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, 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. -15-10-50+5 0 5 10 15 20 Hazard Rate for Developing Diabetes As A Function of Weight Change From Baseline Hazard rate per 100/yr Mean weight change from baseline (kg) Average Risk Intensive Lifestyle Group

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. Placebo Metformin Lifestyle Mean Weight Change in the DPP

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/ 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!

18. 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

19. After Core Goals: Critical to Helping Prevent Diabetes 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

20. 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

21. 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

22. 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

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

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

25. Ideas for Group Campaigns Route 66 Walking Campaign –Formed teams & competed along Rt. 66 –Earned points by: 10,000 steps on pedometer/day or 30 min. of activity Weight loss (i.e. Every lost pound =10 miles) Walk with a team member (enhance more group support) Keeping Track of food and activity

26. 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

27. 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

28. 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

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