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Introduction to After Core

Introduction to After Core. SDPI DPP Lifestyle Balance Meeting March 09, 2006, Denver, CO Brenda Broussard, RD MPH MBA CDE, BC-ADM with help from Mary Hoskin, MS RD Julie Nelson, RD and Shandiin Begay, SW American Indian Center. Workshop Objectives :.

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Introduction to After Core

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  1. Introduction to After Core SDPI DPP Lifestyle Balance Meeting March 09, 2006, Denver, CO Brenda Broussard, RD MPH MBA CDE, BC-ADM with help from Mary Hoskin, MS RD Julie Nelson, RD and Shandiin Begay, SW American Indian Center

  2. Workshop Objectives: • Describe why After Core contacts are critical to long-term success. (Brenda) • Provide scientific evidence of weight loss and weight loss management therapies. (Brenda) • Market “After-Core Nuts and Bolts” Session: (Julie Nelson, RD) • Describe the benefits of keeping track for long-term success. (Alisa Katai, MHA)

  3. Hazard Rate for Developing Diabetes As A Function of Weight Change From Baseline 20 Intensive Lifestyle Group 15 Hazard rate per 100/yr 10 5 Average Risk 0 -15 -10 -5 0 +5 Mean weight change from baseline (kg)

  4. Learning a New Skill

  5. Your Story • Remember when you learned a new skill? • What was it? __________________ • How long did it take? • Did you receive training and support? • Describe the support? • How does this relate to your experiences with lifestyle coaching for diabetes prevention?

  6. Mean Weight Change in the DPP Placebo Metformin Lifestyle

  7. DPP Showed • Weight loss may take longer in our populations. • SW American Indian sites; goals reached in 6 – 15 months - Reality check – weight loss not achieved after 16-week curriculum.

  8. DPP Showed • Maintaining weight loss is at least as difficult as the initial loss. “So what about popular diets – do they work?” – show me the evidence.

  9. Weight Loss Maintenance • Maintaining weight loss is at least as difficult as the initial loss. • Scientific evidence – diets that reduce caloric intake result in weight loss. Freedman MR. Obesity Research 2001;9(Suppl 1), Popular Diets: A Scientific Review. • Long-term outcomes are poor without the other components of an intensive lifestyle program.

  10. The National Weight Control Registry • > 3000 American adults, minimum 30 pounds weight loss • Kept weight off – av. 6 years, 60 pounds • Key behaviors: http://www.nwcr.ws/Research/ • Self-monitoring • Healthy low –calorie meal plan: 1400 Kcal • Eat breakfast • Dieting consistency across week and year • Physically active each day – 60 min/day

  11. Research-Comparison of 2 Diets • 63 people, randomized ctr.1 year study, BMI=34 • Low CHO, high PRO, high FAT -Atkins Diet • 15 pound weight loss at 6 months • High CHO, low KCAL, low FAT - Conventional Diet – 8 pound weight loss at 6 mos. • No difference in weight loss at 1 year • Self-help, minimal professional contact • Adherence poor, attrition high (37 at 1 yr.) • “We wouldn’t make any recommendations on anything else with only one year of data”. Foster, Gary et al. May 22, 2003, NEJM

  12. Research – Comparison of 4 Diets • 160 adults with known hypertension, dyslipidemia or diabetes (Tufts, Boston) • Randomly assigned to either Atkins, Zone, Weight Watchers, Ornish Diets. • Diet adherence rates were low; 35% (Weight Watchers and Zone) - 50% (Atkins and Ornish) drop out rate. • Amount of weight loss associated with self-reported dietary adherence level - not with diet type. • Modest weight loss 5%(5-7 pounds) at 1 yr. Dansinger M, et al. JAMA 2005;293(1):43-53.

  13. DPP Showed • Physical activity is important to weight maintenance. • “Providing Lifestyle Interventions in Native American Communities, DPP Outcomes Study and Look AHEAD”, Obesity Management Dec. 2005 1(6):251-255. • “The DPP: Description of lifestyle intervention”, Diabetes Care 2002:25(12):2165-71. • Earlier supporting work: • Da Qing Study, Finnish Diabetes Prevention Physical Activity & Health: Surg. Gen. , 1996 - R Wing, T Wadden, R Jeffery, L Epstein, A Kriska, S Blair, and others

  14. DPP Showed • Frequent contact and ongoing intervention remain important. • After Core provides the tools you need. • People need support. They need long term support; individual and group support on a regular basis. • Accountability – keeping track

  15. Diabetes Prevention Program (DPP)Lifestyle Intervention is… The “State of the Art” weight management program!

  16. Lifestyle Coach Contacts • Goals: Weight, Fat grams, Calories/day, Activity /week • Self monitoring • Reinforce - “can’t hear it enough” • Weekly contact form & type • Identifies topics • Prompts and “scripts” for After Core topics

  17. After Core Goals: Critical to Helping Prevent Diabetes • Reach or maintain weight loss goals • Reach or maintain activity goals • Minimum - monthly contact, in person or by phone (DPP participants preferred in person contact) • Minimum – in person every 2 months • Minimum - Three group sessions per year • Nutrition, activity, behavior

  18. Planning After Core • Frequent contact remains important – whatever it takes! • Transition slowly and only if high levels of adherence persist. • Be proactive. Schedule an appointment right away if you discover a downward trend in adherence based on data received between visits by phone or mail

  19. Planning After Core (continued) • “Target Five” –Entire team contributes to discussion – learn more at tomorrow’s “After Core Strategies” workshop • Toolbox strategies • Competition – “People love to compete against another group” M Hoskin, RD MS • Goal driven, incentive-based • Build on you and your participant’s history

  20. Negotiate a Plan for Change • Participant’s role • Selection of strategies to implement • Decision-making • Lifestyle coach’s role • Triage & care management • Defining options • Facilitating access to information (vs. teaching) • Reflective listener • Not fixing or problem-solving for client • Not advice-giving nor persuasion

  21. Keep the Excitement Alive!“Repackage”Ideas for Campaigns

  22. After Core Campaigns • Specific goals that are rewarded • 5 pound weight loss • 150 minutes activity each week • Record keeping • Class attendance

  23. Don’t Gain - Maintain! Holiday Campaign • Overview • Use the “Getting Ready for the Holidays” • No Vacations with Lifestyle Balance • Strengths • Weigh-In Dates after major holidays • Incentives for maintaining weight • Accountability

  24. Just Move It Challenge • Let's Get 1 Million American Indians and Alaska Natives Moving!12,825 participants from 178 partner programs   • www.justmoveit.org

  25. Think Positive • DPP after core class attendance - 30% • 65% maintaining some weight loss > 8 y. • Remember your success • Use your energy toward success • Class topics you enjoy while meeting participant needs

  26. THANK YOU! Brenda Broussard, RD MPH MBA BC-ADM CDE Albuquerque, NM Brenda@BroussardConsulting.com

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