A user research analysis: The impact of Holly Health on users with weight management and food relationship goals

Introduction

The high prevalence of obesity in the UK presents a significant public health challenge, affecting 28% of adults and costing the NHS an estimated £6.5 billion annually (Public Health England, 2022). Traditional NHS weight management programmes, focused mainly on general diet and exercise advice, have proven to be largely ineffective in the long term, with a significant number of individuals failing to achieve or sustain weight loss (Carrière et al., 2018). These methods frequently overlook the psychological underpinnings of eating behaviour, such as emotional eating, and often lack the personalised, holistic tools necessary for sustainable change. Even modern pharmaceutical interventions like GLP-1s, while showing promise for short-term weight loss, are often associated with significant side effects, high costs, and a cease in efficacy for most people once the medication is stopped (NHS England, 2025).

Recognising the challenges of traditional weight management interventions, Holly Health has introduced a fresh approach through its recent Innovate UK funded Women in Innovation project. Unlike restrictive, rule-based diets that can trigger cravings and a sense of disconnection from one's body, the Holly Health approach is based on the principles of mindful and intuitive eating. This evidence-based framework helps people rebuild a trusting, compassionate, and sustainable relationship with food. Instead of focusing on weight, mindfulness and intuitive eating approaches help to 'train' individuals to listen to their internal signals of hunger and fullness, leading to increased self-regulation (Friedel et al., 2015). These psychological interventions can improve problematic eating patterns that consequently (and unintentionally) affect weight, including emotional eating (Mercado et al., 2021). 

As part of this project, Holly Health developed a mindfulness and intuitive eating feature, supported by an educational programme and personalised coaching, to help users tune into their body’s natural signals and build healthier coping strategies for psychological triggers that often lead to unhealthy eating patterns. 

The below analysis focuses on a cohort of users with specific weight management or relationship with food goals, examining how the app supports sustainable behaviour change across both mental and physical health. While many users set weight management as a personal goal, Holly Health takes a weight-neutral approach, focusing instead on helping people build consistent, healthy habits through nudges, reminders, motivational messages and self-reflection exercises. By shifting the emphasis from the number on the scale to long-term behaviour change and wellbeing, this approach aims to create results that are not only meaningful but also sustainable.

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Methods 

This analysis focused on Holly Health users who selected either a weight management goal or a goal related to improving their relationship with food. Users were invited to complete a 'behavioural health check' via the app at four time points: upon joining the service (onboarding), and then again at 8 weeks, 6 months, and 12 months after they started using the app. The 'behavioural health check' is a structured questionnaire assessing four key areas: mental health, physical health, nutrition, and sleep. The same set of questions was used at each time point, enabling us to track changes over time and to inform personalised coaching and in-app recommendations. Responses were collected on a 5-point Likert scale for most measures, with the ONS-4 wellbeing questions using a 10-point scale. This report focuses on data collected from over 12,613 Holly Health users who completed onboarding questionnaires. We analysed data from users who had low-to-medium scores at baseline for each measurement area (defined as selecting an option corresponding to a score of 1 to 3, out of 5 on a Likert scale) and who responded to our follow-up surveys.

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Baseline statistics 

Demographics 

The users' most common age ranges were 45–54 years and 55–64 years, each accounting for 23.5% of the total. Demographics were predominantly White (90%), with a gender split of 77% female and 22% male.

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Goals 

A significant majority of users (78.7%) identified weight management as their primary goal, while a not insubstantial proportion of users (21.3%) focused on improving their relationship with food. These findings highlight the various motivations of users and show that while many are driven by weight loss, others are also focused on the behavioural and psychological dimensions of eating.

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Medical conditions

Several health conditions were commonly reported, spanning both physical and mental health. The most commonly reported condition was anxiety (27.12%), closely followed by hypertension (23.80%) and depression (23.47%). Multimorbidity was prevalent, with more than half of users (56%) reporting two or more conditions and 23% managing four or more conditions. Also, one in four users (25.5%) reported experiencing both mental health challenges and chronic physical conditions. This underscores the complexity of users' health profiles and the importance of a holistic approach that supports both mental and physical health.

