Intensive weight loss programme. Report

Transcription

1 Intensive weight loss programme Report April 2013 Blackburn with Darwen Healthy Living is a Registered Charity , Company Limited by Guarantee and is registered in England and Wales No: Registered Office, Ba ngor Street Community Centre, Norwich Street, Blackburn BB1 6NZ Telephone: Fax:

2 Background BwD Healthy Living is a registered charity established in 2007, which evolved from the Healthy Living Centre programme launched to tackle health & social inequalities in deprived communities. Its vision is To ensure that local people have access to and are involved in the design and delivery of services that improve their health and well being. We believe passionately in our approach to tackling health inequalities through a community development approach and we have built strong, trusting relationships in the communities in which we work. Our overall approach is based on a holistic view of health and therefore provides a range of services and projects that meet the needs of people. We work in the top 20% most deprived communities in the Borough and have worked in Highercroft for the past 5 years, where we established our first food co op and run a low cost gym, both of which are supported by eight local volunteers. We have established excellent networks and contacts in the ward through our long term presence and delivery of services. The charity has eight employees, all of which are highly skilled and qualified in their fields, including community development staff with over 70 years combined experience, and over 40 years experience in financial management. A board of trustees, made up of representatives from statutory and voluntary sectors are responsible for the government and management of the organisation. We have recently been recognised for our work and were selected as a winner of the GlaxoSmithKline IMPACT Award 2012, run in partnership with the Kings Fund. The judging panel of health leaders thought we.. put the community voice at the heart of our decision making 2

3 Overview Aspire builds on a simple idea that people need support to make long term changes in their healthy behaviour. For many people there are long term barriers and habits that have contributed to their weight gain. Aspire aims to support clinically obese people to achieve a sustainable weight loss. It aims to help them put in place the long term changes in their awareness and attitude towards food and exercise that will lead to a long term change. Aspire is a non clinical intervention providing intensive support over 6 months through one to one and group sessions. The idea is to radically change attitudes towards food and exercise and to build networks of support to help the change in the long term. Aspire is not about radical weight loss but about radical changes in attitudes and behaviour. It aims to support each person to achieve a 5 to 10% fall in their body weight. The pilot project showed the intensive support provided allowed the change to exceed these relatively modest levels. This support meant people could accelerate changes in their lifestyle in turn helping them lose weight more rapidly. The pilot showed this type of intervention can be delivered for less than 2,000 per participant and will realise an average weight loss of 12 kilograms in 3 months. This is equivalent to an incremental cost effectiveness ratio of 28,000 per quality adjusted life year (even before making any assumptions about sustainability). Blackburn with Darwen Healthy Living has a long established reputation as a community health provider. Over the last 5 years it has developed a wide range of community interventions that have supported people to make sustainable lifestyle changes. This includes community gyms, a food coop and a volunteer cancer network. It has an excellent reputation as an organisation that listens to and can engage with its community. Blackburn with Darwen Healthy Living is seeking support for this project to help more people and the NHS benefit from its output. 3

4 Overview of Programme The programme has three strands: Big group meetings where everyone on the Aspire project comes together. These provide a forum to share information about living a healthy lifestyle; Small group meetings groups of 4 meeting to try different forms of physical activity and to provide peer to peer mentoring support; 1 to 1 meetings these provide people with a focus that is relevant to them. It may cover the specific challenges they face around eating a healthy diet or being regularly physically active. The three elements of the programme combine to ensure a person is fully supported to make sustainable changes. It provides a supportive group environment so people know they are not alone and can draw on the support of their peers. But it also has 1 to1 sessions allowing people to explore their individual challenges and goals. The delivery model Aspire builds on the existing evidence of what makes a sustainable behaviour change. It provides people who are at risk of ill health because of their weight with an intensive period of support to allow them to make substantial, sustainable changes to their lifestyle. The 26 week length provides the time needed for new habits to form and sustainable weight loss to take place. Target group and demand This project aims to target those with a BMI between 30 and 50. This group are classed as obese but broadly fall outside of the scope of direct medical intervention. The pilot showed substantial demand for the service with 101 enquires and 63 returned applications. 50 attended the seminars with 12 being accepted onto the programme. Of these, 5 people did not complete the 6 months (the majority of these discontinued a few weeks into the programme), however 2 additional people were invited to join the programme to replace those that dropped out. In total 9 people finished the Aspire programme. 4

