How to run your own community weight management programme! · PDF fileHow to run your own community weight management programme! ... and produced by NHS Forth Valley Community

How to run your own community weight management programme!

COMMUNITY WEIGHT MANAGEMENT

This weight management pack has been developed and produced by NHS Forth Valley Community Dietitians.

The material used in this pack has been adapted from the Overweight Management Resource Pack, Dietetic Department, NHS Forth Valley.

Contact Details:

If you have any queries about running this weight management programme or require further details regarding any aspect of this resource, please contact:

Community DietitianDepartment of Nutrition and DieteticsNHS Forth ValleyEuro HouseWellgreen PlaceStirlingFK8 2DJTel: 01786 431155

You can also find more information on our website, log onto

www.nhsforthvalley.com

click on health services and select health promotion then select preferred department e.g. Nutrition, HIRS, Oral Health etc.

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INTRODUCTIONThis resource pack has been designed to support communities who wish to run a weight management course.

It aims to give those facilitating the course, whether they have a healthcare background or not, the confidence to plan and deliver weight management sessions.

The pack provides some basic nutritional information and includes a 10 week session planner, which offers the facilitator of the course a step by step outline for each week of the course. The session planner provides a programme outline, this should equip the group leader(s) with ideas of suitable activities to run within the group and ideas for discussion. These are not rigid or set in stone but have been written in a flexible format to ensure they can be used within various group settings. All the material included within this resource pack is photocopiable.

FACTS AND FIGURESObesity continues to be a growing problem in the UK. ‘Obesity has grown by 400% in the last 25 years and on present trends will soon surpass smoking as the greatest cause of premature loss of life.’ These types of worrying statistics clearly illustrate that something needs to be done to address this growing problem.

QUESTIONS TO CONSIDERAt present what is being done in your community to promote healthy living? Could more be done?Are any workers/volunteers keen to lose weight?What initiatives could be carried out in your community to address this national epidemic – obesity?

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This RESOURCE PACK is an excellent starting point. It can equip community workers with the necessary tools to run their own weight management programme.

WEIGHT MANAGEMENT - SOME BACKGROUND INFORMATIONWeight management is an issue for everyone – it’s about keeping control over our weight – striving to be an ideal weight for healthy living. The most effective approach to weight loss is by dietary modification, encouraging healthy eating and by increasing physical activity levels.

GETTING AND KEEPING YOUR WEIGHT BALANCEDIf the energy (calories) you eat is more than the energy (calories) you use up, excess energy is converted and stored as fat. If this occurs over some time, weight gain is inevitable. On the other hand if the energy (calories) you eat is less than the energy (calories) you use up, then fat stores are broken down and used, weight loss occurs. If the energy (calories) you eat equals the energy (calories) you use up, your weight remains the same.

Just a small increase in the amount of food you eat over and above your needs can result in a significant weight gain over time.2 plain biscuits every breaktime for a year can result in a gain of 6-7lbs or 3kgs.One can of fizzy (non-diet) drink or a packet of crisps every breaktime for a year can result in a gain of 8-9lbs or 4kgs.

MAKING SMALL CHANGES OVER TIME TO INCREASE PHYSICAL ACTIVITY AND EAT MORE HEALTHILY WILL HELP WEIGHT LOSS.

IS YOUR WEIGHT IN BALANCE?Two methods can be used to identify individuals whose health is at risk due to their weight. Calculating the Body Mass Index (BMI)Measuring waist circumference

APPENDIX 3 GIVES DETAILS OF HOW TO WORK OUT BMI AND HOW TO MEASURE WAIST CIRCUMFERENCE ACCURATELY.

IF OVERWEIGHT, HOW MUCH WEIGHT SHOULD BE LOST?If BMI is 25 or over or if the waist circumference appears too high then weight loss should be considered.Aim: to lose between 5-10% of your current weight. For example if you weigh 80 kgs you should aim to lose 4-8 kgs. Refer to weight conversion chart to change

into stones and pounds.to lose 0.5-1 kg (1-2lbs) each week.

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EATING FOR HEALTH

The ‘Eatwell’ plate is a nationally recognized model which should be used as a tool in any healthy eating session. It should be used to promote the concept of a healthy diet. This model was developed to help people understand and begin to enjoy healthy eating.

It visually illustrates the type and proportions of foods required to achieve a healthy and well balanced diet.

N.B. This model should not be used for children under the age of 5 years.

This picture shows a plate divided into 5 main food groups.

Bread, other cereals and potatoesFruit and VegetablesMilk and DairyMeat, Fish and alternativesFatty and Sugary Foods

It important to choose a wide variety of food from the first four food groups in order to ensure our bodies are being supplied with the vital nutrients it needs in order to function properly.

Foods from the fifth group, the fatty and sugary food group, are not essential for good health but they can be included in moderation in a balanced diet.

Achieving this balance between the various food groups does not have to be at every meal time but ideally should be achieved over the course of each day.

Bread, other cereals and

potatoes Have 5-9 small

portions of bread, cereals, pasta, rice

and potato each day.

Milk and Dairy

Choose 2-3 small servings of lower fat

milk and dairy products each

day.

Fatty and Sugary Foods

Take very small amounts of fat and

sugar containing foods.

Meat, Fish and Alternatives

Choose 2-3 small servings of meat, fish,

eggs, beans, nuts, pulses or soya products each

day.

Fruit and Vegetables

Have at least five portions of fruit and vegetables

each day.

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© Crown copyright materials is reporduced with the permission of the controller of HMSO and Queen’s printer for Scotland

FIVE FOOD GROUPS

FOOD GROUP

FRUIT AND VEGETABLESFresh, frozen, canned or dried. A glass of pure fruit or vegetable juice also counts.

BREAD, OTHER CEREALS AND POTATOESBreads and rolls (white and wholemeal) pitta breads, naan bread, bagels, tortilla wraps, chapattis, teacakes, cracker biscuits and scones, potatoes, other cereals - pasta, rice, noodles, oats and cous cous.

MAIN NUTRIENTS AND FUNCTIONS

Fibre > Healthy gut, reduces cholesterol, fills you up and can help weight loss.Vit C > Helps fight infections, improves wound healing, helps body absorb iron.Folate > Reduces risk of heart diseaseCarotenes > Good Vision, growth and tissue repair.

Starch (Carbohydrate) > Provides energy, helps brain work.Fibre > Healthy Gut, reduces cholesterol, fills you up and can help weight loss.Calcium > Healthy Bones and teeth, essential for growth.Iron > Helps fight infections, healthy blood, growth and development.

KEY MESSAGES

Eat a wide variety of fruit and vegetablesEat plenty aim for at least 5 times a day.Avoid adding fat, sugar or salt in cooking and serving.

Eat something starchy at every meal.Always have a breakfast.Try to choose wholemeal, wholegrain,brownorhighfibre varieties whenever possible.

Try to avoid:- Fried foods too often for instance fried rice, chips etc.

Adding too much fat i.e. thick spreadings of margarine or butter.

Adding rich, creamy or cheesy sauces.

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FIVE FOOD GROUPS

FOOD GROUP

MILK AND DAIRY PRODUCTSMilk, cheese, yoghurt and fromage frais.

MEAT, FISH AND ALTERNATIVESBeef, lamb, pork, offal (liver, kidney) chicken, turkey, eggs, white fish, oily fish - salmon, pilchards, sardines, herring, tuna, fish fingers, fish cakes, baked beans, kidney beans, lentils, nuts, soya, tofu. Sausages, salami, pate and beefburgers may have a high fat content.


Protein > Growth, maintenance and repair of body tissues.Calcium > Healthy Bones and teeth, essential for growth.Vit A > Helps fight infections, Promotes wound healing.Vit D > Helps Body absorb Calcium, promotes healthy bones and strengthens teeth.

