Summary of the impact

Obesity has a massive impact on health and threatens future productivity. In the UK alone it will cause hundreds of thousands of additional cases of diabetes, heart disease, stroke and cancer, with associated medical costs set to increase by £1.9-2 billion/year by 2030. Obesity is a particular problem for men: in Scotland more men (69%) than women (60%) are already overweight or obese, but only 10-30% of slimming club members are male. The University of Glasgow's Football Fans in Training (FFIT) programme is delivering gender-sensitised weight loss and healthy living programmes to overweight and obese men aged 35-65 through Scottish Premier League football clubs. More than 2000 men have already taken part across 16 football clubs, and the programme is currently being rolled out to Scottish prisons. FFIT is being reformulated for rugby clubs in England and New Zealand and football clubs throughout Europe. The research has been widely publicised in TV and radio, and the Scottish Government has committed further funding to extend the programme.

Underpinning research

The prevalence of male obesity in the UK is among the highest in Europe, yet men make up only 10-30% of participants in existing weight management programmes. University of Glasgow researchers have led a multidisciplinary team which has harnessed the personal connection, loyalty and attachment many men feel to the professional football club they support to attract them to an evidence-based weight loss and healthy lifestyle programme, Football Fans in Training (FFIT).

FFIT consists of 12 weekly sessions (with light-touch post-programme follow-up through email prompts and a reunion session) delivered to groups of men by community coaches at the home stadia of Scotland's top professional football clubs. FFIT is `gender-sensitised' for men in terms of context, content and delivery. The context is the traditionally male environment of football clubs; content consists of accessible information, discussion sessions and materials `branded' with club insignia; and the delivery takes the form of participative, peer-supported learning which encourages the use of humour and informal conversation to facilitate discussion of sensitive subjects.

FFIT is delivered free of charge to participants by community coaching staff employed by clubs and trained over two days by the research team, to groups of up to 30 overweight/obese men (participant: coach ratio 15:1). Participants aim to achieve 5-10% weight loss and to increase physical activity to 45 minutes of moderate activity on most days of the week. They are also taught behaviour change techniques known to be effective in physical activity and dietary interventions (self monitoring, specific goal setting, action planning and feedback on behaviour). The pilot trial (reported in January 2012) showed that FFIT was successful in attracting high-risk men: most were obese, with a mean Body Mass Index (BMI) of 35kg/m², and the majority (68%) had elevated blood pressure. Unlike many health promotion programmes, FFIT was also successful in recruiting participants from across the socio-economic spectrum.

The team at the University of Glasgow, led by Professors Kate Hunt and Sally Wyke and Dr Cindy Gray, conducted a randomised, controlled trial (RCT) of FFIT, the first-ever RCT of an innovative health promotion intervention in a professional football club setting, from June 2011 to December 2013. A paper on the full RCT has been submitted for publication in September 2013 and will report full findings in December 2013. However, the team's feasibility work has already recorded important interim results, including:

• men taking part in the FFIT feasibility study (intervention group) lost significantly more weight (5.2%) than a waitlist comparison group following the 12-week programme;
• the intervention group also showed improvements in physical activity, eating habits, self-esteem and blood pressure at 12 weeks, many of which were maintained to 12 months;
• FFIT attracted men from across the socio-economic spectrum;
• men were positive about the context, content and style of delivery of FFIT which also meant that attendance remained high throughout the programme: 76% attended at least 80% of available sessions.

The feasibility work was conducted in 11 Scottish Premier League (SPL) clubs in 2010-11, and included a pilot trial for the subsequent full randomised control trial (RCT), and qualitative interviews and focus groups with a sub-sample of participants.

Professor Hunt led the Gender and Health programme at the MRC/CSO Social and Public Health Sciences Unit (which was affiliated with the University until joining it in June 2013) throughout the research (both the feasibility study and the RCT). Professor Wyke and Dr Gray were based at the University of Stirling during the initial research funding phases. However, the feasibility 12-month fieldwork and the analysis, interpretation and subsequent publication of the feasibility results have taken place at Glasgow where Professor Wyke was appointed Interdisciplinary Professor of Health and Wellbeing in April 2011, and Dr Gray Research Fellow in June 2011, then Lord Kelvin Adam Smith Fellow in January 2013.

References to the research

[All research outputs above were published in high-quality international journals that operate rigorous peer-review.]

The research was funded following peer-review of the research proposals:

• Feasibility Study: Chief Scientist Office (Grant no: CZG/2/504); Final report (Graded excellent)

• Wyke S, Gray CM, Hunt K, Anderson AS, Dunlop M, Leishman J, Mutrie N, Treweek S. Can a gender-sensitised weight management programme delivered by Scottish Premier League football clubs help men lose weight? A feasibility study for a randomised controlled trial. November 2010-January 2012. £49,862.

• RCT: National Institute for Health Research (Grant no: 09/3010/06); Protocol

• Wyke S, Hunt K, Gray CM, Anderson A, Mutrie N, Treweek S, Donnan P, White A, Fenwick E, Leishman J, MacPhee S. Football Fans in Training (FFIT): a randomized controlled trial of a gender-sensitive weight loss and healthy living programme delivered to men aged 35-65 by Scottish Premier League football clubs. June 2011-December 2013. £852,343.

Details of the impact

In the UK alone, three-quarters of men in the 35-65 age range are overweight; a third of these are obese. The UK government estimates that weight problems already cost the UK £1.6 billion per year, but that this could rise to £50 billion per year by 2050, with men classed as obese rising from 25% to 60%. Obese people who lose just 5-10% of their body weight can significantly reduce their risk of ill health. Football Fans in Training (FFIT) was developed in response to the fact that overweight and obese men are notoriously difficult to engage in weight management programmes. Between 2010 and 2013, the FFIT programme has successfully helped around 2000 obese or overweight men, and has had local, national and international impact.

