Introduction to After CoreIntroduction to After Core

SDPI DPP Lifestyle Balance MeetingSDPI DPP Lifestyle Balance Meeting

March 09, 2006, Denver, COMarch 09, 2006, Denver, CO

Brenda Broussard, RD MPH MBA CDE, BC-ADM Brenda Broussard, RD MPH MBA CDE, BC-ADM

with help from Mary Hoskin, MS RDwith help from Mary Hoskin, MS RD

Julie Nelson, RD and Shandiin Begay, Julie Nelson, RD and Shandiin Begay,

SW American Indian CenterSW American Indian Center

Workshop ObjectivesWorkshop 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)

-15 -10 -5 0 +5

05

1015

20Hazard Rate for Developing Diabetes As

A Function of Weight Change From Baseline

Haz

ard

rat

e p

er 1

00/y

r

Mean weight change from baseline (kg)

Average Risk

Intensive Lifestyle Group

Learning a New SkillLearning a New Skill

Your StoryYour 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?

-8

-6

-4

-2

0

0 1 2 3 4

Years from Randomization

Weig

ht C

hang

e (kg

)

Placebo

Metformin

Lifestyle

Mean Weight Change in the DPPMean Weight Change in the DPP

DPP ShowedDPP 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.

DPP ShowedDPP 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.

Brenda Broussard

Weight Loss MaintenanceWeight 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.

The National Weight Control RegistryThe 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

Research-Comparison of 2 DietsResearch-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

Research – Comparison of 4 DietsResearch – 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.

DPP ShowedDPP 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

DPP ShowedDPP 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

Diabetes Prevention Diabetes Prevention Program (DPP)Program (DPP)Lifestyle Intervention Lifestyle Intervention is…is…

The “State of the Art” weight management program!

Lifestyle Coach ContactsLifestyle 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

After Core Goals: Critical to After Core Goals: Critical to Helping Prevent DiabetesHelping 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

Planning After CorePlanning 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

Planning After Core Planning After Core (continued)(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

Negotiate a Plan for ChangeNegotiate 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

Keep the Excitement Alive!Keep the Excitement Alive!“Repackage”“Repackage”

Ideas for CampaignsIdeas for Campaigns

After Core CampaignsAfter Core Campaigns

• Specific goals that are rewarded– 5 pound weight loss

– 150 minutes activity each week

– Record keeping

– Class attendance

Don’t Gain - Maintain!Don’t Gain - Maintain! Holiday Campaign 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

Just Move It ChallengeJust Move It Challenge

• Let's Get 1 Million American Indians and Alaska Natives Moving!12,825 participants from 178 partner programs  

• www.justmoveit.org

Think PositiveThink 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

THANK YOU! THANK YOU!

Brenda Broussard, RD MPH MBA BC-ADM CDEBrenda Broussard, RD MPH MBA BC-ADM CDE

Albuquerque, NMAlbuquerque, NM

Brenda@BroussardConsulting.comBrenda@BroussardConsulting.com