Protein > Growth, maintenance and repair of body tissues.Iron > Helps fight infections, healthy blood, growth and development.Magnesium > Helps protect against heart disease, lowers high blood pressure.Vit B12 > Lowers risk of heart disease, helps to reduce depression.Other B Vits > May help improve mood and help lift depression. Help prevent heart disease and strokes.

KEY MESSAGES

Eat and drink moderate amountsChoose lower fat versions whenever possible.

For instance semi-skimmed or skimmed milk, low fat yoghurts or fromage frais and lower fat cheeses - edam, half fat cheddar, camembert, cottage cheese.

Eat moderate amountsChoose lower fat versions whenever possible.Avoid adding too much fat and salt in cooking and serving.Trim off any visible fat - remove skin off chicken and eat fishwithoutbatter.

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FIVE FOOD GROUPS

FOOD GROUP

FATTY AND SUGARY FOODSButter, margarine, low fat spreads and other cooking fats and oils and ghee. Salad dressings and mayonnaise, cream, chocolate, crisps, biscuits, pastries, cake, puddings, ice cream, sauces and fatty gravies, sweets, jam and sugar, fizzy drinks (non-diet) and fruit squash (non-diet).


Eating fatty foods frequently, particularly saturated fat can lead to progressive weight gain and can increase the risk of heart disease and strokes. Saturated fat is usually hard at room temperature and usually from an animal source. For example lard, butter or the fats off meat or products containing these fats. Fatty foods contain some vitamins and essential fatty acids.

Although sugar adds sweetness and flavour to foods and drinks eating sugary foods frequently can lead to excessive weight gain and tooth decay.

NB: Diet, No Added Sugar drinks and Fruit Juices contain acids which could lead to dental erosion. The best choices for good dental health are either plain water or milk.

Sugar has no nutritive value and is often referred to as an ‘empty’ source of calories.

KEY MESSAGES

Eat less fatty and sugary foods.Watch out - sugar can be referred to various other names on food labels for instance brown sugar, dextrose, glucose invert sugar etc... They are all types of sugar - so try to limit intake.Choose lower fat versions whenever possible. Watch out low fat foods and drinks can be rich in calories due to a high sugar content.There are different types of fat - the main message is to - reduce total fat intake!Choose fats and oils containing monounsaturates (olive oil or rapeseed oil) or polyunsaturates (sunflower or corn oil) but still use them sparingly, as they are all rich in calories.Butter and margarine contain the same calories. Use a low fat spread if you wish to save the calories.

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HEALTHY EATING – MAIN MESSAGES

Eat a variety of different foods.

Eat plenty fibre rich, starchy foods at every meal – for instance bread, rice, pasta, potatoes or cereals.

Eat 5 fruit and vegetables every day... try fresh, frozen, tinned, dried or juiced!

Eat breakfast everyday.

Eat fish more often, particularly oily fish – aim to eat oily fish once or twice a week.

Halt the salt – sprinkle less and taste more!

Drink more water.

Don’t eat too many foods that contain a lot of fat.

Don’t have sugar or sugary foods or drinks too often.

If you drink alcohol, drink sensibly!!!

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SETTING UP YOUR COMMUNITY WEIGHT MANAGEMENT PROGRAMME

POINTS TO CONSIDER

WHO SHOULD FACILITATE THE PROGRAMME?Anyone in your Community who has an interest in weight management could run this 10 week programme. The facilitator does not have to have a healthcare background but would be beneficial if they have completed the ‘Food and Health’ course. There is a programme outline for each of the 10 sessions – containing ideas of activities to run and details of the resources and materials required.

A group of friends in your community could even get together and run with the programme – in this case it is best that someone takes the lead and co-ordinates the sessions.

LOCATION AND TIMEIf time permits, arrange for the group to go for a 10 minute walk at the end of each session.Each session takes around 30-45 mins to deliver and could be run either weekly or fortnightly.Schedule sessions at a time and location that suits all participants.Ensure participants are well informed about the location and time of the course.Allow adequate time to run each session and ensure you have enough time to set up the room.

GROUP SIZEIdeally there should be between 6-10 people in the group.

PLAN AHEADBe realistic – it can take several weeks to order and receive relevant resources to run a session. So take time and plan ahead.

COSTConsider charging a small fee to attend each session. This could either be donated to charity or used as an incentive – the person who loses the most weight over

the duration of the programme wins all the money – Lose lbs to gain ££££’s!!!!As an incentive, charge group members £10 on week 1 then at the end of the 10 sessions give back £1 for each week of attending, for instance if someone

attends for 8 out of the 10 weeks they would get £8 back. Any remaining money could be donated to charity.

PROMOTIONAllow enough time to promote the course. Advertise the course through posters, fliers, community newsletters or by word of mouth.

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Session 1

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SESSION 1 - INTRODUCTION OVERVIEW

Introduction Welcome Ground Rules Confidential Buddying Scheme

Ice Breaker My Favourite Food

Group Activity Why do I want to lose weight? What influences my food intake - H Diagram A1 Poster on Wall (Appendix 2)

Next Week Handout blank Food Diaries (Appendix 4) to be completed and brought back next week.

Waist - Weigh In Display Appendix 3 next to scale and tape measure. Handout Weight Record Card

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Subject Week 1 - INTRODUCTION Resources

Introduction

Overview of 10 Weeks/ The Contract/ Commitment

Set Ground Rules

Respons- ibility

Introduce yourself to the group.

Give a brief outline of the programme.

State that you need everyones commitment to the programme.

Nobody is to have more than 2 absences. Ask if anyone can foresee any difficulties with that.

Check that everyone understands the importance for the whole group, of their regular attendance, and is ‘signed up’ to their contract with you. That is they MUST attend at least 8 of the 10 sessions.

Emphasize the importance of setting ground rules.

Emphasise all information is confidential and anything discussed within the group should remain unrepeated. Group members should arrive promptly, should be encouraged to listen to others, avoid interupting, involve everyone and should not be judgmental or condescending.

Explain to the group that their decision to attend the programme and whether or not it works for them is in their own hands. Nobody else can be blamed for any apparent failures be it partners, family members, friends, other group members or indeed the facilitators. Equally everyone is responsible for their own successes so they can congratulate themselves when things go well.

Yourself

Give a programme as a handout.

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Subject Week 1 - INTRODUCTION Resources Buddying Scheme

Ice Breaker

Group Activity Why Do I Want to Lose Weight?

Whatinfluences your food intake?

Support and encouragement is a key element of losing weight. It is a good idea to swap names and phone numbers or buddy up with a friend or work colleague.

Ice breakers can help people introduce themselves and may make them feel less anxious about speaking aloud within the group.

Reasons to lose weight may be: you are keen to feel fitter and healthier, have more energy, feel more comfortable in your clothes, drop a size, get into a new outfit, play more with the children, want to look better in a bikini for a holiday coming up, improve self-confidence.

Ask group members to take 5 minutes to write on post its or use flipchart.

After 5 minutes pull group back together - ‘HowconfidentamIaboutmakinghealthychoices’. This can be quite personal - ask people to share any ideas they have with the rest of the group, only if they wish.

Make sure you are losing weight for the right reasons and for yourself, not because someone else thinks you should.

Divide group into smaller groups of 2 or 3s. Ask them to take 5 minutes to think about things that influence their food intake - use the ‘H’ Diagram. What makes it easy - what makes it difficult.

See Appendix 1 - ‘Ice-Breaker’

See Appendix 2 - HowconfidentamIabout making healthy choices.

Flipchart for brainstorming.

Flipchart pens, post-it pads/pens/pencils.

See Appendix 2 - H Diagram. What influencesfoodintake?

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Subject Week 1 - INTRODUCTION Resources Group Activity

Next Week

Ask group to feedback on their ideas they gathered on what factors they feel influences theirfood intake.