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Relationship with food 

Fruit and vegetable intake 

At baseline, most users were not meeting national recommendations for daily fruit and vegetable intake. One-third (33%) reported eating only one portion or fewer per day, while 40% consumed two to four portions. Just over a quarter (27%) met the recommended five or more portions per day. These figures indicate a significant opportunity to support users in increasing their fruit and vegetable consumption to align with national guidelines.

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Physical activity 

At baseline, the majority of users were not meeting national exercise guidelines, particularly for flexibility and strength training. Only one-third (33%) were achieving recommended levels of moderate activity, while 45% were below guidelines and 22% closer to the target. For flexibility, 87% were below the guidelines, with just 3.5% meeting them, and for strength training, 85% were below the guidelines, with only 5.6% meeting the target. These figures highlight a substantial gap between current exercise behaviours and national recommendations, particularly in flexibility and strength.

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Eight-week outcomes:

Relationship with food

After just eight weeks of using the Holly Health app, users showed a statistically significant improvement in their relationship with food scores (p < .001, d = 0.5, a medium effect). 614 respondents showed an impressive average improvement of 38% relative to their baseline, and by 13% on the full scoring scale, reflecting meaningful early progress.

Crucially, these statistically significant improvements were sustained and further enhanced at later follow-up points. By six months (n = 215), a statistically significant improvement continued to be observed (p < .001, d = 0.6, medium to large effect), with an average gain of 54% relative to baseline and 18% on the full scale. At the twelve-month mark (n = 173), improvements remained statistically significant (p < .001, d = 0.5, a medium effect), showing an average 41% gain relative to baseline and 14% on the full scale.  The replication of these positive changes across multiple follow-ups provides clear evidence that Holly Health’s positive effects are both meaningful and sustained over time. One user reflected:

I get up and stretch every day...using the Holly app. I previously overate and, more so the wrong foods, Holly has helped to think about how I eat and what I eat… with success.‍

Physical health 

Beyond eating behaviours, the data also demonstrated statistically significant increases in reported exercise levels, indicating a positive shift towards more active lifestyles. After just eight weeks of engaging with the Holly Health app, users showed strong improvements across all forms of exercise: flexible exercise increased significantly (n = 894, p < .001, d = 0.5, a medium effect), as did moderate activity (n = 610, p <.001, d = 0.6, a medium to large effect), and strength training (n = 893, p <.001, d = 0.4, a small to medium effect). 

Moderate activity, such as brisk walking, running, or cycling, showed the most pronounced improvement, with an impressive 32% increase relative to baseline and a 13% gain on the full scale. This meant over half of these users (50.16%) improved in this area, suggesting strong engagement with accessible forms of physical activity. Flexible exercise also saw significant growth, rising by 28% relative to baseline and 8% on the full scale, while strength training increased by 20% relative to baseline and 5% on the full scale. These consistent increases across various exercise modalities collectively reflect a meaningful and measurable shift towards more active and healthier routines among users. One respondent recounted:

I have been exercising for at least 30 mins every day, also eating more healthier, lots of protein and fruit, and I feel my asthma and my breathing is a lot better.

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Physical activity score improvements (%):

• Flexibility Exercise: 28% relative (8% absolute)** 
• Moderate Exercise: 32% relative (13% absolute)**
• Strength Exercise: 20% relative (5% absolute)**

**p < 0.001

Personal wellbeing

Analysis of the data showed statistically significant improvements across all four ONS-4 wellbeing measures, indicating a substantial positive impact on users' mental wellbeing. Anxiety scores decreased (n = 503, p  < .001, d = 0.6), while happiness (n = 348,  p  < .001, d = 0.6), life satisfaction (n = 354, p  < .001, d = 0.6), and feeling that life is worthwhile (n = 331, p  < .001, d = 0.6) all increased. Relative changes ranged from 25% to 38%, with absolute changes between 11% to 17% on the full scoring scale. Across all four measures, more than 60% of users reported improvement, underscoring the broad and meaningful impact of Holly Health on overall psychological wellbeing.

