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All right. Good evening, everybody. So nice to see a lot of people here.

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Welcome to the guest lecture, which is part of the module introductions to study, design and research.

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Welcome. And then I'd like to introduce Professor Paul Aviat,

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who is Professor of Behavioural Medicine in the Nuffield Department of Primary Care Health Sciences,

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and he's going to talk to us today about how we change behaviour and what each school thinks about it.

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Thank you. Okay. Hello everybody.

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Thanks for coming along today. And if you want to ask me things as we go, that's okay too.

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Otherwise, I will try and leave some time for questions at the end as well.

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Right. So just to say, we do work with commercial companies.

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We have no personal financial entanglement with these companies.

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That was we don't profit from this work, but we do work with them now.

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When my mum was at school, this was in the 1940s.

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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.

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And she used to look up at that and feel terribly proud about, you know, look,

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there's little old Britain here and it kind of has got all that sort of land.

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And we wouldn't necessarily look at that sort of map today with that kind of ethos.

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But back in the 1940s, that's how people looked at it. This is a map of contemporary British colonisation.

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I don't know if any of you can guess what it is and I'll tell you about it in a moment.

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But while we do, I want to just tell you a story. I was giving a public lecture in Oxford.

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It was about smoking, smoking cessation.

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And as part of that, I went to Radio Oxford and was chatting about the lecture to the presenter and what it was about.

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And we had one of our patients, as we tend to call them, in our smoking cessation research,

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come along and talk through what it was that they, you know, why did you suddenly stop smoking?

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This is a man who'd had cancer.

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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.

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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?

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He said, This time I really wanted it.

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And that he's not alone in that. If you talk to people who stop smoking, they say, Well, yes, of course,

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I tried to stop lots of times before, but the last time was the time that I really wanted it.

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And that brings me back to this map, because I don't know if you know,

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but all the countries coloured out of blue or turquoise have all taken the British TV show The X Factor.

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We can all be very proud.

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So and that reminded me of that when that patient said that because and actually what happens in the early rounds of X Factor,

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I used to watch it with my kids because they were young teenagers once and they said, you know, everybody watches it.

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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,

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you know, whoever was presenting and say, you know, I really want this, I really want this.

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And when they open their mouths to sing, you realise that wanting it is not always enough.

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And that's really the lesson that we learn from science of behaviour change.

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We think that motivation is the main story involved.

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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,

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we might say, Well, where does that belief come from?

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Maybe it's from the kind of as a clever sociologist who might want to wonder whether this belief that wanting

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it is enough is sort of sustains and reflects the kind of neoliberal economic society that we live in.

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You know, people will say, well, it was all out there for you, but you didn't want it enough.

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And maybe we can speculate that, but we're not clever sociologists.

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So I'm going to move on and go back to our story and remind you about the British cycling team,

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because they've come from nowhere to world beaters over the last few years, last ten years or so.

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And why was that? Well, it was the law of aggregate marginal gains, as David Brailsford said.

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He said, in other words, if we can make small improvements in every aspect of our preparation,

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then we can get the world championship and the Olympic medals and so on.

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And so it proved and the science of understanding behaviour change is very much like that.

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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,

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because that's not what science tells us. All right.

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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.

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This is a trial from the 1970s. It was published in 1980, 1979.

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It's the citation classic, meaning it's been cited more than a thousand times.

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And in this trial, what doctors.

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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.

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And then they went to see the doctor and the doctor. These were all people who smoked.

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And the doctor said, Either you really ought to stop smoking, it's terribly bad for you, or they didn't.

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And then when they were followed up a year later and Lo, it showed that that sort of thing was effective.

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Now, what we did in this trial was went to recreate it.

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And you can ask yourselves and when I present this to GP's they say to me, well why, why did you do that?

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Really, because you're just putting the responsibility. So in our trial we did it on weight loss for people who were overweight.

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I said, You're just putting the responsibility on society. Now, I wanted to.

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It made me think as I looked at this 1970s trial about my life.

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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.

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That was my primary school there at the bottom. Is this a pointer?

