Helping Students Shed Pounds

Julie Luht and Leah Kasowitz

SCAM

In One Sentence…

All diets work…when you stick to them.

Learning Objectives

Describe the state of the science in weight management research.

Articulate a realistic approach to weight management in Job Corps.

Utilize tools to help students manage their weight.

WHY IS OBESITY ON THE RISE?

Part 1: Identifying the Problem

Why is it so much harder for some people?

In Summary

A toxic, obesity-causing environmentGenetics that tell use to eat when

food is availableContradictory information about

what’s healthyOverly simplistic messages to eat less

and exercise more

HOW DO WE TURN THIS AROUND?

Part 2: Solving the Problem

LESSON #1You’re not going to save everyone.

Success Defined

Drop out rate of less than 20% 20-40% maintain weight loss Weight loss is modest, sustained, and clinically

significant 8 pounds=reduced diabetes 6 pounds=reduced BP/drugs 1.8 pounds=24% reduction in all-cause mortality

at 10.5 yrs.

Source: Powell, L.H. et al. (2007). Effective obesity treatments. American Psychologist.

62(3); 234-246.

What Makes a Program Successful?

Intensive phase followed by indefinite follow up

Meet at least once a week Specific dietary changes, calorie reduction,

and exercise combined Draw on skills of experienced behavior

professionals (self-monitoring, modeling, environmental restructuring, and group and individual support)

Source: Powell, L.H. et al. (2007). Effective obesity treatments. American Psychologist.

62(3); 234-246.

LESSON #2Don’t push.

The Stages of Change and MI

MI Questions

On a scale of 1-10, how ready do you feel to change your eating patterns or lifestyle behaviors? What would it take to move you to a [higher number]?

How is your current weight affecting your life right now? How do you feel about that?

Source: Puhl, R. (2011). The Obese Patient in the Healthcare Environment. Available at: http://www.medscape.com/viewarticle/749440?src=mp&spon=17

MI Questions

What strategies have worked for you in the past?

What makes you feel like you can continue to make progress if you decide to?

What are your obstacles? How do you think you can overcome [insert obstacle]?

MI Questions

What are your hopes for the future if you are able to become healthier?

How would your life be different if you lost weight and adopted a healthier lifestyle?

Intake Activity

Assess readiness for changeRefer appropriately

What Not to Do

Mandatory groupsShort-term competitions/programs

(more harm than good)

Slow gain Diet Regain Diet Regain Diet120

130

140

150

160

170

180

190

200

Yo-Yo DietsSlow Gain

Weight Cycling

Source: Cereda, E. (2011). Weight cycling is associated with body weight excess and abdominal fat: A cross-sectional study. Clinical Nutrition. [Epub ahead of print]

LESSON #3

Focus just as much energy on normal and overweight students as obese students.

Trends

Benefits

Societal benefitsPopulation focusMaintaining weight is a whole lot

easier than losing weight Integration into parenting classes

LESSON #4Focus on behavior, not weight.

Change Focus

“We focus too much on diet and not enough on physical activity; and we focus too much on losing weight and not enough on keeping it off”

Most weight loss programs focus primarily on dietary restriction, and we know those are not generally successful

(http://xnet.kp.org/permanentejournal/sum03/registry.html)

SMART Goals

Use SMART goals SpecificMeasurableAttainableRealisticTimely

What is not a SMART goal?

Walk 5 minutes a dayJoin a sports team/dance teamGet healthyWalk 1 mile per day, 5 days a week

SMART Activity

Goal Setting WorksheetDiscussion questions

How would you use this on your center?Is anyone using this on center now?

Link to HEALs

Healthy Eating 101Cooking 101Nutrition JeopardyMove It!-Making Physical Activity Fun

Move It!

Sports (soccer, volleyball, softball, basketball, running club, jogging club, walking club, etc.)

Dance (hip hop dance, Greek organization stepping, Latin dance, belly dancing, urban dance, aerobics class, step class, dance competitions)

Mind/Body or Stress Reduction Activities Gym Workout Interactive Gaming [Wii Sports™ or Wii Fit™

games, video dance games like Dance, Dance Revolution (DDR)™]

Step Up to Help

Making a Difference MSNBC- Obesity Story in DC “Step up to Help”

http://www.msnbc.msn.com/id/21134540/vp/43286952#43286952

A Consideration

Need to consider the specific needs of overweight teens/young adults

Overweight children may experience negative consequences of participation in activities considered appropriate for normal-weight children

American Heart Association Childhood Obesity Research Summit: Executive Summary

LESSON #5Make sure the environment supports health.

Adding Healthy Choices

Source: Boutelle, K.N. et al. (2011). Nutritional quality of lunch meal purchased for children at a fast-food restaurant. Childhood Obesity. 7(4), 316-322.

Food Selection (teenson a visit to McDonald’s)

Percentage

French Fries 33.0%

Apple Dippers 0.3%

Soda 96.7%

Milk and apple juice combined 3.3%

Baked apple pie 8.6%

Fruit and yogurt parfait 0.8%

Placement Strategies

Place the most nutritious foods at the front of the line (increase 10-15%)

Use descriptive food labels (increase 27%) Give choices of vegetables Use trays (promotes salad consumption) Shrink the breakfast bowl (decrease serving by

24%) Pull the salad bar away from the wall Put fruit in colorful bowls

Source: Wansink, B. et al. (2010). Lunch line redesign. New York Times. http://www.nytimes.com/interactive/2010/10/21/opinion/20101021_Oplunch.html.

