Presentation on theme: "PDP- Personal Dietitans Perspective Jan Biggart Community Team Lead GCWMS 19.11.13."— Presentation transcript:
PDP- Personal Dietitans Perspective Jan Biggart Community Team Lead GCWMS
PDP Role Team Lead Community Co-ordinator Dietitian – the programme and a recent group presentation / the patients journey.
The programme Phase 1 Delivered by Specialist Obesity Dietitians 9 x 1.5 hrs x fortnightly 3 components –Diet, Activity, Behaviour
Session 1 Causes of Obesity Program Overview Benefits and Costs Looking Ahead Benefits of 5-10kg weight loss Goal setting Eat Well Plate Becoming More Active Lifestyle Diaries
Session 2 – Taking Control Personalised Dietary Prescription Barriers and benefits to becoming more active Setting goals and taking control
Personalised Dietary Prescription of 1500 calories per day Food groupPortions recommended per day Starches (bread, cereals, potatoes, rice, pasta) 6 Fruit and Vegetables 6 Dairy 3 Meat, Fish, Alternatives 2 Fats (butter, low fat spread, oil, mayonnaise, salad cream) 2 Extras (sweet foods, extra portions, dessert, alcohol, crisps) 130 calories
Session 3 – Planning For Success Menu planning, shopping and guide to food labelling Binge eating Introduction to Activity
Session 4 – Changing Habits Cooking and eating out/take a ways Changing habits Dealing with social pressures to eat What you can do to fit in physical activity Pedometers
Session 5 – Go Do It Unhelpful Thinking – Thoughts, Feelings and Behaviour Physical activity - what's available Diet Quiz
Session 6 – Riding The Craving Wave Cravings vs. Hunger Practical Dietary Tips Physical activity quiz
Session 7 – Keep It Real Diet Myths/Fad Diets & the Balance of Good Health Staying Motivated to be Active Body Image
Session 8 – The Journey So Far What diet changes have been made? What activity changes have been made? Relapse prevention High risk situations Setbacks Support
Session 9 - Review What is Next….. Mini Eating Questionnaire/ Self Help Manual Lost 5kg options Not Lost 5kg options –Low Calorie Diet (1200kcals/1500kcals) –Pharmacotherapy (Orlistat ) Enter Phase 2 (3-6months) then Phase 3 (12months)
Phase 2 / Phase 2b 4 x monthly sessions of FWL (3 months) with : Pharmacotherapy ( Orlistat ) or Structured LCD 1200 – 1500 kcals ( with meal replacements )
Phase 3- Maintenance Evidence : is less abundant Varying descriptions of success Will expect some weight regain SIGN guidelines GCWMS : unpublished data / pilot NWCR : Our aim is to maintain the 5kg loss target for 12 months. Attending the P3 maintenance programme significantly improves outcomes. Continue to develop and review.
Preliminary findings Maintenance Study :18 month follow up assessing weight maintenance of successful weight loss patients 50% of patients maintained > 5kg weight loss 87% of patients weighed less than initial weight at follow up Attending maintenance programme was highly significant in successful maintainers
Phase 3- Maintenance Most successful strategies to maintenance: Following a low fat/ high carbohydrate diet 1 hour moderate intensity activity/ day Regular eating including breakfast Self monitoring through lifestyle diaries and weekly weight checks. Maintaining a consistent eating pattern across weekdays, weekends and holidays. Monitoring changes in mood.
Group Presentation - Stobhill Evening Group Looking at data for 19 months ( for research purposes look at 1 year )
Stobhill Evening Group - Phase 1 11 started 4 males : 7 females 8 Completed ( 73% ) 5/8 ( 62% ) Success weight loss > 5kg ( Range 6.1kg to 13kg )
Stobhill Evening Group – Phase 2 (i.e. 7 month data) 8 patients started 5 completed ( 45% ) 4 males and 1 female 5/8 (62%) a success after phase 2
SEG – End Phase 3, Maintenance (i.e.19 month data) 5 patients started 4 completed (80%) 3 males and 1 female ( 36% of programme starters) finished the programme. 1. A 2. G 3. C 4. T
Look Beyond the Weights Look at anecdotal evidence Look at patient feedback forms Look at QOL / Psychology reports Look at improved biochemistry Look at physical activity
Results at end of programme Weight/Ax wtP1S1P1S9Wt loss P1 / % wt loss P3S11P1S1 to P3S11 Total wt loss / % wt loss Patient 1. A kg / 7.9% kg / 12.1% 2. G kg / 5.5% kg / 7.8% 3. C kg / 6.4% kg / 18.9% 4. T kg / 4.7% kg / 18.9%
Results – BMI (kg/m 2 ) BMI at referralBMI at end of programme 1.A G C T
Individual Patient 1 51 year old female, total weight loss since ax 22.5kg Has adult asthma and arthritis Dietary changes : has reduced portion sizes and total fat intake. Activity changes : initially had not done any activity for 6 years. Now walks dog regularly and attends gym 3 times a week. Behaviour : I had the knowledge but I've learned new skills, particularly around lapses and in the group I felt supported and not judged. Benefits : The support of this service and the classes in particular has helped me to lose a lot of weight and improve my general health Previously used inhaler every morning, got breathless on stairs and now rarely uses inhaler and runs up stairs. Has less pain in left knee.
Individual Patient 2 65 year old gentleman, total weight loss since assessment = 17.4kg Has Bronchiectasis, stopped smoking 8 yrs ago and weight increased. At ax wanted to improve breathing Dietary changes : changed eating habits completely. Reduced portions fat and sugar. Increased fruit and veg. Activity changes : previously had to stop walking after < 1 mile, now walks 4 miles and uses an exercise bike regularly. Behaviour : kept a diary initially. Benefits : reduction HbA1c (March 2011 was 45 and was 39), reduced breathlessness, increased general fitness.
Individual Patient 3 44 year old gentleman, total weight loss since ax = 23.9kg Had MI 2009, has LVF and pace maker insitu. At Ax I wrote not sure of programme, just wants a diet sheet. Dietary changes : Previously had a lot of take aways and convenience foods. Reduced these and portion sizes. Activity changes : Now attends gym 3 x / wk and walks for 45 mins x 4 / wk Behaviour : group helped develop problem solving skills. has changed his habits, is a bit of a robot Benefits : Improved heart health, improved sleep, less breathless, feels brighter and more alert. Has changed his girlfriends and daughters lifestyle. Ref : Cardiologists letter - Diagnosis : previous obesity
Individual Patient – year old gentleman, total weight loss since ax = 21.8kg No significant medical history, is a chef in a care home. Dietary changes : Has reduced portion sizes, reduced chocolate, crisps and chips. Adapted cooking methods, and increased fruit and vegetables. Activity changes : previously did no activity and now attends gym x 3 / wk and walks 4 miles x 6 / wk. Behaviour : has changed habits, kept a diary at the beginning Benefits : feels fitter, breathing better.