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It doesn't work. It doesn't work on there. That's that's my primary school.

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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.

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One of the things that we used to really love to buy were these, and these were not banned until the 1980s.

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This is 1970s. TV famous actor Richard Burton talking to Michael Parkinson.

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Those who are much younger and live in Britain will recognise him.

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Now he sells insurance for funerals.

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But the thing that you might notice on here is that he's smoking away.

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BBC One Prime Time TV The time when there were only three channels on TV.

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Lots of people used to watch this show and there is smoking.

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Unthinkable today. Life has completely and radically changed.

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We've got to a situation that looks like this where you queue for tobacco that sold in ugly plain packets behind closed doors.

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How did we go from a society where smoking was normal to one that was looking like this?

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And how, for that matter, might we get to a society that also looks like that?

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Well, I want to suggest that part of the rationale for these kind of far reaching reforms that encroach

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on personal freedom is the fact that we all accept that smoking is terribly bad for us.

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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

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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,

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tackling obesity as a problem. Right.

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So let me tell you now about the trial itself. So we we we did exactly what they did back in the 1970s.

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We replicated their methods more or less entirely. And we went along to waiting rooms.

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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.

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And the doctor did one of two things.

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Either they said at the end of they treated them for their sort of a cough, whatever it was they saw the doctor for.

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At the end of that, they said the doctor said, well, you know, in the control condition,

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the doctor said it really helped your health if you could lose some weight.

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So why don't you give that a go, something like that. And in the active intervention, they did three things high.

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They they said, you know,

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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.

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Why not give it a go? And then they said and then the person would go, Yeah, okay.

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And then they walk and the doctor would say, Great, what I want you to do is take this form,

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give it back to the person who weighed you and then book you into a support group right now.

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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.

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I want to see how you getting on. So that's what we asked them to do.

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And the idea was that in both cases, the doctor could do this within 30 seconds.

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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.

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So we aimed for this to be done in 30 seconds. What I explain to you is what happened now?

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Why did we do that? Well, we did it. When you design interventions, you do it for a number of reasons.

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But one of the things that you meant to do is look at what if?

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Of things that we know already. And so we've done this review already.

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This was on smoking, for which there are now lots and lots of trials of these what's called brief interventions.

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And we contrast the two types of interventions, one where the doctor said, you know,

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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,

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why not try one of them? So and it turns out that that second one,

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that offering support why actually is more effective in motivating people to have a go and supporting them to stop smoking.

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The second thing we did was the doctor said, take this form outside and we'll book you into a clinic.

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Right now, what most people will say to me is I'll say, you know,

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if a person's not prepared to go and book their own appointment simply by ringing up a weight loss program,

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there is no way they are motivated enough to lose weight.

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This is a trial of actually smoking cessation now, not our trial,

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but the reason we involved this was based on this sort of study where actually people were randomised to two conditions,

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one where the patient, the doctor said Great, you want to stop smoking, go and ring the quit line, that's that condition.

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Or the doctor said, It's great, you want to stop smoking.

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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.

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And it's much higher in that second condition. And thirdly, we said, come and see me again soon.

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And that's because lots of reasons to think that just somehow being responsible to

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another person for what you're about to do boosts your motivation and keeps you on track.

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All right. So we went to all of these different surgeries.

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There were 137 different doctors involved in the trial, each of them delivering these brief interventions, much as I've told you.

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And we weighed and measured 8403 people.

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That's that lot. And this group here, about a third of them had a BMI in our category, which we classified as obese.

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We didn't use that word when talking to people and we asked them to take part.

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And the people in blue said, no, thank you very much. And all of the rest said, Yeah, I'll take part.

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And we excluded that group, doctors excluded that group, and we enrolled that group.

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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.

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We were after the unmotivated majority of people, not those who are already being active.

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Who did we enrol where we enrolled? People who were just waiting to see a GP.

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So an average there, their age was in their mid-fifties, their BMI was about 35.

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There were slightly more women than men because more women than men go to the doctors, that kind of thing.

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But there is an exceptional group of people.

