How the word ‘diet’ nearly sank the NHS weight loss plan
The plan is a key part the UK government’s latest anti-obesity campaign. But it nearly didn’t happen.
My heart sank. One of the most important projects of my career was about to be brushed aside. It was early 2012. I was working as a content editor for the NHS website (NHS.UK). I had just sat down with policy advisors from the UK Department of Health (DOH) to present a proposal for the first NHS online weight management programme.
These were the tentative beginnings of the NHS Weight Loss Plan (WLP) that would go on to become one of the NHS website’s most popular products, with more than four million downloads and an online community of over 100,000 members. In July 2020, it was relaunched as an app (on the App Store and Google Play) for the UK Government’s £10m healthy weight campaign, Better Health. As the WLP enjoys its time in the sun, here’s the inside story of how it nearly didn’t happen.
Failed “NHS Diet” bid
In a windowless meeting room in the DOH’s offices in Elephant and Castle, south-east London, the policy team made their position clear: “Our preference is for an article page with a list of weight loss tips.” What? A single page? I’m in trouble. I’d just spent the best part of three weeks researching the idea for a 12-week diet and exercise plan.
The policy team had seen me coming. Only a few months earlier, they’d kiboshed our big push for an official “NHS Diet”. They were understandably cautious about associating the NHS brand with an untested product. “Where’s the evidence that it works?” they asked.
At the time, online diets were still a relatively new field of research. There wasn’t a lot of evidence to show if they worked. But it’s what visitors to the NHS website were looking for: a structured weight loss plan from a trusted source. They wanted close support, a degree of hand-holding through their weight loss journey. What they didn’t need was another weight loss listicle. But after the DOH rejection, the NHS diet idea seemed dead.
A walk on the South Downs
A few months later, during a content team day out among the woods and rolling grassy hills of the South Downs in November 2011, we held an ideas session after stopping off for a pub lunch.
Reading from a few notes scribbled on the back of a lunch menu, I spoke about a way around the DOH’s objections to our diet plan. Their issue was the lack of evidence. My solution was to build a plan using diet and exercise content already on the NHS website. It was all evidence-based and policy-approved. My angle was: “We’re not creating anything new, we’re simply repackaging existing advice”. We agreed to give it another go.
The game changer
Back in the windowless room in south-east London, I held my nerve and presented my project. The plan would be delivered through 12 weekly information packs in PDF format, each full of diet, healthy eating and physical activity advice, including weekly challenges. As an extra measure to assuage the DOH, I’d enlisted the British Dietetic Association to provide clinical sign off.
Incredibly, given the gap between our positions at the start of the meeting, the policy team’s response was encouraging. The “repurposing of existing content” was a game changer. It was far from a full-throated endorsement but a green light was all we needed.
A few compromises
We had to make a good few compromises along the way. The DOH’s original position hadn’t changed. We still didn’t have the evidence to position it as a diet. Calling it the “NHS Diet” was for the birds. We couldn’t even call the plan a “plan”. Also out were “guide”, “pack” and “package”. In fact, we had to avoid any suggestion “that if people follow this they will definitely lose weight”. Not an easy sell for a weight loss plan.
The DOH was nervous about overpromising the benefits of an untested product. The title handed down to us was “Losing weight — Getting started”. Not a contender for title of the year. But looking at the big picture, these tweaks were small trade-offs to secure sign off for what would be the NHS’s first and only online weight loss plan.
Positive media coverage
From concept to go-live, the WLP took about six months to produce and was a great team effort. It went live in January 2013, just in time for peak weight loss season.
Its popularity took off in a way none of us had anticipated. Downloads of the plan rocketed. Positive national media coverage followed including articles in the The Telegraph and the Mail Online. One of the most powerful testimonials was from Andy Leeks, the man who did 10 diets in 50 days and found one that really worked. With no promotional budget, we spread the word through social media, press releases and forums.
The WLP’s strong performance and favourable headlines gave us a bit more room for manoeuvre. Over the course of the next few iterations, we slipped in a few more “plans” and “guides” until eventually we renamed it the NHS Weight Loss Plan — and no-one at the DOH batted an eyelid.
Oxford study
But does it work? Does it help people lose weight? Feedback down the years suggests it does. But it’s a first step. There’s lots of room for improvement. A more rigorous assessment of the plan, in the form of a randomised controlled trial (RCT), was recently carried out by the University of Oxford. Results are due to be published in early 2021. Their findings will no doubt feed into future iterations of the WLP app, which was ranked 5th and had a 4-star rating in the App Store’s Health & Fitness section shortly after its release. The app is the WLP’s future.
Despite its hesitant beginnings, the WLP has established itself as one of the tools in the government’s fight against obesity — thanks in no small part to its popularity. In a country where three out of four adults are overweight, online weight loss plans hold the promise of a low-cost solution for weight management at population-level. For a healthcare service under constant pressure to spend wisely and where the mantra is “prevention is better than cure”, the NHS WLP is a no-brainer.
Lessons learned
Producing the WLP showed me that when you come up against a brick wall with a project, it doesn’t necessarily mean you’ve reached a dead end. Look for a loose brick to find a way through. To get through, you may need to show flexibility.
- Be prepared to compromise: always think about the big picture. Be prepared to make changes if they move you closer to your ultimate goal.
- Use evidence: the most persuasive arguments are those backed-up by good quality evidence, including user insights and data.
- Choose incremental change: small changes are often easier to get through than big ones. But over time, many small changes add up to one big one.