Factorswhichinfluencefoodintakemaybe:Here are some ideas to share with the group, after their brainstorming session:- boredom, stress, anxiety, anger, comfort, tiredness, habit, availability, sight and/or smell of food, to be sociable, time of day, advertising, hunger, hormones, depressed - feeling down, greed, alcohol, laziness i.e. to prepare healthy foods.

Most people don’t tend to eat because of hunger, but they eat in response to other feelings mentioned above. If people are more aware of the reasons why they overeat then they can concentrate on these and try to combat them, which in turn should help prevent them from continuously reaching for food when in reality they are not even hungry.

Ask group members to carry out a dietary recall excercise and bring it along next week. Ask them to record everything that they ate or drank yesterday i.e the day before starting their new healthier eating regime. Note a typical days dietary intake up until now. Analysisng this next week should help give a true picture of what you were eating and drinking, as well as ideas of what you could change. During this first week, try to make a few changes to your dietary intake. Refer to the Eating for Health handout for general tips on healthier eating.

Writing down what you eat helps you become aware of your actual dietary intake. People are often surprised to see in ‘black and white’ what they have actually eaten in a day. Becoming aware of what you are eating and how much you are eating is an excellent starting point for losing weight. Buy a small notebook and jot it down as you go or write it up at the end of a day.

NB: Remember to try to be honest with yourself and remember the odd snacks you had!

‘Appendix 4’ - A blank diary for each group member.

Handout‘Eatwell. your guide to healthy eating’ available from HIRS.See Resources Table.(pages 76-78)

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‘Appendix 2’ - H Diagram either on wall or individual.

Subject Week 1 - INTRODUCTION Resources Waist and Weigh In

Discuss with group members the procedures of the weekly weigh in.

Point out where scales and tape measures will be set out each week. Encourage group members to weigh themselves either weekly, fortnightly or on week 1, 4, 6 then week 10. This encourages group members to take responsibility for their own weight, and also helps evaluate the success of the programme. Some individuals may wish to be weighed by the facilitator - they may feel that this would increase their motivation.

The facilitator should record individuals weights on week 1 and 10 as a measure of success.

If you lose a pound in a week this is equivalent to a 500g tub of butter.

Explain to the group that in order to lose weight you need to burn off more calories than you take in. So eating less food and increasing your physical activity levels work well together and help you lose weight.

Refer to instructions on Appendix 3 - A laminated A3 poster of Appendix 3 has been included within this pack. This should be displayed in a prominant position - beside the scales - for those who wish to weigh themselves. It provides a step by step guide to calculating Body Mass Index (BMI) and taking weight and waist measurements.

Take individuals weights, calculate Body Mass Index, take waist measurement and calculate the amount of weight they should aim to lose (10%). Record all these details in the weight record card.

Encourage group members to bring their Weight Record Card each week.

‘Weight Record Card’ - Available from HIRS - See Resources Table(pages 76-78)

‘Appendix 3’ for materials required.

‘Laminated A3 poster’ - Appendix 3- Pin up on wall next to scales and tape measure.

‘Appendix 4’ - A blank diary for each group member.

Butter - 500g Tub

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APPENDIX 1

MY FAVOURITE FOOD

This ice breaker acknowledges that everyone enjoys eating and sets the scene for talking openly about indulgent foods.

PURPOSE/AIM:To give participants an opportunity to:introduce themselves to each otherspeakreveal something about themselves.

MATERIALS AND PREPARATION:A blank sticky label or post-it plus coloured pens/pencils for each member of the group.

THE ACTIVITY: (15 mins)Each person is given a sticky label/post-it and are then asked to write their first name on it and to draw a picture of their favourite food. Participants are then asked to introduce themselves and explain what they have attempted to draw.

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APPENDIX 2

H Diagram

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What makes iteasy to choose ahealthier lifestyle?

What makes itdifficulttochooseahealthier lifestyle?

Can you identify changes you could make towards healthier choices?1.2.3.4.

No Control0

Full Control10

How much control do we have over what we eat and physical activities.

HowconfidentamIaboutmaking healthy choices?

APPENDIX 3THE MOMENT OF TRUTH – WAIST/WEIGH IN

Have To Hand:Set of Scales (Same scales each week) Weight and Height Conversion Charts (Included within this pack)BMI Chart (on back of Weight Record Card) Tape MeasureWeight Record Cards for each Group memberCalculator

WEIGH – IN1. Weigh yourself on the scales provided (Remove your shoes first)2. Convert your weight into kilograms using the conversion chart.3. Convert your height into metres using the conversion chart.4. Take your weight in kilograms and divide by height in metres, then divide by the height again - this will reveal your Body Mass Index (BMI).5. Record your Weight and BMI in your Weight Record Card – Remember to put the date next to your weight.6. What Category do you fit into?

Underweight BMI less than 18.5Okay BMI of 18.5 to 24.9Overweight BMI of 25 to 29.9Obese BMI of 30 to 39.9Very Obese BMI of 40 and over

BODY MASS INDEX (BMI) is used to determine how much you weigh in relation to your height. There is a BMI Chart on the back of your Weight Record Card. To find out your BMI on the chart draw a line horizontally across the chart at your height and a line vertically up from your weight. Where the two lines intersect - this will reveal your BMI.

Try not to weigh yourself too often – once a week at the same time of day (mornings are best) is enough.Aim to lose 1-2lbs (0.5-1Kg) each week.

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APPENDIX 3WAIST COUNTS

1. Measure your waist using the measuring tape. Measure midway between your hips and ribs, making sure the tape measure is straight and snug but not ‘digging in’ to the skin. Measure after breathing out.

2. Record your waist measurement on your Weight Record Card.3. What category do you fit into?

Women - Ideal Less than 80cm (32 inches) Increased Health Risk 80cm (32 inches) or more High Risk 88cm (35 inches) or more

Men - Ideal Less than 94cm (37 inches) Increased Health Risk 94cm (37 inches) or more High Risk 102cm (40 inches) or more

ARE YOU AN APPLE OR A PEAR?It is not just the quantity of body fat that counts but also how it is distributed in our bodies.

Waist size is a good indicator of your general health and your exposure to health risks such as heart disease, diabetes and high blood pressure.

People who are pear-shaped with excess fat on their hips and thighs seem to be less at risk of heart disease than people who are apple-shaped and carry their weight around their abdomen.

As your waist gets bigger, your risks to health increase.Remember any reductions in your waist measurement - is a step in the right direction!!

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APPENDIX 4FOOD DIARY

Write down everything you ate or drank yesterday?Be honest with yourself!! – Remember to note down all the little extras you had!Be as accurate and descriptive as possible – For example if you had toast at breakfast was it one or two slices – was it white or wholemeal bread and

what did you put on it.

TIME FOOD + QUANTITIES DRINK + QUANTITIES

Early Morning

Breakfast

During Morning

Midday

During Aternoon

Evening Meal

During Evening & Before Bed

Extras During Night20

Session 2

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SESSION 2 - EATING FOR HEALTH AND FOOD DIARY OVERVIEW

Welcome

Weigh - In - Appendix 3

Group Activty Food Diary and Handout Empty Plate (Appendix 5 & 6)

Set Personal Goal(s)

Next Weeks Reminder What to do and what to bring?

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Subject Week 2 - FOOD DIARY & EATING FOR HEALTH Resources

Welcome Welcome everyone back to the session.

Weigh-In

Group Activity

Food Diary

As each group member arrives, ask if they wish to weigh themselves. Ask group members to log their weight and waist circumference in their Weight Record Card.

Writing down what you eat helps you become aware of your actual dietary intake. People are often surprised to see in ‘black and white’ what they have actually eaten in a day. Becoming aware of what you are eating and how much you are eating is an excellent starting point for losing weight. Buy a small notebook and jot it down as you go or write it up at the end of a day.