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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,

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that if you go in with a sore tone, the doctor says, Oh, while you're here,

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can I just talk to you about your weight, that that might be intrusive and unwanted.

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And so we were careful to assess that in this trial.

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We asked people, you know, fill in a short questionnaire, and we asked them two questions.

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How appropriate was that or how inappropriate and how helpful or unhelpful was that on a

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scale from very unhelpful to very helpful and very inappropriate to very help appropriate.

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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.

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And for those a red green colour band, green is at the top.

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So that's appropriate. And us, you see the red band is quite small and that's helpful.

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The Red Band is quite small. And what's surprising to us was that just telling people that they ought to lose some

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weight was had quite this was seen as helpful as offering them help to support weight.

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Now most people who thought this is inappropriate thought it was helpful and vice versa,

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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.

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So surprisingly positive results there, while more than eight in ten thought it was both appropriate and and helpful.

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All right. So the 2000 $64,000 question, of course, is what effect did that have on people?

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And we weighed them at three months. This is the difference then.

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So the people who heard the message, this is not people who went to the weight loss coach.

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Remember, the the intervention was the best way to go. And then they were referred for 12 weeks to Slimming World or Rosemary Connolly.

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That's not necessarily people who go that's everybody who heard that message and that's everybody who heard the advice message.

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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,

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as you can see, but still a highly significant difference.

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It's not massive weight loss. It's 2.4 kilos versus one kilo, not massive weight loss.

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And you say, well, why is that any good? And that's just showing five and 10% weight loss.

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Why is that any good? Well,

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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.

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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.

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Now in the first bit of modelling, I'll show you that's not happening.

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All we're doing is looking at trends in the prevalence of obesity, a BMI over 30 without any intervention.

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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.

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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.

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If doctors were to do this once a year, we think it will get less than half that prevalence.

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So dramatically drop. This assumes this model that people who have been will regain the weight back

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to zero unless they happen to go again for a second time over five years,

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which is what we think is is the natural course of events.

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So and that will save about half a percent of the NHS budget.

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So as far as we can calculate over this period.

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So a substantially it's cost saving and improves outcomes in quite a dramatic way from small changes delivered at scale.

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Of course the key will be to get GP's to behave and that is another question.

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Right? Where did this idea come from? Well, I don't know if you've seen these these type of characters around.

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These are chokers, as we say in Britain, charity muggers or people who work for charities.

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More charitably, and I don't know about you, but I'm pretty immune to sugars on the street.

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That's because I give regularly through my various direct debits and so forth.

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But when they come to the door, then I find that a difficult encounter because I feel like I'm trapped by that.

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And the idea for this intervention sort of came from my experience of being chucked on my doorstep by the British Heart Foundation.

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It happens. Now, I actually gave most of my all my or almost all of my giving.

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As you'll hear in a minute, is to charities that work in low and middle income countries like Oxfam and so forth.

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And and this is British Heart Foundation.

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So I didn't wasn't inclined to give them my direct debit.

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But of course, the conversation proceeded in such a way that in the end, I was there signing the direct debit.

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And it's gotten me to thinking that there's something in the way that those

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conversations are structured and managed that leads to that kind of outcome.

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And also, I said, I showed you this early, and just as the facts look compared with advice, offering support is more effective.

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P values and whatnot on there. But take it from me that there, there.

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But why? What is it that's happening?

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And so over the once we did the trial, we not only did we, we measured the outcomes, we also recorded the consultations.

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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,

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who's working with me looking at these consultations and using this thing called conversation analysis,

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where essentially she's looking at how that consultation is going, the flow of the consultation,

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and you can tell whether people are responding to you in a positive way or not so positive if you listen to that consultation.

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So, for example, if the person says, oh, do you want to go to Weightwatchers or Slimming World or something like that?

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And there's a longish pause and then they go, Yes, that's generally means no.

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Right? So that's that's what conversation analysis is.

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Whereas if you said you want to get to slimming world, yes, that means yes.

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So that's sort of what she's been doing.

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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.

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So that's what she's doing.

