Tier 3 Specialist Weight Management Service. Helen Moffat, Fiona Campbell Mary McCallum

Transcription

1 Tier 3 Specialist Weight Management Service Helen Moffat, Fiona Campbell Mary McCallum

2 WEIGH FORWARD GROUP INTERVENTION FOR ADULTS WITH SEVERE AND COMPLEX OBESITY -OVERVIEW Our service and client group ACT as the basis for what we do Where we get stuck How CFT compliments ACT for our clients Is it effective?

3 Staffing Specialist Dietitians (1.6 wte) Referral Criteria BMI >35 ( >30 with co-morbidities) Age 18 years + Clinical and Health Psychologists (1.5 wte) Previous engagement with structured weight management programme Admin Support (0.5 wte) Close working with local physical activity providers / third sector Motivated to change and able to engage with 6 month programme

4 Dietetic Input (healthy balanced diet, with moderate energy deficit) Evidence based psychological model (ACT + CFT) Physical activity (pedometers/fitness bands; links with local providers; seated exercise class) Joint assessment 12 x 2 hour group sessions over 6 months

5 ACT Acceptance - when you and get stuck Commitment with weight Therapy concerns

6 Callum s matrix INSIDE (head & heart) W AWAY Who and What s important? Friends and being social To feel fitter and have more energy Manage work better Confidence for intimate relationship TOWARDS OUTSIDE (hands & feet)

7 Callum s matrix INSIDE (head & heart) What I don t want to think and feel Stressed about family arguments; Isolated; Worried about work Feeling tired, down, a failure AWAY W Who and What s important? Friends and being social To feel fitter and have more energy Manage work better Confidence for intimate relationship TOWARDS OUTSIDE (hands & feet)

8 Callum s matrix INSIDE (head & heart) What I don t want to think and feel Stressed about family arguments; Isolated; Worried about work Feeling tired, down, a failure AWAY Irregular, unplanned eating Over eating when stressed Avoidance Who and What s important? Friends and being social To feel fitter and have more energy Manage work better Confidence for intimate relationship TOWARDS OUTSIDE (hands & feet)

9 Callum s matrix INSIDE (head & heart) W Stressed about family fall out; Feeling isolated; Worried about work Feeling down, sense of failure AWAY Irregular, unplanned eating Eating when stressed Avoidance What s important? To feel fitter and have more energy Manage work better To have confidence to go out socially again, friends TOWARDS Planning meals and snacks, reduced portions and sugar, taking food to work Playing football twice a week, walking every day OUTSIDE (hands & feet)

10 The Choice Point Model

11 Where we get stuck: 5 challenging conundrums...

12 (1) The many functions of food: Survival Nutrition Nurture Sharing Caring Reward Pleasure Comfort Distraction

13 Also... Avoidance Numbing Relief Control Self-harm or punishment Protection My best friend My suit of armour

14 (2) Distant and disconnected from values...

15 (3) Well developed strategies for turning away from pain...

16 (4) Committed actions bring very aversive thoughts and feelings

17 (5) The power of the self blame / failure story... (with societal reinforcement) You ve blown it. Just give up!! You re disgusting! You re useless. You ll never do it!

18 How CFT helps us...

19 The Evolutionary Perspective: from huntergatherer to 24/7 home delivery

20 The Evolutionary Perspective: Food as comfort, soother, security, reward

21 Normalising the threat response

22 How the alarm system and caring system affect the choice point:

23 The workability of the critical self What are the consequences when you give yourself a hard time? Does the critical self help you achieve what s important? What kind of teacher/ boss/ coach would you choose? What would it be like if you weren t so hard on yourself? Why is it difficult to be kinder to ourselves?

24 The shared group experience Helps to normalise and highlight common humanity Opportunities for being compassionate to others and addressing isolation Facilitates perspective taking, defusion from self-blame story

25 Encouraging self-compassion Learning to nurture rather than loathe the body Non-food ways to soothe, calm, nurture and care for self Letter of encouragement to self

26 Challenging committed actions more achievable Pain and suffering more tolerable Skills in self - kindness

27 Is it effective...??

28 Group Outcomes at 6 months (N=30) T1 T2 p Mood (HADS depression) Binge Eating (BES) Emotion regulation (DERS) Self- efficacy (composite) Self-efficacy ( nutrition) Self-efficacy (Exercise) W HO-QoL (psych) 8.13 (4.11) 5.83(3.56) < (8.26) (6.86) < (25.28) 80.31( 19.06) < (2.59) (1.58) < (3.36) (2.25) < (3.91) (3.97) < (14.32) (15.85) <0.00

29 Weight Outcomes At 6 months (n=44): 40% lost 5% and 15% lost 10% Assessment Weight Kg Start of group programme Kg Completed 6 month group programme Kg At 12 months (n=13) 66% lost 5% Of those who previously lost 5%, all had maintained or increased their weight loss Assessment Weight Kg Start of group programme Kg Completed 6 month group programme Kg Completed 12months Kg

30 I learned about being good to myself, and to take control of my life. Participants Feedback about the Programme You gave us choices, not reprimands. I feel like the group sessions were a launching pad for me to go off on my own and put this into practice... I continue to lose weight and am seeing my psychiatrist less...and I have after many years been able to secure a part time job. I have learned that food is not my enemy but that at times I am my enemy. I feel like a different person now and my weight loss will come. Just that sense of understanding that folk struggle the same way as I do. Both the mind and the diet definitely go hand in hand. It has been a life saver for me in more ways than one

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