7Personalised Dietary Prescription of 1500 calories per day Food groupPortions recommended per dayStarches (bread, cereals, potatoes, rice, pasta)6Fruit and VegetablesDairy3Meat, Fish, Alternatives2Fats (butter, low fat spread, oil, mayonnaise, salad cream)Extras (sweet foods, extra portions, dessert, alcohol, crisps)130calories
8Session 3 – Planning For Success Menu planning, shopping and guide to food labellingBinge eatingIntroduction to Activity
9Session 4 – Changing Habits Cooking and eating out/take a waysChanging habitsDealing with social pressures to eatWhat you can do to fit in physical activityPedometers
10Session 5 – Go Do ItUnhelpful Thinking – Thoughts, Feelings and BehaviourPhysical activity - what's availableDiet Quiz
11Session 6 – Riding The Craving Wave Cravings vs. HungerPractical Dietary TipsPhysical activity quiz
12Session 7 – Keep It RealDiet Myths/Fad Diets & the Balance of Good HealthStaying Motivated to be ActiveBody Image
13Session 8 – The Journey So Far What diet changes have been made?What activity changes have been made?Relapse preventionHigh risk situationsSetbacksSupport
14Session 9 - Review What is Next….. Mini Eating Questionnaire/ Self Help ManualLost 5kg optionsNot Lost 5kg optionsLow Calorie Diet (1200kcals/1500kcals)Pharmacotherapy (Orlistat )Enter Phase 2 (3-6months) then Phase 3 (12months)
15Phase 2 / Phase 2b 4 x monthly sessions of FWL (3 months) with : Pharmacotherapy ( Orlistat )orStructured LCD 1200 – 1500 kcals ( with meal replacements )
16Phase 3- Maintenance Evidence : is less abundant Varying descriptions of successWill expect some weight regainSIGN guidelinesGCWMS : unpublished data / pilotNWCR :Our aim is to maintain the 5kg loss target for 12 months.Attending the P3 maintenance programme significantly improves outcomes.Continue to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.
17Preliminary findings Maintenance Study :18 month follow up assessing weight maintenance of successful weight loss patients50% of patients maintained > 5kg weight loss87% of patients weighed less than initial weight at follow upAttending maintenance programme was highly significant in successful maintainers17
18Phase 3- Maintenance Most successful strategies to maintenance: Following a low fat/ high carbohydrate diet1 hour moderate intensity activity/ dayRegular eating including breakfastSelf monitoring through lifestyle diaries and weekly weight checks.Maintaining a consistent eating pattern across weekdays, weekends and holidays.Monitoring changes in mood.
19Group Presentation - Stobhill Evening Group Looking at data for 19 months ( for research purposes look at 1 year )
20Stobhill Evening Group - Phase 1 11 started4 males : 7 females8 Completed ( 73% )5/8 ( 62% ) Success weight loss > 5kg( Range 6.1kg to 13kg )
21Stobhill Evening Group – Phase 2 (i.e. 7 month data) 8 patients started5 completed ( 45% ) 4 males and 1 female5/8 (62%) a success after phase 2
22SEG – End Phase 3, Maintenance (i.e.19 month data) 5 patients started4 completed (80%) 3 males and 1 female ( 36% of programme starters) finished the programme.1. A2. G3. C4. T
23Look Beyond the Weights Look at anecdotal evidenceLook at patient feedback formsLook at QOL / Psychology reportsLook at improved biochemistryLook at physical activity
24Results at end of programme Weight/Ax wtP1S1P1S9Wt loss P1 / % wt lossP3S11P1S1 to P3S11Total wt loss / % wt lossPatient1. A127.4119.4109.99.5kg / 7.9%104.914.5kg / 12.1%2. G119.8111.11056.1kg / 5.5%102.48.7kg / 7.8%3. C112108.6101.76.9kg / 6.4%88.120.5kg / 18.9%4. T118.5119.3113.75.6kg / 4.7%96.722.6kg / 18.9%
25Results – BMI (kg/m2) BMI at referral BMI at end of programme 1.A 44 402.G38.733.13.C37.729.44.T35.929.7
27Individual Patient 151 year old female, total weight loss since ax 22.5kgHas adult asthma and arthritisDietary 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.
28Individual Patient 265 year old gentleman, total weight loss since assessment = 17.4kgHas 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.
29Individual Patient 344 year old gentleman, total weight loss since ax = 23.9kgHad 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 / wkBehaviour : 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”
30Individual Patient – 4.34 year old gentleman, total weight loss since ax = 21.8kgNo 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 beginningBenefits : feels fitter, breathing better.