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And this is some of the things that she's found that are consistently associated not just with positive signs in the consultation,

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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.

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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.

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So and the key thing is it's this good news thing.

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It's fairly obvious when you put it like this,

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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.

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And what we normally do is send people to this, you know, not give it a thing.

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Like I'm pleased to say it's a good opportunity.

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It's fully funded on the NHS, some good news delivery,

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somehow just getting across the fact that you're pleased to offer them something is associated with a person taking action.

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Secondly, in this context, people I think think that things like weightwatchers and slimming world are expensive.

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They're not particularly expensive. They're about £5 a week.

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But note saying that it's free was absolutely crucial.

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If you if if you said, oh, what, you can go to slimming world and they say,

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oh no, then then saying it's free later on in the consultation didn't rescue it.

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You've got to say upfront. Right delivering successful asking the question there's all sorts of ways you can crunch claim.

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You could say would you be willing to give it a go?

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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?

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What about giving it a try?

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The reason that would you be willing is such a powerful construction is because it creates this expectation of a person saying yes,

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what sort of person would be unwilling to give it even a go like that?

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So that's why that you get more people saying yes and more people turning up.

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It's not just that they say yes, but once they say yes, they're kind of half locked in collaboration.

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There's a lot self consultation styles.

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Motivational interviewing is the most classic example that people think you should use in this thing, which is about collaboration with your patients.

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Obviously, you can't tell people what to do, and I none of us want to do that.

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But actually what we're talking about is just paraphrasing the patient saying, you know,

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you were telling me earlier on about your knees or as you were saying and just using these idioms.

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And phrases in the way that you're talking. When you're talking about this, you're sort of drawing the person in.

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If you notice, when I did my little spiel, I probably said, Did you know?

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You sort of again, it's just that did you know that the best way to lose weight is to go, too?

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So it's sort of drawing them in as their partners in this.

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But you're sort of providing information.

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You're not necessarily asking them what their ideas are about ways to lose weight, which is sort of the approach in motivational interviewing.

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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.

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We asked them, Make it sound like it's coming from you.

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What they did was they would say, The trial thinks you should go to slimming world, right?

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These folks out there, they're nutters who go on about obesity all the time.

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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.

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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.

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All right. Here's some things that they should not do based on Charlotte's research.

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And the first is rather on a rather surprising, which is to link weight and health.

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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,

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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,

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linking weight and health from a doctor, strangely enough, tends to lead to resistance.

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So it might be a good idea. Some obvious no no's don't say obesity or obese.

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It has a lay meaning and a technical meaning.

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Doctors clearly meaning it technically, but it's understood in a different term don't sound hesitant or negative, obviously.

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But again, because doctors would do things for the first few times in their lives, they often did so.

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And that was associated with a very bad outcome.

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So that's just a summary slide. Okay.

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The final thing I want to draw your attention to is I mentioned this already with this other trial.

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This isn't one of our trials. This is a trial in Denmark, but it's a forum randomised trial.

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And these two arms here, these are the crucial ones I want you to think about.

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The first one, they were these were people who were somewhat ambivalent about stopping smoking involved in this trial.

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And they were randomised to two types of interventions.

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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.

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I think it's five sessions. You have five sessions of support in to make a quit attempt, right?

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That sort of like if you went to a smoking cessation clinic in Britain, that's what it would look like.

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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?

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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%.

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And this is the number of people who completed treatment, 25% or a quarter versus nobody at all.

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And most crucially of all, this prolonged 12 months of abstinence.

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So long term cessation, four or five fold higher.

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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.

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But actually, the reverse is true.

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Somehow or other, we as humans can accomplish marvellous things for ourselves if only somebody makes the arrangements for us to do so.

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Oops. What happened there? Right.

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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.

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It's like the atoms of what counselling or support or other sorts of behavioural interventions,

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including policy interventions, look like the kind of micro micro components.

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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.

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And that can either be advice on, such as what you should do is give them a ring or arrange.

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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.