The Point…

Serving healthy food increases the chances that people will eat healthy, but it doesn’t mean that people will choose it

Need some tricks

Discussion Topics and Worksheets

How Can You Eat Healthy When You Eat Out?

Navigating a Grocery StoreHealthy ChoicesFamily and Food

LESSON #6Create positive feelings and mitigate negative ones.

Types of Motivation

No Motivation

Extrinsic Motivation Intrinsic Motivation

N/A External Somewhat External

Somewhat Internal

Internal Internal

Will not make a

change on their own

External rewards and punishments, controlled by

others

Self-control,ego, avoid guilt, pride

Accepted as

personally important,

value system

Behavior is part of

the person, synthesis, outcome

based

Interested in behavior,

find enjoyment in the process

Source: Ryan RM, Deci EL. Self-Determination Theory and the Facilitation of Intrinsic Motivation, Social Development, and Well-Being. American Psychologist. 55(2000)68-78.

Support

Choice and

Autonomy

Foster Competence

What Drives Eating Decisions?

Health Taste Cost Convenience

Source: O’Hagan, M. (2011). State still seeks winning strategy against childhood obesity. The Seattle Times. June 20, 2011.

The Correct Order

1. Taste2. Cost3. Convenience 4. Health

Source: O’Hagan, M. (2011). State still seeks winning strategy against childhood obesity. The Seattle Times. June 20, 2011.

What Drives Eating Decisions?

1. Taste2. Cost3. Convenience 4. Health

Source: O’Hagan, M. (2011). State still seeks winning strategy against childhood obesity. The Seattle Times. June 20, 2011.

How did you like your snack?

Unhealthy=Tasty Intuition

People enjoy food more if they think it’s unhealthy

Belief about the food affects the experience

Source: Raghunathan, R. (2006). The unhealthy=tasty intuition and its effects on taste inferences, enjoyment, and choice of food products. Journal of Marketing. 70(4), 170-184.

Decadent

Healthy

McDonald’s McLean Burger

Positive Food Exposure Therapy

The Hommos

“These are the best kabobs ever.”

Making an Introduction

Cultural nightsTasting partiesCookouts

Body Image

Beauty Boot Camp at Oneonta JCC

Activity

Body Image WorksheetDiscussion

What did you get out of this worksheet?/What would a student get out of this worksheet?

How could you use this on center?

LESSON #7

Focus on skills. Knowledge alone rarely leads to behavior change.

Education ≠ Change

“Health education is the most common approach to obesity treatment in clinical practice today despite the absence of empirical support for its efficacy. Education may be necessary but does not appear to be sufficient to promote any lasting change.”

Source: Powell, L.H. et al. (2007). Effective obesity treatments. American Psychologist.

62(3); 234-246.

Take a Different Perspective

Perspective Change

When knowledge alone rarely leads to behavior change what do we do?

Change your perspectiveSmall changes should become

“habits” and become a way of life

Supportive Environment Now and Later

Individuals with obesity receive numerous instructions about what to do to address their weight, but very few are given appropriate long-term guidance or support with which to follow through those instructions

Understanding the positive role of social networks may be particularly important in engaging individuals in physical activity

Source: They all work...when you stick to them

 

Now What?

Often times students learn basic nutritional information but why not teach them to cook?

Others may be afraid to try new foods

Navigating the Grocery Store

What we can do in Job Corps? We can use HEALs

The Grocery store fieldtrip suggestion in the heals toolkit

Navigating the Grocery StoreNavigating the Grocery Store

Step 1. Find a recipe in a cookbook or online that sounds appealing. It should be something that you feel that you would be able to make without too much difficulty. Your recipe should have at least five ingredients but not more than 10. Do not count water or salt and pepper in your ingredient list. Step 2. Make a grocery list in the chart below. Be sure to include how much of every ingredient you need in the “Amount needed” column. Before going to the store, the first two columns should be completed. Step 3. As a class, you will visit a grocery store and shop for your items. Step 4. While at the grocery store, complete the “Cost of item” column in the chart below by locating the least expensive items available to make the recipe you selected. (Make sure you look at the different brands to comparison shop. Sometimes the least expensive will be the store (generic) brand. Other times it may be the brand that comes in the smallest container that fits your needs. Sometimes it might be an item that is on sale.) Recipe name: Item Amount needed Cost of item

Total cost

LESSON #8Small victories.

Nothing Succeeds Like Success

Goal Setting: Think again to SMART goals to set yourself up for success and not failureConsecutive goals that move you ahead

in small steps are the best way to reach a distant point

Consecutive rewards keep the overall effort invigorated

Part of the WE CAN! Program from nhlbi

Rewards

Reward Success (But Not With Food!!)A movie or music CD, or a payment

toward buying a more costly itemDefine Success

Stepping on the scale daily vs. trying on an old pair of jeans you want to wear again.

Fighting the Fight

We as humans are programmed to eat, we are pleasure seekersBut if we are able to teach ONE new skill

or healthy behavior, we should consider it a success.

Supportive Environment

Job Corps is the environment in which to make positive health changes

Giving students a solid foundation at the center is the best way to start in an supportive environment

Keep in mind things are sometimes beyond our control