A collaborative, whole system, stigma-free approach to weight

In the UK, many people live with negative impacts on their health, wellbeing and wider life because of their weight. According to the National Food Strategy, nearly one in three adults over 45 in England are classed as living with obesity. High blood pressure, type-2 diabetes, heart disease, stroke and cancer are all diseases linked to high weight and diet. Weight-related challenges are an issue of equity, with evidence that children in low-income households are more likely to have higher weight, and this gap is consistently widening. 

Weight is driven by a wide variety of factors, a majority of which are outside of people’s direct control. The cost and availability of high sugar, ultra processed food, a lack of active travel routes, advertising as well as psychological, biological and socio-cultural factors all steer individual responses  related to weight. Nonetheless, the dominant narrative suggests that it is individuals who are to blame for poor decision-making, fuelling weight-related stigma and shame. Tackling obesity is one of the most complex challenges of our time, with a significant burden being put on individuals as well as on a national health service lacking the resources to deal with the effects. 

This can show up in the form of exhausted frontline staff and overwhelmed weight management services driven by a competitive culture and performance-based indicators. Partners in Devon recognise that in order to improve population health outcomes more broadly, the system needs to shift towards preventative approaches. However, in the face of budget cuts and increasing service demand, creating future-oriented solutions poses a significant challenge.

One Devon, a collaboration of NHS, local authorities and VCSE, commissioned Innovation Unit as a learning partner, and committed to a whole-system approach in addressing this challenge locally. Specifically, Innovation Unit supported One Devon to develop  a collective understanding of weight-related challenges at population level, generate deep insights into the problem and  identify sustainable, long-term, non-stigmatising solutions for the future, building a credible pathway between this and today’s urgent challenges.

In April 2023, we launched a 12-month collaborative learning programme under the banner Healthy Devon Learning Labs.

Applying Innovation Unit’s Formula for Innovation and Impact, we enabled One Devon to:

Generate deep insights
grounded in the perspectives of professionals and people with lived experience

Mobilise energy
across multidisciplinary stakeholders to develop a shared ambition for and approach to change

Design and prototype innovative solutions
that are building on existing local assets and ‘bright spots’

Set the foundations for system change
influencing One Devon’s strategic direction.

Generate deep insights

Generating deep insights, grounded in the perspectives of professionals and people with lived experience

We conducted an extensive evidence review and provided staff training in ethnographic research, enabling One Devon to engage with nearly 30 individuals across both lived and professional experience.

Our findings shed a new light on the societal and psychosocial burden people with higher weight are facing, the significant role of trauma and shame, and the pressures felt by healthcare professionals at the forefront of service delivery. It also pointed to a range of opportunities for intervention, including shifting current measures of success and working more closely with embedded, place-based organisations in the prevention space. 

Insights from our ethnographic research have already spurred some important organisational steps and actions. Reading about the lack of plus size gowns at the hospital, and how this exacerbates patients’ feelings of shame, the Deputy Chief Nurse at Torbay NHS Foundation Trust ensured that urgent action was taken to increase availability of gowns.

Mobilise Energy

Mobilising energy across multidisciplinary stakeholders to develop a shared ambition for and approach to change

The complexity, scale and far-reaching impact of obesity meant that engaging people in a powerful, shared vision was a core focus of our work. 

Since April 2023, we have been convening senior leaders, operational staff and people with lived experience from across the NHS, Devon County Council, Plymouth Council, Torbay Council and more than 40 Devon-based voluntary community sector organisations. Healthy Devon Learning Labs created safe, open, human-centred spaces for  partners to generate a vision for a healthier Devon and map current interdependencies, assets and opportunities. This included designing and delivering the Health Devon Learning Conference, bringing together 100 system stakeholders from across the region and country as well as leading academics, sharing latest research in the area of weight stigma and public health approaches to tackle obesity. 

Throughout this work we have held space to explore the inherent tensions at the centre of this complex challenge. This has included, for example, the pressure to address existing demand for specialist weight management services whilst also beginning to shift towards more system-wide preventative approaches. In practice, this has meant applying Innovation Unit’s expert facilitation skills and allowing key stakeholders to be truly listened to, to foster new connections, see things from different perspectives as well as begin to envision a better future, by using creative imagination techniques. Working in this way has enabled us to foster a strong, trusting relationship with our core client team, including representatives from Devon’s local authorities and NHS ICB. 

Design new solutions

Design new solutions and set the foundations for system change

Another important aspect of this work was establishing the Healthy Devon Prototyping Lab, a collective of 13 Devon-based stakeholders from across health, local authority and VCSFE. As coaches, we helped them develop innovative approaches to creating health and addressing obesity, highlighting systemic barriers and opportunities along the way. Prototypes included testing the impact of weight-neutral support to combat weight stigma; empowering young people to design health interventions that meet their needs; and building health care professionals’ confidence in social prescribing. Not only did the Prototyping Space allow One Devon to cast an even wider net and engage new partners in this work, but it built on existing assets and ‘bright spots’ across the system, demonstrating what effective approaches to tackle this challenge could look like.

Towards the end of the year, we brought the learning from the initial evidence review, ethnographic work and prototyping projects back to  strategic system leaders and supported them to develop a set of clear recommendations for the future, including principles and outcomes for whole-system ways of working and a clear set of areas for intervention. This work is informing the re-drafting of the ICB’s Joint Forward Plan, defining the organisation’s strategic priorities for the next five years. 

Healthy Devon Learning Labs has already proven a successful case study and brand for whole-system ways of working in Devon, bringing together diverse perspectives and co-creating a shared narrative for the inherently complex challenge that is obesity. Most importantly, this early work has enabled us to highlight a pathway that starts from a deep reflection of current issues and points to the potential of a different, better future, whilst drawing out clear enabling conditions and areas for change. There is appetite and potential to deepen the work of Healthy Devon Learning Labs in this area as well as to apply its methodology to tackle other persistent health inequalities across the system, a vast majority of which are prevalent across the UK. 

If you are interested in learning more or want to find out further details about our methodology, please contact: Steph Gamauf or Christina Cornwell