NB: Remember to try to be honest with yourself and remember the odd snack you had!

Ask group members to analyse their diet diaries.

They should go through their food diary and put each food and drink into the appropriate food group section on Appendix 6.

For example a bowl of Fruit and Fibre with semi-skimmed milk at breakfast write Fruit and Fibre in cereal section and the milk in the dairy section and so on.......

Allow approximately 10 minutes for this exercise.

‘Weight Record Card’

‘Appendix 5 - Food Diary’

‘Appendix 6 - Empty Plate’

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Subject Week 2 - FOOD DIARY & EATING FOR HEALTH Resources Group Activity

Eating for Health

Make S.M.A.R.T Changes

Handout‘Are you getting the balance right? What is a portion? - Available from HIRS - Refer to Resources Table (pages 76-78)

Optional‘Eating for Health Floor Mat and Food Models’ - Available from HIRS - Refer to Resources Table.(pages 76-78)

‘Eating for Health Poster’ - Available from HIRS - Refer to Resources Table.(pages 76-78)

Handout‘Just what you have been weighting for’ - Available from HIRS - Refer to Resources Table. (pages 76-78)

Once everyone has their plate completed - individuals can review their own dietary intake and see how many times in the day they’ve eaten something from the fruit and vegetables section or how many times in the day they’ve eaten a starchy food and so on.

Questions to raise to the group, (no need to answer) Have you all reached at least 5 portions of fruit and vegetables in the day?How many foods do you have in the fatty and sugary food section?Did you eat something starchy at each meal?Were there any sections blank at the end of the exercise?

Eatwell plate model is a nationally recognised model - it should be used to illustrate a well balanced diet. This model was developed to help people understand and begin to enjoy Health Eating. It illustrates the five different food groups. Those people trying to lose weight often find it difficult to gauge portion sizes, the ‘what is a portion?’ leaflet should help as a guide.

Comparing food diaries with this model should help highlight areas of our diet which could change for the better! For example if you have 4-5 items in the fatty sugary section this maybe an area you should focus on - limit to 1 treat a day! Or maybe you only had 2 portions in the fruit and vegetable section - aim for 5 each day.

Keeping food and activity diaries can make individuals more aware of their current habits and can help individuals focus on their lifestyle and highlight areas which could be changed for the better.

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Make S.M.A.R.T. Changes

Setting Personal Goals

When individuals are setting themselves personal goals to reach - encourage them to make S.M.A.R.T. changes. That is changes which are S (Specific), M (Measurable), A (Achievable), R (Realistic), T (Time-limited).

Bear in mind people need help to prepare and set realistic goals. The process of change is not an easy process.

Making changes for a few weeks can start off well but maintaining the changes needs continued effort. This is where the value of group support comes in.

If people fail to reach a set goal, it is important to look at the reasons why they haven’t managed to achieve it and address these issues. Relapses should not be seen as a catastrophe - it is perfectly normal.

Ask group members to take a few minutes to think carefully about setting 1 personal goal for the week - bearing in mind the group activity carried out in this weeks session.

This setting personal goals exercise will be done at the end of each weekly session.

At the end of the 10 week programme, individuals will have a set of 10 personal goals. The idea being that these could be expanded or built upon over time.

Appendix 2 - The H Diagram from last week could be revisted to prepare for goal setting.

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Next Week

Examples of GoalsI will eat a piece of fruit instead of a biscuit every morning at breaktime.I will park my car at the furthest away parking space from the office and walk more everyday this week.

Peopleoftenfindtheysticktoagoalmoreeasilyif itispersonaltothem,if theyactuallywriteit downandmakeitquitespecific.Forexampledon’tjustplantocutdownonbiscuitswritedown exactly how many you’ll have each day or week, in what situation and which more nutritious foods you’ll choose instead. It can also help to plan a non food reward for yourself once you have achieved sayafewsmallgoals.Forexampleamanicure,atriptothecinema.....

Remind group members to bring their copies of ‘Just what you’ve been weighting for!’ and ‘Weight Record Card’ next week.

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APPENDIX 5FOOD DIARY

Write down everything you ate or drank yesterday?Be honest with yourself!! – Remember to note down all the little extras you had!Be as accurate and descriptive as possible – For example if you had toast at breakfast was it one or two slices – was it white or wholemeal bread and

what did you put on it.

TIME FOOD + QUANTITIES DRINK + QUANTITIES

Early Morning

Breakfast

During Morning

Midday

During Aternoon

Evening Meal

During Evening & Before Bed

Extras During Night27

APPENDIX 6

Drink

Fruit a

nd Vegetables

Bread, Cereals and Potatoes

Meat, Fish and

AlternativesFatty and Sugary

Foods

Milk and Dairy

Products

Session 3

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A Quick PizzaBase: use pitta bread, baguettes, naan bread,

bagels, scone.

Spread: use tomato puree or chopped tomatoes and sprinkle with mixed

herbs or spices.

Toppings:use pineapple, sweetcorn, mushrooms,

peppers, spring onions.

Select additional toppings eg cooked ham, tuna, pepperoni, cooked chicken.

Grated cheese: 2 dessertspoons of grated edam or cheddar.

To Make It: preheat oven to gas mark 7 or 220 degrees celsius. Spread puree on to the base. Top with vegetables and small amount

of meat. Sprinkle with grated cheese on top. Cook in oven for 10-15 minutes.

Potato Wedges1 medium/large potato1 dessertspoon of olive oil

To Make It: preheat oven to gas mark 7 or 220 degrees celsius. Cut potato lengthways into 4-6 wedges. Place in a tub, small pot with lid or food bag. Add oil, give a good shake (you could add garlic, herbs or chilli powder at this stage). Place on a baking tray and cook in hot oven for about 30 minutes.

Fruity Crumble Tumbles 3 pieces of tinned fruit in own or fruit juice

(drained) try pears, peaches, pineapple, apricots2 dessertspoons of greek style natural yoghurt

2 dessertspoons of cereal e.g. shreddies, cornflakes, rice krispies

To Make It: chop the fruit into small chunks, place in the bottom of a small bowl or cup. Spoon greek

style yoghurt on top of the fruit. Top with cereal (can be crushed if you like)!

SESSION 3 - PRACTICAL SESSION

Quick and easy snacks, tips etc. To be arranged and discussed by group - either a demonstraton, participatory or at least discussion or ways of changing foods.

Quickie Lentil Soup 2 mugs hot water½ ham stock cube2 dessertspoons of lentils1 small potato chopped½ mug of frozen mixed vegetables

To Make It : put water into a medium sized pot and dissolve stock cube, add lentils and allow to boil for 5-10 minutes. Chop the potato and add to the pan with the rest of vegetables. Simmer for about 30 min-utes till vegetables are well cooked. Leave chunky or mash with a potato masher.

Tips: you could use fresh chopped vegetables eg chopped carrot, turnip and leek.

Spicy Salsa 4 medium tomatoes, skinned and chopped finely or ½

tin (400g) of tomatoes. 3 inch piece of cucumber chopped finely.

2 spring onions, chopped finely .1 red chilli, de-seeded and chopped finely or 1 teaspoon

of chilli paste.1 teaspoon of lemon juice.

To Make It: mix it all together, leave for a short while in the fridge to let the flavours mix.

Session 4

31

SESSION 4 - PHYSICAL ACTIVITY OVERVIEW

Welcome

Waist and Weigh - In - Appendix 3

Feedback/Reflection

Group Activty Benefits of physical activity Barriers to exercising Ways to increase activity levels at work


Next Weeks Reminder What to do and what to bring? Bring in 1 or 2 food labels Weight Record Card

32

Subject Week 4 - PHYSICAL ACTIVITY Resources

Welcome

Weigh-In

Feedback on Personal Goals Group Activity Benefitsof Exercise

Welcome everyone back to the session.

