Student whitepaper - The self-care revolution in health and fitness

Posted by Jenni Armstrong on 22 January 2016

The final module of Squared Online sees Squares work in groups to create a whitepaper that sells their ideas on how a major digital trend will affect a specific industry.

From the whitepapers submitted, three outstanding groups are identified through a peer marking process and invited to present their projects in an upcoming live class. Students then vote on which overall whitepaper is the most viable, persuasive and creative.

They're great examples of how Squared Online grads combine an in-depth understanding of the digital landscape, the ability to identifty emerging trends and the creativity and strategic knowledge to make valuable, forward-looking recommendations that drive innovation and strategy in their organisations.

Here's a recent top-voted whitepaper from our recent May graduates that considers how wearable technology could benefit consumer health, and the NHS.


Executive summary

wearables1.jpgObesity is a direct cause of many health problems and its treatment is causing massive financial demands on the NHS at a time when health resources are stretched like never before. This situation is unsustainable.

In this report we explain how recent innovations in digital technology are primed to revolutionise the trend towards self-care and health-monitoring through the use of wearables. All of which will greatly ease the pressure on the NHS and the British economy.

The strongest digital trend to influence the health and fitness industry is wearable technology combined with health and fitness related apps. According to forecasts from the International Data Corporation (IDC), the global market for wearables will reach roughly 45 million units shipped in 2015, a strong growth of 133% from the previous year and the increase will continue. IDC predicts that this trend will continue, with 126.1m units shipped in 2019. 1

Based on August 2014 research, Kantar Media estimated that the number of consumers in Great Britain using health and fitness wearable devices and smartphone apps would nearly double between 2014 and 2015, from 6.7m to 13.1m. 2

The real benefit of the self-care revolution is linked to the improvement of users’ wellbeing and also a reduction in NHS expenditure. We have to keep in mind that rates of obesity are estimated to rise to 47% for adult men and 36% for women by 2035. By 2050, 60% of males and 50% of females could be obese. By 2050, the NHS cost of treatment for overweight and obesity could rise to £9.7 billion, with the wider cost to society being £49.9 billion (at today's prices). 3

Relevant recent innovations

Today, wearables offer consumers a range of possibilities, and they are most interested in receiving health and fitness information. 4


Fitbit, a wristband, and Apple’s smartwatch monitor location, continuous heart rate, sleep patterns, calories burned and steps taken.5 The Dash made by Bragi is one of the first examples of a ‘hearable’, an earphone which tracks physical activity, heart rate, body temperature and blood oxygen whilst the user listens wirelessly to music or talks on the phone. 5

Another emerging sub-sector of wearables is ‘smart clothes’, which has a scale advantage over smaller devices: “because smart shirts and other smart garments can hold more sensors closer to the skin, they can collect more information and produce better data, like the full wave of the heart beat rather than just the pulse”. 7

There are still more interesting wearable categories and technologies currently in development, Google for example is working together with Novartis on a smart contact lens that can continuously measure the glucose levels in the wearer’s tears to help diabetes patients manage their insulin levels. 5

In parallel with the growing ownership of physical health and fitness devices is the use of fitness andhealth apps on smartphones such as MyFitnessPal or Apple Health. In 2014 there were 100,000 apps dedicated to mobile health available for Android and iOS according to an mHealth report which states that the global health and fitness mobile app market was worth roughly $4bn in 2014 and could increase to $26bn by
2017. 8

The problem

The NHS is in financial crisis and it’s struggling to meet the demands of an ageing population. Professor Sir Bruce Keogh, medical director of the NHS in England, said that without massive changes to the way the NHS treats patients, including far less reliance on hospitals, the service risked becoming unaffordable and could see its entirely taxpayer-funded status challenged. 9

Being overweight or obese is the main modifiable risk factor for Type 2 diabetes. In England, obese
adults are 5 times more likely to be diagnosed with diabetes than adults of a healthy weight. Currently 90% of adults with Type 2 diabetes are overweight or obese. Not only can being obese or overweight lead to diabetes but it can also increase the probability of associated diseases such as cardiovascular problems, blindness, amputation, kidney problems and depression by around 5 times. 10

In terms of pure economic impact, it is estimated that in 2010-11 the cost of direct patient care for those living with Type 2 diabetes in the UK was £8.8 billion and the indirect costs (such as productivity loss due to increased illness and death and the need for informal care) were approximately £13 billion. Prescribing for diabetes accounted for 9.3% of the total cost of prescribing in England in 2012-13.