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And if there's one single thing you take away from this lecture as a sort of single Best Buy in behavioural

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behavioural interventions is probably this just somehow organise for people to do things for themselves.

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Right. The upshot was when the doctor said wine, you know, the best way to lose weight is to go to slimming world.

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Why not give it a go? Well, when they said that to.

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Almost all comers. These are just all people who turned up nearly well more than three quarters.

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Nearly 80% of people said, yes, I will do. Dr.

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Amazingly high proportion. You think about why that is.

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I guess if you were just talking to your friend, that wouldn't be the case.

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Know if you turned around to your friend and said, you know, the best way to lose weight is to go to slimming world.

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Why don't you go? He or she would likely not say yes, but because it's in the context of consultation.

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That's what patients do with doctors. They tend to say yes.

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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.

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But they don't say that. That's an idiotic idea to give me that prescription.

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But of course, they then we ask them to make an appointment.

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This little group here, they forgot their diary or made other excuses as to why they weren't making their appointment.

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This little group made an appointment but didn't turn up, and this group actually turned up.

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And this group completed the treatment course this group didn't.

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Now, this ratio between completers and non completers is the same as we see in motivated populations.

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It's as though motivation was enough to get them through the door and what happened next depended upon what was behind the door.

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In this case, the door was the door of the slimming world or Rosemary Connolly group that they got referred to.

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So that's what takes over. So it's not this intrinsic motivation that's carrying people through,

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but simply whether they got on with or did not get on with that form of support to lose weight.

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Right. And this is why the treatment works.

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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.

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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.

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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,

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which was to go along to the slimming world or Rosemary Connolly group.

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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.

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Why not go along to Rosemary? Connie or Slimming World did so. And that's what's driving that.

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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.

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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.

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But I want to suggest to you that it probably is a lot less important than you imagine.

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This was one of the trials we did quite a few years ago is one that shows that the best

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way to lose weight is to go along to one of these commercial weight management groups.

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This is a trial that shows that you can see these are highly significant differences for those who worry about that kind of thing.

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And here are some NHS owned brand alternatives.

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No better than no intervention there. And here's the Choice group, which did a bit better than everything else.

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But the reason it did so was because most people who were given a choice chose that.

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And to the extent that they didn't, they did worse.

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But if we if we look at the difference in people who chose that treatment compared with people who didn't choose that treatment,

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we just allocated it at random. This these guys, they did just exactly the same.

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There was no evidence of a difference. Choosing your treatment does not improve somehow commitments or carry through.

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Here's another trial that I came across where they were randomised to a diet they chose.

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In other words, do you want to go on a vegetarian diet or a standard diet or the diet?

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They did not choose the opposite of what they chose. That's what they were randomised to.

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And here is what they outcomes were.

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So if they got that preference, that's the blues.

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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.

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They, they, they did better. So choosing here is actually worse.

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And the outcome for people, when you get what you choose, you do worse than if you get.

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When you get what you choose, you do worse than if you'd get the thing you didn't choose.

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All right. Where are we? Okay. Just to show how malleable choices can be,

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here's a randomised trial of some different types of nicotine replacement treatments for people stopping smoking.

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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.

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People who got gum, which was the least preferred choice. Their ratings of how good gums have shot up.

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You know, Patch remained the most popular treatment choice in that trial, but it choices were modified easily by experience.

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Now, here's a trial. We did a smoking cessation trial where we randomised people to two ways to stop smoking,

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either to cut down first or to stop back like that without cutting down at all.

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So we asked people at the beginning, Which do you prefer?

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These groups had no preference. That group said, I want to quit.

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Bang like that abruptly. Or these people said, I want to cut down first and sort of more natural way of doing it.

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On the whole, if you're building up your training, for example, you build up, don't you?

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Don't you don't you don't do it all in one lit. So it seems a natural thing to do.

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It turns out. Oh, just to say the trial was funded by British Heart Foundation and thanks to my direct debit also by me,

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it turns out across the board doing it gradually was worse.

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I haven't shown you the overall trial results. These are 95% confidence intervals here.

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You can see they're all crossing the one line. But if we take this group as a whole.