Congratulate group members on attending half of the 10 week course.


Ask people to reflect back to last weeks personal goals - did they manage to stick to their goals - any difficulties and how did they overcome these obstacles. Encourage group members to share their experiences.

Divide group into smaller groups of 2 or 3’s and ask groups to think firstly about the many benefitsthat can be gained from being more active.

After 5 minutes bring group back together and brainstorm as a group.

May want to share these ideas below after the groups have thought for themselves:

Exercise helps improve suppleness, stamina, sleep patterns, helps control stress and anxiety - improves relaxation, increases energy levels, makes you feel more alert, improves self confidence, tones up muscles and helps improve body shape, can speed up weight loss, helps reduce blood pressure and helps prevent heart disease and reduce your risk of bowel cancer and osteoporosis, it can also be fun!

‘Getfitteriseasierthan you think’ ‘Hassle free exercise’ ‘Walk more feel the difference’ - Leaflets Refer to Resources Table(pages 76-78)


Refer to H Diagram if appropriate - Appendix 2

Flipchart and pen for brainstorming.

‘Appendix 7 - Physical Activity’

33

Subject Week 4 - PHYSICAL ACTIVITY Resources Group Activity

Barriers to Exercising

Ways to Increase Activity Levels

Flipchart and pen for brainstorming exercise.

Divide group into the same smaller groups - ask them to jot down a few barriers or obstacles they face when thinking about exercising and then think of ways they could increase their physical activity levels without attending a leisure centre or exercise class.

May want to share these ideas with the group after their individual brainstorming sessions:

Despite all the benefits associated with exercising most people don’t exercise enough. There are many reasons for this:- lack of time, lack of confidence, lack of appropriate leisure facilities and equipment, self consciousness about body shape, no money, nowhere to leave the children, cul-tural barriers, too tired, bad weather, dark nights, boring, not co-ordinated.

People should be encouraged to become more physically active in their everyday living, its nevertoolatetostartandthebenefitstoyourhealthareenormous.

May want to share these ideas with the group after their individual brainstorming sessions:

Go for a walk with a friend.Get out with the kids - chase the kids around the garden/park or have a kick around.Get off the bus a couple of stops early and walk the rest of the way.When you pop to the local shop, walk rather than taking the car.Get out into the garden - planting, weeding, digging are good forms of exercise.

34

Subject Week 4 - PHYSICAL ACTIVITY Resources Group Activity


Next Week

See www.pathsforall.org.uk/pathstohealth/pedometesr.asp for suggestions on where to obtain pedometers.

Ideas to get the group active:Set up a walking/jogging group.Run a competition - use pedometers - who walks the most in your group.

Aim to burn at least 1000 calories a week through extra activities - this equates to 30 minutes brisk walking everyday. If trying to lose weight aim to build up to 60 minutes of moderate activity on most days of the week.

Ask group members to take a few minutes to think carefully about reviewing or setting new personal goals for the week - bearing in mind the group activity carried out in this weeks session.

Ask group to write down 1 S.M.A.R.T. goal they wish to focus on.

Write todays date + goals..

Examples of GoalsI will get off the bus 2 stops earlier.I will walk to the shops to collect the morning papers.

Remind clients to bring their ‘Weight Record Card’ next week.

35

APPENDIX 7

BENEFITS OF EXERCISING

BARRIERS AGAINST EXERCISING

WAYS TO INCREASE PHYSICAL ACTIVITY

36

Session 5

37

SESSION 5 - PHYSICAL ACTIVITY WALK

To be arranged with group.

For ideas of local walking routes go to your local council’s website or:-

www.walking-routes.co.uk www.thefalkirkwheel.co.uk/visit/walkingroute.html www.walkswithbuggies.comwww.braveheart.uk.netwww.feetfirstcanalwalks.comwww.pathsforall.org.uk

Next WeekAsk group members to bring along their favourite restaurant or take away menu.

38

Session 6

39

SESSION 6 - EATING OUT / TAKEAWAYS / ALCOHOL OVERVIEW

Welcome


Feedback/Reflection

Group Activty Eating Out Made Healthier - Takeaways - Appendix 8 Takeaway Game - Appendix 9 Alcohol Questionnaire - Appendix 10


Next Weeks Reminder What to do and what to bring? Bring in a recipe or packaging of your favourite dish. Weight Record Card

40

Subject Week 6 - EATING OUT - TAKEAWAYS - ALCOHOL Resources

Welcome

Weigh-In

Feedback on Personal Goals

Group Activity

Eating Out

Made Healthier


Take weights of all those who wish to be weighed - direct others to the scales to weigh themselves. Remind individuals to record their weight in their Weight Record Card.


Modern lifestyles involves more eating ‘on the run’. Eating out and takeaway are eaten regularly by some. If it’s a one off occasion you should eat what you want and enjoy it. Eating out can cause quite a problem as you don’t know exactly what’s in the meal or how it has been cooked. In reality alot of takeaways are likely to be rich in fat particularly saturated fat. Don’t be afraid toaskaboutingredientsandcookingmethods.If youfindyouareeatingoutregularlythinkof a few strategies that might help you eat or drink less but still enjoy yourself.

Divide the group into smaller groups of 2 or 3’s and ask them to think of some ways to make eating out a bit healthier.

Ideas to share with the group after their individual brainstorming sessions:Skip a course, avoid creamy, cheesy, fatty dishes, take a small snack before you go out, so you’re not absolutely starving when you get there, fill up on salad and vegetables, if your drinking alcohol ask for some water as well, add soda to wine - a long drink lasts longer, choose potatoes instead of chips or boiled rice instead of fried. Ask waiter for sauce or salad dressings or oils to be served separately then you can add the amount you want, avoid puddings too often or try a fresh fruit salad or sorbet.


‘Appendix 8 - Takeaways’

41

Subject Week 6 - EATING OUT - TAKEAWAYS - ALCOHOL Resources Group Activity

Refer to Appendix 10Place the cards on a table, so everyone can see, with the name of the meal face up. Give everyone a blank piece of paper and ask them to write down the meals ranking them 1 to 13. 1 having the most calories and 13 having the least calories.

As a whole group, discuss responses and try to get a consensus. Place cards in the true order and distribute the handout showing the full list. The calorie values are interesting when considered in the context of someones daily meal plan/allowance of say 1500 or 1700 calories.

Choose Avoid

At the Indian Plain Naan Bread Creamy dishes - Korma, masala Drier dishes - tandoori, karia and dhansak and bhuna Deep fried dishes - bhaji, samosa, Plain boiled rice pakhora Pilau rice, biryani, fried rice

At the Chinese Won-ton soup Deep fried dishes Stir fried dishes - vegetables, Sweet and sour dishes chicken in black bean sauce Lemon chicken Plain rice or noodles Crispy fried beef or duck Friend rice, prawn crackers or sesame prawn roll

At the Mexican Chicken fajitas High fat enchaladas Cajun chicken Tomato based salsa sauces and dips

Blank Paper + Pens

Using the material in ‘Appendix 9’ make a set of 13 individual cards each with the name of the takeaway meal on one side and showing the calorie and fat intake on the other.

Have a copy of the full list for everyone to keep.