Improved health and wellbeing
Men taking part in the feasibility study lost an average of 5.0kg (or 4.6%) of their body weight over the course of the programme. Almost half of participants (45.5%) achieved the weight loss target (5-10%) that has been shown to reduce obesity-related health risks, and many (39.5%) maintained this to 12 months. One participant explained that his personal risk of diabetes had been reduced by his participation in FFIT:

"I knew before the course that I was overweight and... going `doonhill' [downhill] — so that was a huge win for me."

As well as reporting increases in physical activity levels and improved eating habits, many men taking part in FFIT experienced great improvements in physical and mental wellbeing. For example, one man talked about playing with his young children:

"It's just quality time that I didn't have, because I didn't have a life, you know, [I was] just coming home from work, working all hours, because I never had the energy.... So it's been lifechanging for me."

The project has generated media interest locally, nationally and UK-wide. In autumn 2011, BBC Scotland followed the progress of the men who took part in FFIT at three clubs: Celtic, Dunfermline Athletic and St Johnstone FCs. The resultant TV documentary was broadcast on BBC2 on 19^th February 2012 at 18.45, publicising the programme to a wide audience. It generated a waiting list of 226 men to take part in FFIT (in August 2012), and led to additional interest from other organisations (see below).

Influenced practice leading to improved services
The research team has worked closely with the Scottish Premier League (SPL) Trust (now Scottish Professional Football League [SPFL] Trust) to keep the Scottish Government fully informed of the progress of the FFIT project. This collaboration has been successful in securing ongoing funding for programme delivery, allowing the SPFL Trust to begin expanding into other professional football clubs in Scotland. Feedback from the Scottish Government indicates that they particularly value the programme's ability to engage `hard to reach' middle-aged males, as well as the rigorous evaluation framework and firm research base provided by the University of Glasgow expertise. The Creating Health Team (Scottish Government Office of the Chief Medical Officer/Public Health Directorate) wrote:

The work is undoubtedly an area we will wish to examine as the obesity route map is reviewed, particularly given the programme's ability to attract equal participants across income groups. It is also an area we believe worthy of exploration in its use in tackling smoking and excessive drinking where the subject group particularly amongst those at the lower end of the socioeconomic scale continue to be difficult to engage let alone positively affect.

A knowledge exchange seminar with NHS Adult Obesity leaders on 6th December 2012 attracted interest from NHS Weight Management Services in the Lothian and Grampian regions. In a letter to the research team, the Clinical Service Lead of Lothian Weight Management Service indicated his intention to extend the programme:

We feel that FFIT could help engage some of our patients in weight loss and lifestyle improvements in a way that has not been possible through our standard weight management programmes... We are currently working to secure funding for additional programmes... we hope that our involvement with FFIT will further increase its impact by making it available to different population groups.

Influenced policy and practice in secure institutions
Staff from Perth Prison and Carstairs State Hospital approached the research team following the BBC broadcast to investigate adapting and delivering FFIT to inmates, patients and shift-work employees at their institutions. The pilot delivery at Perth Prison began on 5 February 2013, and Perth Prison has already reported its satisfaction with the progress of prisoners taking part:

Many of them have started coming to the gym for the first time and are succeeding in cutting down on some of the unhealthy snacks they can purchase from the prison canteen. They are also spreading word about the benefits of FFIT to other prisoners, and we are confident that the programme will be sustainable going forward. (Physical Education Instructor, Perth Prison)

Influencing wider practice nationally and internationally
FFIT has been adapted for delivery to rugby clubs in the English Premier League and in New Zealand (RuFIT). The new RuFIT programme began in October 2013 in England, and the research team is collaborating with researchers in New Zealand on a proposal for funding RuFIT programmes at rugby clubs across New Zealand. While the impact of RuFIT on participants will fall outwith this assessment timeframe, the adoption of this programme has clear impact on health policies in these clubs.

FFIT will also be adapted in a new programme to help men across Europe improve their physical activity and reduce their sedentary time. EuroFIT, a £5.1M research and development programme funded through FP7 funds, will start in November and extend the FFIT model to top-flight football clubs in the Netherlands, Norway, Portugal and England.

Sources to corroborate the impact

1) Statement from General Manager, SPFL Trust, corroborating impact FFIT Programme. [Available from HEI]

2) Dr Gray evidence to Scottish Parliament Health and Sport Committee Inquiry into Support for Community Sport, discussed in Parliamentary debate on 20 September 2012: Link

3) Statements from Perth Prison, Scottish Government and NHS Lothian confirming benefits of FFIT participation. [Available from HEI]

4) Media coverage includes: Documentary on BBC2 19 February 2012; documentary on BBC Radio Scotland 18 June 2011 (repeated 9 July 2011 and 18 February 2013) [video link and available from HEI]. Interviews and coverage on `The Hour', STV 9 May 2011

5) Print Media coverage, indicative sample: Daily Record 14 March 2011, Sunday Post 10 July 2011 [also available from HEI], Dundee Evening Telegraph 29 May 2013, Paisley Daily Express 19 May 2012; The Guardian 8 April 2013

6) Online materials and resources for FFIT programme coaches, participants and the public available at: Link. The Football Fans in Training awards are reported on the SPL Trust website: Link ; NHS Health Physical Activity and Health Alliance website: Link and the Scottish Council for Voluntary Organisations: Link