Holly Health has helped me realise that my problem with weight is not just about exercise and diet but the underlying issues with my mental health that cause me to constantly turn to emotional eating and so in turn I need to try to address those issues.

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ONS-4 score improvements (%):

• ONS4 Anxiety: 25% relative (17% absolute)**
• ONS4 Happiness: 37% relative (14% absolute)** 
• ONS4 Satisfactions: 30% relative (11% absolute)**
• ONS4 Life feels worthwhile: 31% relative (12% absolute)**

**p < 0.001

Other health outcomes 

Beyond diet, exercise, and overall wellbeing, users reported notable positive changes across a range of other health-related behaviours over the eight weeks.

Energy levels and sleep: Energy levels rose on average by 19% relative to baseline and by 9% on the full scoring scale (n = 385), while sleep duration increased by 8% (4% on the full scale; n = 294).

Nutrition: On average, daily fruit and vegetable intake grew by 15% relative to baseline and by 8% on the full scale (n = 264). Drinking frequency showed healthier patterns, with an average 12% relative change from baseline (5% on the full scale; n = 120).

Eating behaviours: The timing of the last meal before bedtime shifted earlier by an average 32% relative to baseline (16% on the full scale; n = 125).

Social wellbeing: Levels of weekly social activity increased on average by 10% (6% on the full scale; n = 125).

Mindfulness and stress: Reports of operating on “autopilot” decreased on average by 15% relative to baseline, reflecting greater mindful awareness in daily life (7% on the full scale, n = 396), and reports of stress over the past two weeks improved by 16% relative to baseline (8% on the full scale; n = 406).

Collectively, these findings point to broad, meaningful improvements in day-to-day health behaviours. By enhancing energy and sleep, nutrition, daily routines, social connections and mindfulness and stress, users built a stronger foundation for overall health, which also plays a key role in supporting sustainable weight management. One respondent explained:

I love Holly, I feel someone gets me, and she reminds me of doing exercise and reading to unwind, she is also looking at my eating habits with me.

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Other health score improvements (%): 

• Energy levels: 19% relative (9% absolute)**
• Sleep hours: 8% relative (4% absolute)**
• Fruit & veg portions: 15% relative (8% absolute)**
• Drinking: 12% relative (5% absolute)** 
• Last meal time before bedtime: 32% relative (16% absolute)**
• Socialising weekly: 10% relative (6% absolute)**
• Mindfulness: 15% relative (7% absolute)**
• Stress last two weeks: 16% relative (8% absolute)** 

**p < 0.001

Weight 

Since many users set weight management as a personal goal, we also examined changes in body weight. At 8 weeks, users showed a significant reduction compared to baseline, with an average decrease of –2.2 kg (–2.4%), t(245) = 2.85, p = .005. The mean weight fell from 91.1 kg (SD = 21.9) at baseline to 88.8 kg (SD = 21.4) at 8 weeks. The median weight decreased from 88 kg at baseline to 86 kg at 8 weeks, reflecting a typical reduction of –2 kg. Importantly, while Holly Health provides a weight-neutral approach, this early reduction complements broader improvements in eating behaviours, physical activity, and psychological wellbeing, which are known to be stronger predictors of long-term, sustainable weight regulation. Clinical guidelines from the NHS recommend a safe and sustainable rate of 0.5–1.0 kg per week. The average reduction of 2.2 kg observed here reflects gradual, behaviour-led change, which is less likely to lead to rapid regain and is more consistent with sustainable long-term weight management.  Users  commented on their experience:‍

I like that it's moved away from diet culture and it’s about creating healthy habits rather than the number in the scales. It allows you to feel progress this way.

I have lost weight and feel better about my body weight.

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Engagement metrics 

Holly Health supports users in practising small, repeatable habits that build lasting lifestyle change. Many users chose general wellbeing habits such as drinking more water, stretching, and walking, but a notable number focused on food-related behaviours. These included checking in before eating, practising mindful eating, eating balanced meals, and reflecting on food satisfaction. This pattern highlights that users were not only aiming to improve fitness and daily routines but were also actively addressing their relationship with food. One person reflected:

Establishing new habits is so much easier than you think, especially when logging it on the Holly health app. It can make a huge difference to your life and diet. Give it a go!