42

Subject Week 6 - EATING OUT - TAKEAWAYS - ALCOHOL Resources Group Activity

Alcohol

Choose Avoid

At the Italian Plain crusty bread Creamy or cheese sauces Mixed salads/tomato salads High fat meats like salami or Pasta with tomato, onion and pepperoni basil based sauces Too much cheese such as parmesan Thin based pizzas with vegetable topping

At the Cafe Homemade soup Too much cheese, coleslaw and rich Crusty roll meat sauces Baked potato (no butter) with Fresh cream cakes, rich pastries or baked beans, vegetable chilli, chocolate cake curry, tuna(no mayo) or Sugar in tea and coffee cottage cheese and order a High calorie fizzy drinks e.g. side salad cola, irn bru, lemonade Scone with jam - no butter Sweeten drinks with artificial sweeteners Water is the best option

People often forget the impact that alcohol can have on weight gain. Alcohol is loaded with calories

1 pint of beer = 180 calories. 1 small glass of white wine = 94 kcals1 large glass of white wine = 187 kcals A 25ml serving of spirit e.g. whisky = 55 kcals. Then add calories from mixers e.g. ½ a can of cola contains 70 kcals.

Therefore cutting back on your alcohol consumption means you’ll cut back on your calorie intake.

OptionalALCOFACTSA Guide to Sensible Drinking Available from HIRS - See Resources Table (pages 76-78)

Sensible Drinking Available from HIRS - See Resources Table (pages 76-78)

43

Subject Week 6 - EATING OUT - TAKEAWAYS - ALCOHOL Resources Alcohol


Next Week

Sensible Drinking Men - should drink no more than three to four units per day. Consistantly drinking four or more units per day is not advised. Try to have at least 2 drink free days.

Women - should drink no more than two to three units per day there. Consistantly drinking three or more unites per day is not advised. Try to have at least 2 drink free days.

Divide the group into smaller groups of 2 or 3’s again and ask them to answer the7 questions from Appendix 10. They should answer either TRUE or FALSE. This activity will take around 5-10 minutes. Once everyone has completed bring group together and discuss the answers.

The answers are written in Appendix 10.

Ask group members to take a few minutes to think carefully about reviewing or setting new per-sonal goals for the week - bearing in mind the group activity carried out in this weeks session.

Ask group members to write down 1 S.M.A.R.T. goal they wish to focus on.

Write todays date + goal.

Examples of GoalsDrink less alcohol this weekend - no more than 3 white wine and sodas.Only have takeaways once a week and choose healthier options - no chips!!

Everyone to bring in a recipe of your favourite dish. Going to be looking at adapting the recipes to make them healthier.

Remind clients to bring ‘Weight Record Card’ next week.

What’s in a drink? The straight facts about alcohol. Available from HIRS - See Resources Table (pages 76-78)

‘Appendix 10’ - Alcohol Questionnaire.Photocopy Appendix 10 Questions only to distribute to group members.

44

APPENDIX 8

WAYS TO MAKE EATING OUT HEALTHIER

STARTERS TO AVOID STARTERS TO CHOOSE

MAIN COURSES TO AVOID MAIN COURSES TO CHOOSE

PUDDINGS TO AVOID PUDDINGS TO CHOOSE

45

APPENDIX 9

TAKEAWAY GAMEUsing the material overleaf, make a set of 13 individual cards each with the name of a takeaway meal on one side, and showing the calorie and fat values on the other.

Place the cards on a table, with the name of the meal face up. Give everyone a blank sheet of paper and ask them to write down the 13 takeaway meals in rank order, by calorie content. Thatis,writetheMOSTcalorificasnumber1andtheLEASTcalorificasnumber13.

In the whole group, dicuss responses and try to get a consensus.

Place the cards in the true order and distribute the handout overleaf showing the full list.

The calorie values are interesting when considered in the context of someones daily meal plan of say 1,500 or 1,700 calories.

46

APPENDIX 9

FACTS ABOUT TAKEAWAY MEALS MEAL (Standard Portion) kcalories Fat (grams) Fish and chips 1134 52 Sweet and sour chicken (battered) and fried rice 970 50 Vegetarian pizza (small) 936 27 Chicken tikka massala and pilau rice 860 47 Fried chicken and chips 814 45 Cheeseburger and chips 663 29 Bean burger in bun 589 20 Baked potato with cheddar cheese and butter 533 27 Chicken Deli Sandwich 410 11 Donor kebab 405 21 Chicken Chow Mein 384 22

Baked potato, cottage cheese and salad 374 5

47

APPENDIX 10

ALCOHOL QUESTIONNAIREAnswer the following questions either TRUE or FALSE.

1. Five pints of beer has the same calories as a cheeseburger and fries?

2. A “beer belly” is only caused by downing too many pints?

3. Alcohol is measured in units with the recommended maximum intake for men being 3-4 units per day?

4. If you’re trying to lose weight a good choice is non-alcoholic beer?

5. When you consume alcohol, you lose more water in your urine than you take in, in the drink itself ?

6. Switching between beer, wine and spirits will lead to intoxication more quickly than sticking to one type of alcohol beverage?

7. There are no health benefits to drinking alcohol?

8. Write down a few ways that you think you could enjoy drinking without adding to the waistline.

48

APPENDIX 10

ALCOHOL QUESTIONNAIRE1. FALSE The five pints is equivalent to almost 1 and a half cheeseburgers and a portion of fries. With a pint of beer containing about 180 calories per pint or 900 in total whereas the cheeseburger and chips totals about 600 calories.

2. FALSE A “beer belly” is caused by eating or drinking too much therefore you don’t need to drink beer to get one but it certainly won’t help it.

3. TRUE Currently the recommended intake for men is 3-4 units of alcohol per day. It is also recommended that you have at least one or two alcohol free days per week. One unit of alcohol is equivalent to: half a pint of ordinary strength beer or lager a small glass of wine a single pub measure of spirits

Men - if you drink 3 or 4 units a day or less, there should be no significant health risks. Women - if you drink 2 or 3 units a day or less there should be no significant health risks.

4. FALSE Non-alcoholic beer actually has the same calories as alcoholic beer: 148 calories in a pint. If you drink a light beer you’ll only take in around 99 calories per pint. Take care with your choice - a can of extra strong beer or lager is equal to two pints of ordinary strength beer or lager, or four units of alcohol.

49

APPENDIX 10

ALCOHOL QUESTIONNAIRE5. TRUE Alcohol affects the hormones responsible for fluid balance. As a result, it causes you to pee frequently, losing body fluids. You then feel thirstier so you have another alcoholic drink and so it goes alcohol - pee - thirst and so on. The only way to break the cycle is to have water or another non-alcoholic beverage. Along with the fluids drinkers lose, they excrete important nutrients as well. It’s one of the main reasons that after a lot of drink you wake up suffering from what is known as a “pain in the hair roots” in Sweden, “wailing of the cats” in Germany or “a hangover” in Britain.

6. FALSE Remember that a standard drink or beer, wine, or spirits contains equivalent amounts of alcohol. Alcohol is alcohol and a drink is a drink.

7. FALSE There is some evidence that alcohol taken in moderation may have some health benefits. For men over 40, drinking 1 or 2 units of alcohol a day may help prevent coronary heart disease. For women who have been through the menopause, drinking 1 or 2 units of alcohol a day may help prevent coronary heart disease.

8. Suggestions may include: Drink Spirits with a diet or low calorie mixer e.g. swap Bacardi and Cola for a Bacardi and Diet Cola. Alternate between Alcoholic and Non-alcoholic drink. Be careful of the choice of non-alcoholic drink. Order half pints instead of pints. Add soda water to wine - a longer drink can last longer.

50

Session 7

51

SESSION 7 - MAKING GOOD CHOICES / FOOD LABELS OVERVIEW

Welcome


Feedback/Reflection

Group Activty Food Label Quiz - Guess the Food Game (Appendix 11) Handout - Your Guide to Food Labels


Next Weeks Reminder What to do and what to bring? Weight Record Card

52

Subject Week 7 - MAKING GOOD CHOICES / FOOD LABELS Resources

Welcome

Weigh-In


Group Activity

Guess the Food

Game




So much of what we buy and eat is now pre-prepared so we simply have to reheat it in the microwave or put it in the oven for 20 minutes. This means we don’t know exactly what is in it. Nutritional information printed on food labels sets out the amount of each key nutrient in an individual food or drink product. This can help you keep track of what your eating.

