Working with the Manual of Operations Lessons from the Diabetes Prevention Program Mary Hoskin &...
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Transcript of Working with the Manual of Operations Lessons from the Diabetes Prevention Program Mary Hoskin &...
Working with the Manual of Operations
Lessons from the Diabetes Prevention Program
Mary Hoskin & Carol PercyJanuary 13, 2005 DP Meeting
Key Findings from the DPP
• Lifestyle Intervention reduced the risk of diabetes by 58%.
• Treating 7 people with Lifestyle intervention will prevent 1 new case of Diabetes in 3 years.
The DPP Research Group, NEJM, 346:393-403; 2002
• Weight loss was the factor that prevented Diabetes in the Intensive Lifestyle group.
Hamman, R. for the The DPP Research Group, ADA Oral Presentation, 2002, # 115
• Lifestyle intervention was beneficial Lifestyle intervention was beneficial regardless of ethnicity, age, BMI, or sex.regardless of ethnicity, age, BMI, or sex.
• For every 1 Kg of weight lost, diabetes risk was reduced by 13%.
• Increased physical activity was not associated with initial weight loss but was significantly related to long term weight loss.
• Self-reported improvements in diet and physical activity that do not result in weight loss do not result in lower diabetes risk.
Key Findings (continued)
Lifestyle Intervention An intensive program with the
following specific goals:
• >> 7% loss of body weight and maintenance of 7% loss of body weight and maintenance of weight lossweight loss
– Dietary fat goal -- <25% of calories from fatDietary fat goal -- <25% of calories from fat
– Calorie intake goal -- 1200-1800 kcal/dayCalorie intake goal -- 1200-1800 kcal/day
• >> 150 minutes per week of physical activity 150 minutes per week of physical activity
The Core Curriculum16 easy to use sessions over 24 weeks of
education and training in diet and exercise methods and behavior modification skills
Emphasis on:• Self monitoring techniques• Problem solving• Individualizing programs• Empowerment and social support• Frequent contact with case manager
and DPP support staff
Lifestyle Core Class Sessions
1.Welcome and Getting Started Losing Weight.
2.Be a Fat and Calorie Detective.3.Three Ways to Eat Less Fat.4.Healthy Eating.5.Move Those Muscles.6.Being Active: A Way of Life.7.Tip the Calorie Balance8.Take Charge of What’s Around You
Lifestyle Core Class Sessions (continued)
9. Problem Solving10. Four Keys to Healthy Eating Out.11. Talk Back to Negative Thoughts.12. The Slippery Slope of Lifestyle Change.13. Jump Start Your Activity Plan.14. Make Social Cues Work for You.15. You Can Manage Stress.16. Ways to Stay Motivated.
Principles from Manual of Operations
• 7% weight loss goal set because it was believed to be safe, effective and feasible
• Emphasis on group interaction and discussion
• Each lesson has a model script• Time to plan group and not lesson• Based on clearly defined study goal• Intervention is based on participant self-
management• Tailor to participant lifestyle, learning style
and culture
Common Questions
• Fat and calorie goals & one at a time
• 16 weeks of weekly contact• Weight lifting/Thai chi, etc• Focus on limiting fat, not
carbohydrates questions• Focus on success
Daily Fat and Calorie Goals
Weight (lbs)
Fat Goal (grams)
Calorie Goal
120-174 33 1,200
175-219 42 1,500
220-249 50 1,800
>250 55 2,000Be a Fat and Calorie Detective
Lifestyle Core Session #3:Three ways to eat less fat
• Eat high fat foods less often
• Eat a smaller amount of high-fat foods
• Eat lower fat foods instead
Keys to success
• Clearly defined and achievable goals and expectations
• Case management approach• Frequent contact• Relationships- staff and family• Intensive, ongoing intervention
Keys to Success (Continued)
• Individualization• Materials and strategies that
addressed the needs of an ethnically diverse population
• Keeping track• Provide tools to achieve goals• Staff Training
Defined and Achievable Goals
• Individualized fat and calorie goals for weight loss
• Individual weight loss goal (7%)• Physical Activity goal of 150 min per
wk• Time frame to meet stated goals• Participant contracts
Case Management
• Consistent relationships• Work with the participant as a
team• Hang in there- reinforcement• Be supportive• Utilize multidisciplinary approach
Lifetime Maintenance
• Continued self-monitoring and Continued self-monitoring and other behavioral strategiesother behavioral strategies
• Frequent contactFrequent contact
• Group classes and motivational Group classes and motivational
campaignscampaigns
• Tool box strategiesTool box strategies
Individualization
• Goals individualized to starting weight and what makes them successfully lose weight
• Recipes and menus• Interpersonal and individual needs
like jobs, literacy and language• Team approach they choose how to
Targeting for population
• Use local examples to reinforce points– 3 ways to eat less fat
• Recipes and Foods• Designed for use in many different
ethnic groups• Physical Activity
Staff Training
• Required reading Appendix D.1• Videotapes• Observation by centrally trained
personnel• Audio taped practice session• Ongoing team meetings
Weight Control RegistryKeys to Success:
• Eat a reduced-calorie, low-fat, moderately high carbohydrate diet
• Eat breakfast daily• Check weight regularly• Regular Physical Activity
Motivational Interviewing
• Listening and Summarizing• Resolving Ambivalence• Building Motivation and
Strengthening Commitment• Providing Information
Services-Research Continuum
Improve practice and
standards of care
Identify problems and
research questions
Research StudyHealth Services
That doesn’t make it easy for you, but the DPP demonstrated that it can be done.
NIH Pub. No. 03-5335 Feb 2003
•Thanks to the DPP participants for their commitment and dedication to the goal of diabetes prevention