5 Details of the programme The intervention consists of 3 elements, a big group meeting (everyone on the Aspire program), a small group meeting (groups of 4 people) and a 1 to 1 meeting. The big group meeting is split into two sections of 45minutes each: an information giving session and an exercise session. The information given is designed to increase knowledge and skills in specific areas that could enhance a client s ability to make lifestyle changes that result in weight loss. The exercise session starts as a way of introducing different types of structured exercise, as the program progresses it allows the group to be tested and pushed in their exercise intensity whilst building group relationships and support through peer encouragement. The small group meetings are purely exercise based and give clients another hour long opportunity for structured instructor led exercise; they also enable proper technique of exercises to be observed, which is harder in the large group setting. The 1½ hour 1 to 1 meetings combine elements of both big and small groups and but make it personal and relevant to the client. In the first weeks of the program discussions in 1 to 1 sessions are linked to the information given at the big group meeting: following up and evaluating understanding and putting the knowledge and skills learned into a personal context. As the program continues and the trainer client relationship develops, the 1 to 1 sessions offer an opportunity to discuss barriers to success as they occur, any difficult situations coming up and to other general support, advice and motivation. It is this element that allows the program to be totally client centred. The 1 to 1 meetings also include individual exercise time with the trainer. This allows clients to be pushed in an exercise setting and safely test their physical limits. 5

6 Impact of the ASPIRE project The most direct impact of the project has been around weight loss. The project was able to reduce participant s weight by an average of 17%. The diagram below demonstrates how this has lead to a reduction in BMI of more than 7 kg/m2. Note that several participants traversed the 40 BMI boundary and out of the consideration for surgery. See table 1, page 5 for a detailed breakdown of weight and BMI change per client. 6

7 Name Table 1 Weight and BMI change of individual clients at the end of 6 months weight, kg (BMI, kg/m 2 ) Current weight, kg (BMI, kg/m 2 ) Total weight loss, kg % Person A 15.4 (40.63) (35.77) (4.86) % Person B 25.8 (39.86) (31.07) (8.79) % Person C 19.3 (37.14) (30.80) (6.34) % Person D 23.5 (43.13) (34.95) (8.18) % Person E (40.93) 33.6 (31.49) (9.44) % Person F 22.0 (44.46) (36.26) (8.2) % Person G 11.8 (36.26) (31.34) (4.92) % Person H 17.3 (48.68) (41.71) (6.97) % Person I 26.2 (37.64) (28.73) (8.91) Percentage weight loss (BMI loss, kg/m 2 ) 1 BMI cut offs (for white European individuals) <18.5kg/m 2 : underweight kg/m 2 : healthy weight kg/m 2 : overweight kg/m 2 : obese class I kg/m 2 : obese class II 40 kg/m2 and above: obese class II 7

8 The Patient Health Questionnaire (PHQ 9)2 was used to measure client s level of depression at the beginning and end of the programme, it is a self administered version of the PRIME MD diagnostic instrument for common mental disorders, it has been validated for use in primary care and is used to monitor the severity of depression and response to treatment. At the beginning of the project all clients had some degree of depression, with 7 (of the 9 who completed) being classed as moderately severe or severely depressed. By the end of the program everyone was classed as having no depression. See table 2 for PHQ9 change per client. Name Person A Person B Person C Person D Person E Person F Person G Person H Person I Table 2 PHQ9 score change of individuals at the end of 6 months PHQ9 score 20 27: severe PHQ9 score 15 19: moderately severe PHQ9 score 10 14: moderate PHQ9 score 5 9: mild PHQ9 score 0 4: none score: 20/27 score: 3/27 score: 20/27 score: 25/27 score: 19/27 score: 15/27 score: 19/27 score: 16/27 score: 10/27 score: 7/27 score: 0/27 score: 0/27 score: 1/27 score: 0/27 score: 2/27 score: 2/27 score: 1/27 score: 1/27 8

