Tier 2 weight management at under 4% of the national cost

The service

Birmingham City Council commissions a digital Tier 2 weight management programme for residents aged 16 and over with a BMI over 25, or over 23 for people of Asian or Black origin. Since April 2024, Healum has run it as a 12-week programme in the app, on an annual budget of £27,540.

What the council asked for

• Direct access to the app for eligible residents, and referrals, with consent, from primary care, other healthcare professionals and partners
• Access 24/7, with translation and accessibility built in
• A multi-component programme of diet and exercise advice, appropriate to age, gender and ethnicity
• Goals set from what people enter, weight and activity tracking, and a self-assessment at the start and along the way
• Reminders and rewards to keep people motivated, and a chat to ask about the programme
• Everything written in a health-literate way

How it works

Residents get a dashboard of daily actions, the programme’s content, SMART goals, a personalised plan, tracking, notifications and a chat with their health coach.

The programme is built to be flexible, so people use it when and how they want; personalised, in its content, plans and conversations; dynamic, changing with each person’s needs; scalable, so more people can join without adding cost; and better value per outcome than face to face.

The results in 2025

• 4,617 referrals: 4,063 from primary care, 518 self-referrals and 36 from elsewhere
• 4,435 met the criteria, and 1,656 started the programme
• 729 completed: a 44% completion rate by the end of the year, up from 35% at mid-year
• 445 tracked their weight, and 377 lost weight: 323 lost 3% or more, and 157 lost 5% or more
• A mean weight change of −4.4% for those tracking, against −3.9% on the NHS national programme
• £37.80 per completer, against £1,052 on the NHS national programme

2026 so far

From January to June 2026:

• 1,898 referrals, 1,823 of them eligible
• 1,027 started: 56% of eligible referrals, up from 37% in 2025 and ahead of about 50% on the NHS national programme
• 402 completed, taking part in at least 9 of the 12 weeks: 39% of starters, against 44% in 2025. Starts were running 24% ahead of 2025, so more people were still mid-programme at 30 June.
• 330 tracked their weight, and 151 lost weight: 110 lost 3% or more, and 72 lost 5% or more
• A mean weight change of −4.4% for those tracking, as in 2025
• £34.20 per completer, down from £37.80 in 2025

What made the difference

• Enrolment was paced on purpose, to keep waiting times down and quality up.
• Better onboarding, more engaging tools and content, and targeted follow-up by health coaches lifted completion.
• Automated prompts to weigh in, and nudges from health coaches in the chat, meant more people tracked their weight.
• Messages follow the week: a check-in every day in week 1, a new topic every Monday and a check-in every Friday, then local services and new goals at the end.
• Health coaches match how often, and how, they get in touch to how much each person uses the app.

What we learned

• Some people expected medication. We made clear, at onboarding and in coach conversations, that this is a Tier 2 behavioural programme, and worked with the council and primary care on the message.
• Some people had low digital confidence. We added a screen reader, text resizing, colour contrast and voice access, and health coaches helped people get started.
• Some people stopped early. Smarter onboarding in the app, automated reminders and a structured follow-up before anyone is withdrawn now reach them sooner.
• Not everyone liked the same pace. We cut notifications, simplified goal suggestions and refined how often content arrives.

What’s next

Planned for 2026, with the ICB: a standard digital referral form within the obesity pathway, referral criteria and expectations aligned across obesity services, and an end to referrals processed by hand from an inbox. That frees health coach time for early engagement and keeping people on the programme.