A new study has found that non-judgemental and personalised lifestyle modification plans improve the physical and mental health of people living with obesity.
The study, which was presented at the EuroHeartCare - ACNAP Congress 2021, found that participants lost weight, improved their cardiovascular health, lowered their blood pressure, and felt less anxious and depressed within just 10 weeks.
The 10-week Croí CLANN (Changing Lifestyle with Activity and Nutrition) programme began by assessing the participant’s baselines measurement of weight, blood pressure, cholesterol, blood glucose, fitness, and levels of anxiety and depression. Each participant was seen by a nurse, dietician and a physiotherapist to agree personalised goals and a management plan.
For the first eight weeks, participants attended a weekly two-and-a-half-hour session. The session was split into slots, with the first 30 minutes dedicated to goal-setting, the next hour for exercising (led by the physiotherapist), and the final hour devoted to a health promotion talk. The talk focused on topics such as healthy eating, portion sizes, reading food labels, emotional versus physical hunger, stress management techniques (e.g. meditation), physical activity, sedentary behaviour, cardiovascular risk factors, and making and maintaining changes.
In the last week, patients had an end of programme assessment with the nurse, dietitian and physiotherapist to discuss the outcomes of the programme, before being referred back to hospital. In total, 78% of the participants completed the programme.
Participants lost weight, improved physical activity levels and felt less anxious and depressed
At baseline, the average body mass index (BMI) was 47.0 kg/m2 and 56.4% of participants had a BMI above 45 kg/m2. In addition, 26.7% had type 2 diabetes, and 31.4% had a history of depression.
The average reduction in body weight was 2.0 kg overall, with 27.2% of participants losing more than 3% of their initial weight. Additionally, those who achieved the recommended levels of physical activity increased by 31%.
There were significant reductions in total cholesterol, low-density lipoprotein (LDL) cholesterol, and blood pressure. The proportion of participants with high blood pressure fell from 37.4% (at baseline) to 31.1% at 10 weeks. In those with type 2 diabetes, the proportion achieving the recommended blood sugar target rose from 47.6% to 57.4%.
Psychosocial health was also assessed using the 21-point Hospital Anxiety and Depression Scale (HADS), where 0-7 is normal, 8-10 is mild, 11-15 is moderate, and 16-21 is severe.
Anxiety and depression scores decreased by 1.5 and 2.2 points respectively over the course of the programme. Furthermore, the proportion with an anxiety score greater than 11 fell from 30.8% to 19.9%; for depression the corresponding proportions were 21.8%, falling to 9.5%.
"Our approach is non-judgemental, which builds rapport and gains trust"
The author of the study, Aisling Harris, cardiac and weight management dietitian, Croi Heart and Stroke Centre, Galway, Ireland, says that the findings suggest that the content and format of the programme allowed for improvement across all psychosocial and health outcomes during a relatively short period. This indicates that the programme could be used as a model of service for other health centres.
She continued: “We focus on changing behaviours and improving people's relationship with food. Many participants have tried diets with strict rules and have fears about foods they can't eat. Our programme has no diet or meal plan, and no foods are excluded. Each person sets their own goals, which are reviewed weekly, and our approach is non-judgemental, which builds rapport and gains trust."
"Obesity develops for multiple reasons and blaming someone for their weight can stop them from getting healthcare and advice. It can lead to emotional eating and feeling too self-conscious to exercise. By identifying each person's triggers, we can develop alternative coping strategies, all within the context of their job, caring responsibilities, external stresses, and so on. For some people, coming to a group like this might be the only social contact that they've had in the week or that they've had in years. People share experiences and support their peers."