Handout the quiz and ask people in pairs to guess the food or drink item by looking at the ingredients list. Explain that the ingredients list is always written in descending order, so the main ingredient is the first one.

Bring group back together and give out the answers to the quiz.

Handout the booklet - ‘Check the Labels’. Hopefully once the booklets have been read the complex issue of food labelling may become a bit clearer.


‘Appendix 11 - Food Label Quiz’

‘Check the Labels’ - Refer to Resources Table(pages 76-78)

53

Subject Week 7 - MAKING GOOD CHOICES / FOOD LABELS Resources Group Activity

Assess Food

Labels


Next Week

May be useful to have a few other labels to hand just in case some people forget to bring any in.

Divide the group into smaller groups of 2 or 3’s and ask them to assess the food labels on the items brought in, using the ‘Check the Labels’ - leaflet. Each small group should have 2 or 3 labels to assess.

Does your food/drink items contain A little or A lot of sugar, fat, fibre?

This credit card can be stored in your purse or wallet and when out shopping it can be used as a quick guide to assess the nutrition labels. Remember to use the amounts per 100gms on thefoodlabels,tocomparewiththeamountsonthecreditcard-‘YourGuidetoFoodLabels’.



Write todays date + goals.

Examples of GoalsPay particular attention to food labels when shopping - take ‘Your Guide to Food Labels’ credit card and compare labels.Write a shopping list and stick to it. Plan ahead meals for each night of the week.

Remind group members to bring and ‘Weight Record Card’ next week.

Also bring in a copy of their favourite recipe.

54

APPENDIX 11

FOOD LABEL GAMEGUESS THE FOOD / DRINK GAME

Lookatthefollowingingredientslists,whichhavebeentakenfromthelabelsof variousfoodsanddrinks.Trytoguessthefoodordrinkandwriteyouransweronthedottedline.

1. INGREDIENTS: Carbonated Water, Sugar (carbohydrate), Colour (caramel E 150d), Phosphoric Acid, Flavourings (including caffiene)

………………………………………………………………................

2. INGREDIENTS: Water, Sweetcorn (3%), Potato Starch, Creamer [Contains Hydrogenated Vegetable Oil, Glucose Syrup Solids, Milk Proteins, Acidity Regulator (Monopotassium Phosphate) and Emulsifier (E471)], Glucose Syrup, Chicken (1%), Onion, Salt, Flavourings (contain Wheat), Flavour Enhancers (E621, E635), Parsley, Stabiliser (Xanthan Gum), Colour (Beta-Carotene), Natural Flavourings.

………………………………………………………………................

3. INGREDIENTS: Meat and Animal Derivatives (Turkey min 4%, Chicken min 4%), Cereals, Minerals, Various Sugars.

…………………………………………………………………...........

4. INGREDIENTS: Cereals (34%)(Wheat Flour, Whole Oats, Wheat Bran), Glucose-Fructose Syrup, Apples 8%, Sugar, Vegetable Oil, Humectant (Glycerol), Maltodextrin, Honey, Dextrose, Stabalisers (Sodium Alginate, Cellulose, Xanthan Gum, Carrageenan, Locust Bean Gum), Calcium Carbonate, Modified Stach, Dried Skimmed Milk, Salt, Flavourings, Cinnamon, Raising Agent (Potassium Hydrogen Carbonate), Malic Acid, Calcium Phosphate, Citric Acid, Colour Caramel (E150d), Emulsifier (E472e, E471, Wheat Gluten Starch, Niacin, Iron, Vitamin B6, Riboflavin (B2), Thiamin (B1), Folic Acid, Vitamin B12.

…………………………………………………………………...........

5. INGREDIENTS: Wholewheat, Dried Fruit (28%)(Raisins, Coconut, Banana (Flavouring), Apple, Hazelnuts ) Sugar, Salt, Barley, Malt Flavouring, Niacin, Iron, Vit B6, Riboflavin (B2), Thiamin (B1), Folic Acid, Vitamin B12.

…………………………………………………………………..

55

APPENDIX 11

FOOD LABEL GAMEGUESS THE FOOD / DRINK GAME

ANSWERS

1. Cola Drink

2. Slim A Soup – Chicken and Sweetcorn

3. Cat Food – Sheba – Delicious morsels of turkey and chicken.

4. Kelloggs Nutrigrain Bar – Apple

5. Kelloggs Fruit and Fibre Breakfast Cereal

56

Session 8

57

SESSION 8 - RECIPE ADAPTATION OVERVIEW

Welcome


Feedback/Reflection

Group Activty Recipe Adaptation (Appendix 12)



58

Subject Week 8 - RECIPE ADAPTATION Resources

Welcome

Weigh-In


Group Activity

Recipe

Adaptation




People often feel dreadfully deprived having to forego their favourite recipe. By doing this next exercise, people can see that there are some ways around that, by modifying favourite unhealthy recipes, to make them a little more healthy.

Split the group into 2 or 3’s - The group task is to work out how the recipe could be modified to make it healthier, but just as tasty. They could also think about accompaniments (breads, veg, salads) and puddings that could be served alongside to make a complete healthy meal.

Each group should feedback and share ideas with the whole group.


In case the group don’t bring in their own recipes - have copies of popular, recipes to hand. For example Lasagne, Spaghetti Carbonara, Macaroni Cheese.

‘Appendix 12 - Recipe Adaptation’

59

Subject Week 8 - RECIPE ADAPTATION Resources

Group Activity


Next Week

Some IdeasTo reduce fat in a recipe:use low fat spread instead of butteruse less butter/oil than stated in recipeuse non stick frying pan with a lid and add less or no fatuse skimmed milk instead of whole milkuse low fat creme fraiche or low fat yoghurt instead of creamuse some vegetable stock instead of milkuse reduced fat cheese or less cheddar - grate it - it goes further!bulk meat dishes out with more vegetables or pulses

To reduce sugar in a recipe:cut amount of sugar in recipes by about a halfuse tinned fruit in natural juice instead of in syrupuse reduced sugar jams or pure fruit spread in spongesuse nutmeg, mixed spice and cinnamon with fruit for extra flavour



Write todays date + goal.

Examples of goalsConcentrate on making more homemade dishes - focus on lowering the fat and sugar contentGo to Step Class, once this week

Remind clients to bring Weight Record Card’ next week.

60

APPENDIX 12

RECIPE ADAPTATION

USING YOUR CHOSEN RECIPE WRITE DOWN WAYS IN WHICH THE FAT AND/OR SUGAR CONTENT COULD BE LOWERED

Think about healthy accompaniments that could be served along with your recipe and suitable healthy puddings to make a complete healthier meal.

61

Session 9

62

SESSION 9 - SNACKING OVERVIEW

Optional Prior to session - Set up Snack Food Model Display Swap & Save

Welcome


Group Activty Beat the Snack Attack (Appendix 13) Ideas of Healthy Snacks



63

Subject Week 9 - SNACKING Resources

Prior to Session

Welcome

Weigh-In


Group Activity

Beat the Snack

Attack

OptionalSet up Snack Food Model Display. This display visually illustrates the amount of sugar and fat found in some everyday snack foods.



Ask people to reflect back to last weeks personal goals - did they manage to stick to their goals - ask about any difficulties and how did they overcome these obstacles. Encourage group members to share their experiences.

Most of us will probably snack during the day but snacking needn’t be bad news for your waistline. Snacking on healthy, low calorie foods can help keep hunger pangs at bay.

Divide group into smaller groups of 2 or 3’s and ask groups to brainstorm - Ideas of Healthy Snacks.

