Lena Osei had been through four programmes before this one, and could recite the pattern: intense start, early result, quiet collapse around month five.

There was a plateau from about week twenty. Nothing was going wrong; the body had simply arrived somewhere and wanted to stay there for a while.

Where the plateau came from

Medication was reviewed twice, and on both occasions the change was a reduction. That is not the usual direction of travel and nobody in the room pretended otherwise.

We build for the fifth month, because that’s when the enthusiasm is gone and the habit has to carry it.

Ines Cardoso, nurse practitioner

What the numbers hid

Baseline took three weeks and no intervention at all. The team wanted a picture of an ordinary month before they changed anything about it.

Eleven months in, she is past month five for the first time in her adult life.

Contributing writer

Ines Cardoso

A demonstration byline created for this prototype. Not a real writer, and not a clinician.

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