Weight-loss NHS patient dreams up digital approach
BBCAbout four million people in the UK are thought to be at "tier three" in terms of their obesity.
Get to tier 4 and the NHS starts to look at surgical options to reduce your weight.
There are interventions for people at tier 3, but the NHS can only see 35-45,000 people in a year, just 1% of those who could be helped.
But now a patient and a doctor in the NHS's own weight-loss service are looking to change all that with an entirely digital approach to treating patients.
Rather than trekking to hospital to see dieticians and consultants, people can do everything online instead.
Richard Green admits he enjoyed his retirement a little too much, with too much nice food and a general weight increase as he also gave up smoking.
After a conversation with his GP, he ended up at University Hospitals Coventry and Warwickshire locked in a room for 24 hours.
This is a very special room though. Overseen by Dr Petra Hanson from the University of Warwick, this is a calorimeter.
Inside the sealed chamber there is a bed, internet and TV, and even a toilet.
Scientists can use the chamber to track exactly what you eat, and so the energy you take in and what your body gives out. The end result is a very accurate measurement of your metabolism.
For Dr Hanson, this was all part of her University of Warwick research into patients who were trying to lose weight, running alongside Mr Green's treatment.
But over many days and nights in the chamber over the course of the year, Mr Green and Dr Hanson would talk and in particular discuss the state of weight-loss services in the NHS.
For example, Richard Green was given an appointment to see a dietician at the start of his treatment and, when it rolled round three months later, the first thing he was asked is would he keep a food diary.
Would it not make more sense, he thought, to be told that at the start so he could turn up three months later with a food diary all filled in and ready to go?
His business brain could see lots of ways to improve things.
Meanwhile, Dr Hanson was worried about the number of people fighting to be seen if capacity in the NHS was just 1% of the need.
Seven years later, the two have worked together to find a company and experts to create an alternative to the traditional weight-loss pathway.
The platform, completely online, features everything from exercise classes to video calls with consultants and dieticians.
Everything that would be done during a hospital visit can now be done online instead.
Patients can also link the service to a smartwatch, to add in exercise and step counts for doctors to track.
The service is called W8Buddy and it is now being trialled at four NHS sites.
Patients are being offered a choice between traditional or online service and over the next two years their outcomes will be monitored.
These are very early days and just a few patients are currently taking part, but the hope is this will be a cost-effective alternative that can remove some of the existing bottlenecks and so be used by more patients.
As for Richard Green, he went on to lose 3.5 stone (22kg) thanks to the traditional NHS tier 3 service, but he believes the digital option he has helped to create will allow many more people to lose weight and get healthy just like he did.
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