This shift is significant; research shows that when behaviours become automatic, they are more likely to be sustained long term. The early development of automaticity in food- and lifestyle-related habits suggests that Holly Health is helping users embed meaningful changes in daily life, supporting sustainable improvements in health and wellbeing. One Holly Health user noted:

After eight weeks, 63% of users reported that at least 1 of the habits they had been practising started to feel automatic.

The Holly health app has been a great help in establishing new habits. It's empowered me to know that I can make small changes to my diet and routine that will quickly become permanent. Thank you.

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Self-management

Beyond improvements in wellbeing and behaviour, use of Holly Health was also linked with a reduced reliance on primary care. Frequent attenders (users with 3+ appointments per 8 weeks at baseline) reported a decrease in GP visits by 29% after eight weeks compared to baseline at onboarding, suggesting that some users may be managing elements of their health more independently with support from the app.

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Emerging trends since introducing the hunger-fullness scale feature 

Building on these findings, we examined early outcomes following the introduction of a new interactive feature called the hunger fullness scale that was designed to help users tune into their body’s needs. Early data collected after the rollout of the new feature point to possible shifts in key outcomes, with initial indications suggesting greater improvements in measures such as the relationship with food. One user’s comment reflects this: 

Can I just say how great the new additions are. I love that I can monitor myself anytime before, during a meal or after. Makes me really think about the stage I'm at in a meal and I hope will stop any overeating! The progression bit is good to dip into. Thank you!‍

As part of the feature, we also began tracking three additional eating behaviour measures: Mindful eating (how often users have a meal without any external distractions such as TV, computer or phone), Emotional eating (how often users eat when feeling emotional, for example, sad, bored, angry, or worried, even when not hungry) and Intuitive eating (the extent to which users agree with the statement ‘There are some foods that I don’t allow myself to eat’). 

While the current sample size is small, early patterns suggest improvements across these eating behaviour measures, with mindful eating scores increasing, emotional eating scores decreasing, and intuitive eating scores moving in a direction that indicates less perceived food restriction. These trends indicate a potential shift toward more present, less restrictive, and less emotionally driven eating behaviours. As more data are collected, these preliminary findings will be examined to determine whether they remain consistent and statistically robust.

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Conclusion

The findings from this analysis show that Holly Health users experienced meaningful improvements not only in their relationship with food, but also in physical activity, psychological wellbeing, and daily lifestyle routines. These wide-ranging shifts matter because long-term weight management and health are shaped by more than calories and exercise alone.

Research consistently shows that sleep, energy levels, and nutrition quality, alongside stress, mindfulness, mood, and social support, all play interconnected roles in shaping behaviours. Poor sleep can disrupt appetite-regulating hormones, high stress can drive emotional eating and reduce motivation, and low energy makes it harder to exercise or prepare healthy meals. By contrast, stronger social support and higher energy are linked with greater consistency in maintaining healthy routines. Seeing improvements across all of these domains suggests that users are creating the conditions for genuine, sustainable change.

Taken together, these outcomes not only support individual wellbeing but also point toward broader system-level benefits. Improvements in eating behaviours and mental health can reduce demand on healthcare services by lowering the risk of conditions linked to stress, poor diet, and inactivity. The fully digital, personalised nature of Holly Health makes it more accessible to people who may face barriers to traditional care, offering a scalable way to reach underserved groups. In addition, encouraging more mindful and balanced eating habits has the potential to reduce reliance on highly processed foods and food waste, creating secondary benefits for both health and the environment.

Overall, the data show that Holly Health’s small-habit, mindfulness and intuitive eating approaches deliver meaningful improvements while supporting long-term lifestyle change. As a fully digital and scalable tool, it has the potential to ease pressure on healthcare services and contribute to a healthier, more sustainable future.

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