9 Cast Study of Ian McWhirter weight in September 2012: kg, 18st 4lb weight in March 2013: 91.3kg, 14st 5lb Total weight loss 25.8kg, 4st, 22% less compared to starting weight 9

10 My name is Ian McWhirter. I am a 65 year old Scotsman; I was born in Ayr, I moved to Darwen in 1969, eventually becoming a fully affiliated Lancashire Lad (with a Scottish accent). I am a 10

11 widower having recently lost my wife in January 2012, we had been married for 44 years. I have 4 children and 7 grandchildren who I adore and am devoted to. I have had problems with my weight since being a young boy and have had my weight yo yo from 12 stone to 20 stone. I had 3 different sizes of clothes in my wardrobe depending on my weight at that time. From around my mid twenties I tried dieting without any advice but my weight always fluctuated. I tried slimming pills in my mid thirties and did lose a lot of weight but put it back on when I stopped taking the pills, in my fifties I tried the Atkins diet and lost weight but after a time I began to feel ill and I stopped, resulting in me again putting the weight back on, I also joined a private gym but did not continue long enough for any real results, so in my sixties my weight continued to go up and down due to my poor diet and drinking. I was on various medications for high blood pressure, water retention and severe back pain. My wife had to put my socks on for me as I couldn t bend down to do this myself. Running around with my grandchildren was impossible for me to do. I have learned a lot about the healthy food and drink I can have and how they affect my body strength, in fact I have learned more on this course about healthy eating and exercise than I have in the past 65 years! I am beginning to realise that this isn t a diet (the dreaded D word!) but a lifestyle change and I am enjoying discovering delicious new meals to eat, I know that healthy eating can be tasty, but you can also have the odd treat. I also save money on my food bill because I am not buying cakes, sweets and fizzy drinks and cutting down on alcohol has saved me around 45 a week. The most important bit of the course is that for whatever reason you stray a bit, you can get back on the healthy eating and exercise again which I never seemed to be able to do before. I am more aware of the benefits of exercise and the proper way to exercise. Most importantly I am more aware that I am not alone and whether it is my family, fellow Aspire friends or Abbey or Sophie there is someone I can speak to about any concerns. It is tough but I seem to get pushed just enough and encouraged in just the right way. I really enjoy the 1 to 1 sessions and the widely varied exercise programmes that we undertake. I didn t like the way I looked and didn t feel like I could do many activities, but now I am a regular at the gym and also go to aqua 11

12 aerobics and body pump. As I have got fitter I have started jogging and have jogged 10k from start to finish, I am also able to volunteer at Blackburn food bank lifting heavy boxes. I go and do all my own shopping and walk and carry bags most of the time, I even experienced Christmas shopping with my daughter for the first time! My lifestyle has changed so much in one way or another, I don t think I could have lasted much longer the way my life was going. I used to take paracetamol and ibuprofen pain killers and drugs for water retention but I don t need any of these any more, I also took 2 blood pressure tablets, now I only take one and am hoping to be off this altogether. Aspire has helped me cope better with family life by being able to play games with the grandchildren. I would have a kick around with them but couldn t do this for long, now I have a whole bundle of energy and regularly have my grandchildren overnight. Before aspire I was a bit down and wanted to be on my own, sometimes I didn t even want to answer the phone. I used to always put a front on, use humour as a cover to pretend that I was happy with my size, I had a saying that for every fat person who looked happy, there was a sad person inside. I can see now that I was never happy being the size I was but now I feel great about my body and it is fantastic to be able to shop anywhere, look fantastic and feel great about the way I look. I am a happy thin person inside and out. The most important thing aspire has taught me is even at 65 years I can do lots that I didn t think I could ever do and it has to continue for the rest of my life. The main achievement from doing aspire is the fact that I know that the days of losing weight and gaining weight have gone forever. 12