What we did

Using the first version of Umio Health Ecosystem Value Design^®:

• First, we framed the challenge of diabetic obesity to reveal distinct ecosystem assemblages of subjective experience, events, states, forces and affects related to the high-level primary affective capacity of “the power to lose and maintain weight”. The frame used a durational context of the life course to ensure we also explored multi-generational factors.
• Second, we mapped the “structure of interactions” that make-up the Lose and Maintain Weight Ecosystem. This consists of current actors, roles and practices whose direct and indirect interactions either promote or diminish diabetic obese persons’ affective capacity (their power to lose and maintain weight).
• Next, we undertook approximately 80 interviews with diverse ecosystem actors in three countries (US, UK and Germany) along with background desk research. We explored the subjective experience of a representative mix of diabetic obese persons[1], and undertook telephone and face interviews with physicians, specialists, GPs and health system managers. Also, we spoke with a handful of community leaders (we wished to do more but were limited by budget). The semi-structured interviews captured the vital elements of ecosystem actors’ diverse experiences, perspectives, values, meanings, desires, constraints and frustrations as well as the services, technologies and other resources used, pertaining to diabetic / obese persons’ affective capacities for losing and maintaining weights.
• These inputs were reviewed qualitatively and then refined and netted down into individual affective capacity factors consisting of carefully worded capability, force and affect statements, resource types, other contexts as well as objective measures. These were then surveyed with obese diabetic persons and other actors in the ecosystem, and then analysed using kurtosis, factor and cluster analysis to identify distinguishable assemblages of people’s affective capacity for losing and maintaining weight, as well as distinct assemblages of actors’ capacity to support them do so.

• Four obese diabetic person affective capacity assemblages were revealed from the analysis, along with five high-level ecosystem agent (healthcare, counselling, community) actor assemblages. The revealed diabetic obese persons assemblages are (described here at a very high-level):
  • CAUTIOUS CONTEXTERS “Just-doers” not planners. Weight loss is important but not always. They take action to lose weight when faced with everyday decisions, but not always successfully.
  • ENTHUSIAST GOAL-TRACKERS Deliberate, analytical and project-goal focused, wanting to measure and learn what works and understand why; engaged socially in weight loss
  • CONSTRAINED DISENGAGED Time and social force constrained non-starters; remote from health care support as it is not for them; not engaged and left alone. These are more likely to be diabetic women with young / mid-aged children.
  • BATTLING REPEAT TRYERS Battling to lose weight repeatedly but struggling to do so due to multi-morbidity limitations and anti-diabetic medications, mainly insulin.

Each of the above assemblages displays important variation in key measures of lose weight / maintain weight affective capacity factors. Each assemblage acts as a distinctive learning and design “platform” for use in workshops and in asynchronous ideation activity. Each reveals novel knowledge about distinct yet repeating experiences of living with diabetes and obesity. Each supports advanced co-creation of more impactful strategies, programmes, technologies, concepts and actions for driving lose / maintain weight affective capacity at the individual, family, social / community, formal agency (healthcare, social care), forces actor role (positive or negative, e.g., industry) and governmentality levels of the ecosystem

Results

We helped our client to fully map the obesity weight loss problem, revealing unseen assemblages of distinctive, repeating experiences and related forces, powers and affective capacity. This provided much clearer insight into the systemic nature of real experience when living with diabetic obesity and revealed real possibilities for intervening in and breaking the cycle of force, event/state and affect that reproduce and intensify the disease.

Although we completed the work successfully, a senior leadership change at the client led to a shift in its priorities, and the programme was cancelled. Fortunately, we have continued to work on the study without a client sponsor, still have all the data and are now able to reapply the frame, models and the captured factors to a different obesity/diabetic context. Doing so will help you accelerate your progress to addressing positively the forces and experiences of diabetic and non-diabetic obesity with sustained power and impact.