted to sort of, I guess show that you can create behaviour, change opportunities relatively easily.
I'm a GP so I can do it in the course of my my working day and that there are ways
in which you can prompt people to take action that are not not too difficult,
can easily be learned and that that will spur a lot of people who don't have high motivation into taking action.
And if you gather around some of those forces about arranging things and creating some slight sense of accountability,
then you can create behaviour change where you mightn't have expected it to occur because the person didn't really want it.
Thank you very much for listening.