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This is by split by baseline preference, then you'll see a significant improvement of abrupt over of a gradual.

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But you see absolutely no difference whether you get what you choose or you get what you don't choose.

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You have the same as it were, worse and outcome regardless of.

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Type across, whether you've got preference or not. But nonetheless, people who quit that way, it became really a popular choice.

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So what I want to try to suggest to you is that choices can be, you know, beguiling thing,

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but actually there's very little evidence that they make a difference to

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behaviour change and some evidence in some cases that they worsen the outcomes.

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Now if there's one area that surely makes a big difference is gender.

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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.

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And the classic example, of course, is weight loss.

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So I've been saying the best way to lose weight is to go along to weight or slimming world.

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And if you do that, you will find that if you go as a man, you'll be one of very few men almost.

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This is the people who just choose to go by themselves. But 95% of women and 5% of men.

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So one in 20 men and 19 in 20 women of their own volition go there.

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If instead you look at what GP's naturally do, then you can get that up.

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So about one in ten men and nine in ten women.

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That's what those two right hand columns represent. And if you look at the websites of these organisations, this is weightwatchers.

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This is what at the time I put this slide together, that's what it looked like.

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And slimming world, you say, well, no wonder women go and men don't go.

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This does not look like something that men are interested in. And this is, of course, this and more generally,

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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.

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Here's a big commissioned report saying, you know, look, we've got this problem.

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Men don't go for support. We know that support really makes a difference to weight loss success.

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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.

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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.

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Right. That's what they say. And that was just a commissioning brief.

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Now, this is as I said, I've showed you that already.

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That's what we achieve naturally. And we did a trial where we wrote to people and said, Well, why not go?

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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.

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So instead of being 9 to 1, we get down to 2 to 1.

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And if we look in our trial, the brief interventions where the GP was offering support, this ratio of what these are,

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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.

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And that's sort of what it looks like. And if we say, well, look this, where are we?

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That's sort of gender, the slipped a bit, but that's gender neutrality.

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If you look at it simply by, say, a GP saying, you know, why don't you just give that a go?

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That's what you can get. You can get most of the way towards gender neutrality by that simple expedient.

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And maybe there is something to do with cultural adaptation towards men that can get the rest of it.

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00:39:50,330 --> 00:39:53,540
Maybe that's that's something that we need to do.

384
00:39:53,870 --> 00:40:00,260
But actually, the reason men aren't going in this country to support us is because nobody's suggesting that they do.

385
00:40:00,650 --> 00:40:06,320
And men are men. And maybe we just don't get off our own bottoms and go ourselves.

386
00:40:06,680 --> 00:40:10,730
But if only somebody suggested to us to do so, we might.

387
00:40:12,380 --> 00:40:22,090
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.

388
00:40:22,100 --> 00:40:26,270
These were people referred. So these were brief interventions down here.

389
00:40:26,480 --> 00:40:30,890
This is 12 weeks of Weight Watchers and 52 weeks of Weight Watchers.

390
00:40:31,850 --> 00:40:37,910
No evidence at all that men and women were doing differently in these weight loss programs.

391
00:40:38,180 --> 00:40:46,880
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.

392
00:40:47,690 --> 00:40:53,810
But in our trials, certainly no difference across the range of several of these sorts of trials now.

393
00:40:55,410 --> 00:41:08,940
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.

394
00:41:09,750 --> 00:41:15,659
I'm a GP so I can do it in the course of my my working day and that there are ways

395
00:41:15,660 --> 00:41:21,000
in which you can prompt people to take action that are not not too difficult,

396
00:41:21,330 --> 00:41:28,409
can easily be learned and that that will spur a lot of people who don't have high motivation into taking action.

397
00:41:28,410 --> 00:41:35,820
And if you gather around some of those forces about arranging things and creating some slight sense of accountability,

398
00:41:36,480 --> 00:41:43,080
then you can create behaviour change where you mightn't have expected it to occur because the person didn't really want it.

399
00:41:43,620 --> 00:41:44,880
Thank you very much for listening.