The opportunity

As we have shown, the forecast for a rise in obesity and related conditions such as Type 2 diabetes has serious consequences for individual health, the British economy and the NHS. It is therefore vital that people take charge of their owearables_3.jpgwn health and fitness in order to alleviate financial pressure on the NHS.

Digital technology is now ideally positioned to disseminate responsibility and the power to make a personal change to a broad audience across the country. Smartphones and wearables have economies of scale for cheap production, are kept close to the user at all times (75% of smartphone owners check their phone more than 10 times a day)11 and are used by an increasing proportion of the population (smartphonepenetration has risen from 52% in 2012 to 76% in 2015).11

 This has already caused a boom in health monitoring both directly and through connected devices such as the recent innovations discussed above. As monitoring becomes ever more pervasive and innovations bring new ways to monitor previously un-monitorable statistics (eg. passive calorie counting) the opportunity will not lie in the saturated device market but in the services which collate and interpret the large sets of data collected from numerous sources. Home health monitoring for both healthy and unhealthy people will take data from various connected sources (direct tablet input, what drugs have been taken, vital signs, exercise regime, diet etc.) and allow a doctor, health advisor or an automated service to provide advice. Apple Health is already beginning to do this12 with data sources from numerous other applications but a closed ecosystem with several proprietary approaches to monitoring and recording are hindering progress.

An example of this already taking shape is “low intensity telehealth”13, tested with 92 residents of nursing and care homes in Sussex. Patients had typical ailments of old age and the homes involved were given Android tablet computers fitted with an app devised by Docobo, a digital health company. Staff were able to remotely ask patients regular questions about how they were feeling, with the information then analysed
remotely by four “admission avoidance matrons”. The early warning system (just 90p a day per
patient) led to a 75% drop in admissions. Understanding the state of an individual's health in a closer to real time way enables this reduction in unnecessary updates but acts quickly when help is most needed.

The strategy

The fitness and health industry should be the connection between technology and human beings. In terms of interpreting the data and finding solutions for the user we propose that an ecosystem of wearable items (clothing, watch/trackers, glasses, lenses, apps etc.) should be developed to help increase exercise and
measure calories and sugar intake. One key innovation should be cloud based computation of calories and sugar consumption. Measuring calorie intake has been the most difficult problem in any fitness solution and we recommend that cloud based image analysis is developed to enable this.

Users can access their data through a simple dashboard and choose to allow their primary health care provider to have access to all or subsets of the data. 14


The application of technology to address the issue of obesity and Type 2 diabetes has to be a nuanced, gently nudging approach to achieve maximum effectiveness. This subtle approach of gradually encouraging, educating and informing stands a better chance of acceptance than a “big brother” forceful approach. 15

There are 3 key strands to the strategic approach:

  1. Act as a digital friendly coach - to gently suggest goals, give positive feedback on performance and provide motivation for those at risk
  2. Constant monitoring for those most at risk - for those already diagnosed provide an “always on” approach to their condition and optimise advice designed to keep them out of future hospital visit
  3. Easy access to advice - provide a pathway through the administration minefield of the NHS and enable relevant and timely advice when needed on their issues

Challenges and recommendations

Whilst our proposition will potentially be of huge significance and use to the health and fitness industry in the future, it also raises a number of considerations.

