Transcript Individual Patient 1

PDP- Personal Dietitans
Perspective
Jan Biggart
Community Team Lead
GCWMS
19.11.13
PDP
Role
• Team Lead
• Community Co-ordinator
• Dietitian – the programme and a recent
group presentation / the patients journey.
“The programme”
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Phase 1
Delivered by Specialist Obesity Dietitians
9 x 1.5 hrs x fortnightly
3 components
–Diet, Activity, Behaviour
Session 1
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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 group
Portions 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
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Evidence : is less abundant
Varying descriptions of success
Will expect some weight regain
SIGN guidelines
GCWMS : unpublished data / pilot
NWCR : www.nwcr.ws
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
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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 wt P1S1
P1S9
Wt loss P1 /
% wt
loss
P3S11 P1S1 to P3S11
104.9 14.5kg / 12.1%
Total wt loss / %
wt loss
Patient
1. A
127.4
119.4
109.9 9.5kg / 7.9%
2. G
119.8
111.1
105 6.1kg / 5.5%
3. C
112
108.6
101.7 6.9kg / 6.4%
88.1 20.5kg / 18.9%
4. T
118.5
119.3
113.7 5.6kg / 4.7%
96.7 22.6kg / 18.9%
102.4 8.7kg / 7.8%
Results – BMI (kg/m2)
BMI at referral
BMI at end of
programme
1.A
44
40
2.G
38.7
33.1
3.C
37.7
29.4
4.T
35.9
29.7
Weight (kgs)
Weight loss journey
140
120
100
80
Ax wt
P1S1
60
40
20
0
P1S9
P3S11
1
2
3
Phase of Programme
4
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
2.11.12 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 – 4.
• 34 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.
MDT working !