Data Protection and Privacy:

The biggest challenge we face is the issue of data protection and privacy as individuals question the security of their personal information. Research showed that 82% said they felt concerned that wearable technology would invade their privacy, and 86% indicated concern that wearables would make them more vulnerable to security breaches.16 68% of consumers said they would wear a device provided by their employer if data was anonymous and if it was in exchange for a break in their insurance premiums. They would also be more willing to try a wearable device if provided by their doctor, even though privacy would still be a concern. 17 It is for wearable tech developers to ensure security and encryption levels are a high priority and that privacy policies are clear in order to gain the trust of the consumers.


The high initial costs of wearables have resulted in a low rate of adoption of wearable devices due to lack of affordability. A survey found that consumers do not want to pay much for wearable devices but would rather they get paid to use them instead.17 Forecasts say that between 2018 to 2025, wearable devices will be offered increasingly by gyms, wellness providers, insurance providers, weight loss clinics or
employers, at subsidised prices or for free.18 We believe that this trend will follow Moore’s law and that prices of wearables will be affordable for everyone to adopt.19


In order to keep consumers interested, and for health and fitness wearables to succeed, they will have to be "interoperable, integrated, engaging, social and outcomes-driven," 17 whilst those providing them must bear in mind the importance of data and privacy issues.


If nothing is done to address the rise in obesity and the predicted generational trend continues, whereby each generation is becoming heavier than the previous one, then by 2050 60% of men and 50% of women will be clinically obese. The direct cost of this is forecast to rise to around £50 billion per annum. 10

The real benefit of wearables and connected technology will be seen when devices, monitoring and feedback all combine to give the right advice to the right person at the right time, whether that be to motivate for fitness, diet or a vital correction in insulin levels. The opportunity lies in providing more value to an individual than they can currently get from individual devices and services.

This way forward represents the best opportunity for individuals by giving them access to the coaching they need, and the NHS - by providing the cost efficiencies it needs.

The industry should look at - and beyond - wearables to make the most of connected users and data to help individuals achieve goals more effectively while reducing cost of care in the NHS. 

As these wearable technologies become cheaper and more sophisticated, and data quality improves, these devices and their associated apps will become a part of consumers’ lives and the wider health ecosystem - and be of great benefit to the NHS.

Find out more about Squared Online: you can give us a ring on +44 (0) 20 7173 5938, or download the brochure to read about the course and the Squared experience.

1 Press release, Worldwide Wearables MarketForecast of International Data Corporation, Mar. 2015
2 “Will UK Consumers Sport Fitness Wearables?”, eMarketer, Oct. 2014
3 “Tackling Obesities: Future Choices”, Government Office for Science, 2007;
4, 17 “Health wearables: Early days”, HRI/CIS Wearables consumer survey 2014
5 “The revolution will be digitized”, The Washington Post, May 2015
6 “This in-ear assistant will make you healthier and happier”,, Oct. 2015
7 “Forget smartwatches – smartclothes are the future, analysts say”, The Guardian, Nov. 2014
8 “2014 is the year of health and fitness apps, says Google”,, Dec. 2014
9 "NHS cannot cope with ageing population, warns top doctor", The Guardian, Jan. 2015
10 "Adult obesity & Type 2 Diabetes", UK government,July 2014
11 UK edition, Deloitte mobile consumer survey, 2012-2015
12 “An innovative new way to use your health and fitness information.” Apple Health, Nov. 2015
13 “Use of low intensity Telehealth in Adult Social Care to prevent avoidable admissions”, Docobo June 2014
14 “[Infographic] wearable tech boom in healthcare”, Orange Healthcare, Feb. 2014
15 “Wearable Technology: Putting the patient at the centre of healthcare” PA consulting 2014
16 “The Wearable Future - Consumer Intelligence Series”. PwC, Oct. 2014
17 see 4
18 "Forecast: Wearable Electronic Devices for Fitness”, Worldwide, 2014."
19 “Moore’s Law” Wikipedia, Nov. 2015


Topics: Digital trends, Expert comment, Digital marketing, Whitepaper, health and medicine