Focus on healthy snacks. Then think of ways you could introduce healthier snacking into your day.

‘Snack Food Model Display - Swap + Save’ - Available from HIRS(pages 76-78)


Flipchart and Pen for brainstorming.

‘Appendix 13 - Snacking’

‘Healthy Snacks’ fact sheet - download from www.bda.uk.com/foodfacts/07092healthy snacks.pdf

64


Group Activity


May want to share these ideas with the group after their individual brainstorming session:

‘Quick convenient snacks’ - fruit - banana, handful of grapes, chopped melon, small bag of sultanas, handful of cherry tomatoes, small cucumber sticks, wholemeal scone and low fat spread or jam, small bowl of wholegrain cereal with semi skimmed milk, rice cake and savoury spread, half a bagel with low fat cheese spread.

‘Introducing healthier snacking @ home and @ work’

plan ahead and take healthier snacks into workmake smart choices from vending machines or the local shopjoin forces with friends or colleagues and take a walk to the local shop for some fruit

Ask group members to take a few minutes to think carefully about reviewing their goals or setting new personal goals for the week - bearing in mind the group activity carried out in this weeks session.

Ask group members to write down 1 or 2 additional S.M.A.R.T. goals they wish to focus on.

Write todays date + goals.

Examples of GoalsI will drink a large glass of water at my afternoon break instead of my usual cup of coffee.Plan ahead - snack times and take them into work from home - to avoid vending machine temptation.

Flip chart and pen for brainstorming.

65


Optional

Healthy Snack Tasting Session - choose from the following ideas:-

fresh fruit - bananas, grapes, apple, pineapple, melon, orange etcdried fruit - raisins, apricots etcvegetable sticks - with low fat dip e.g. spicy salsa (see recipe in pack) or cottage cheeserice cakes/crackers with savoury spreadmini wholemeal pitta stuffed with salad and/or tunahalf a bagel or a few oat cakes with low-fat cheese spreadsmall wholemeal or fruit scone with a little low-fat spread or jamdiet or low fat yorghurt/fromage frais

66

APPENDIX 13

IDEAS OF HEALTHY SNACKS

WAYS TO INTRODUCE HEALTHIER SNACKING INTO OUR DAY

67

Session 10

68

SESSION 10 - WEIGHT MAINTENANCE AND FEEDBACK OVERVIEW

Welcome


Feedback/Reflection

Review of Personal Goal(s) - Recognising Achievements and relapses

Feedback

What Next? and moving on... Think about future plans?

Achievements - Calculate overall group weight loss.

Ending / Closing Activity

69

SESSION 10 - CYCLE OF CHANGE

Where are you on the Process of Changes? Research has shown that there are different stages involved in

the way people make changes. At first, people may not even be ready to change. They may be not interested in change or are thinking about change, but not quite sure. These people may need to set some relevant information about why change is a good idea. They might need time to think about the pros and cons involved in changing. Even when people are ready to change, they need to prepare themselves before they actually get down to making the changes. Making changes is one thing, but maintaining the changes over weeks or months - or forever - is another. Sometimes people relapse. For whatever reason, they find they can’t keep to their action plan. A relapse doesn’t mean a permanent failure, just that things didn’t quite go to plan that time! People can use relapse as a learning experience, think about why things went wrong, and work out whether and how they will prepare to take action again. Once people have maintained changes for many months they may eventually go out of the circle and become a person who has permanently changed. For these people, the new way of doing things feels absolutely normal and they know they will never slip back to their old ways.

70

Maintaning Healthier Lifestyle

Not interested in Changing

‘Current Lifestyle’

MaintainingChanges

Relapsing/Set Back

MakingChanges

Ready to Change

Thinking about Change

Adapted from Prochaska and Di Clemente

Subject Week 10 - WEIGHT MAINTENANCE - FEEDBACK Resources

Welcome

Waist & Weigh-In


Review of Personal Goals

Recognising Achievements

and Relapses

Welcome everyone to the final session and congratulate everyone for staying on the course.

Weigh everyone and record final weights.

Measure everyones waists and record results.


Remind group members that making lifestyle changes is one thing, but maintaining the changes over weeks or months - or forever - is another. Sometimes people relapse. For whatever reason, they find they can’t keep to their set personal goals. A relapse doesn’t mean permanent failure, just that things didn’t quite go to plan that time!

People should use a relapse as a learning experience, thinking about why things went wrong and work out whether and how they will prepare to take action again.

Ask people to form pairs and take it in turns to review all their personal goals.

Notice the things that have gone really well and they now consider an integral part of their lifestyle.Notice also the things they are still doing but find difficult. Discuss barriers and ways of overcoming these.Notice goals which have been abandoned and work out together what happened.


Each person needs a copy of their personal goals with them.

Use the change cycle.

71


Feedback

What Next? Moving On...

Post it Notes

Three sheets of flipchart paper headed:

Things I really liked about... the programme

Things I didn’t particularly like about the programme

I think the program would be better if.........

Tell the group how important it is for you to get their feedback about how they felt the whole programme went. Stress that this means comments about the good and the not so good things. Their ideas for improving the programme are really welcomed.

Give out a batch of post it notes to each person and ask them to respond to the three headings on the flipchart, with one comment per post it. Invite them to stick the post its on the relevant piece of flip chart paper.

Ask the whole group to think about what their future plans are, now that this programme has come to an end. Get the group to come to an agreement about future meetings.

Present options:

nothing at all, individuals may wish to carry on individually with their personal goals, recording their own weights and resetting new target weights.

have room set aside within the community centre where they can drop in at any time to review their weight or the room could be set aside for a drop-in weigh-in session on a particular day and time each week.

72


What Next? Moving On...

Achieve- ments

have an informal arrangement to stay in touch with other group members/ workmates and get together say once a month, at a regular time, in a specific place.

continue to meet regularly (e.g. weekly) as a self-help group, to keep on track with weight management.

all join another group such as a commercial slimming group or a suitable keep fit group.

group members may not wish to continue meeting but they may wish to continue to keep in touch with each other. They may wish to swap names, addresses and phone numbers.

Ideally 2 people will volunteer to be responsible for co-ordinating a follow-on group.

Ask group members to calculate any weight loss they have achieved over the 8 week programme - get them to write it anonymously on a post-it. Gather these in and add them up - Reveal to the group - the groups combined weight loss over the 10 weeks.

There are 14lbs in 1 stone. Therefore if the group has lost 1st 10lbs between them that is the equivalent of 24lbs or 12 bags of sugar!

1 x 14 = 14 + 10 = 24 lbs ÷ 2 = 12 bags of sugar.

Post - It Notes

Optional - Kilogram bags of sugar equal approximately 2lbs.

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Ending and Closing Activity

Bringing the group to a formal close is important.

Open it up for each person, if they want to say a few words about their very best moment (in terms of their personal achievements) during the programme.

Allow people to speak at random making it easy for those who haven’t anything to say, to remain silent.

Congratulate group members for completing the 10 week programme.

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WEBSITESFor more information on Weight Management, healthy eating and physical activity - Check out the following websites...

Weight Managament Advice Written by Dietitians www.nhsforthvalley.com

Weight Management Advice Written by Dietitians www.bdaweightwise.com

British Heart Foundation www.bhf.org.uk

Food Standards Agency www.eatwell.gov.uk

Take Life On Campaign www.takelifeon.co.uk

British Dietetic Association www.bda.uk.com/foodfacts/index.html

British Nutrition Foundation www.nutrition.org.uk

Walking Routes ww.walking-routes.co.uk

Weight Watchers www.weightwatchers.co.uk

Walking the Way to Health Initiative www.whi.org.uk

Scottish Slimmers www.scottishslimmers.com

Slimming World www.slimmingworld.com

Active Scotland www.activescotland.org.uk

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RESOURCES TABLE

Weight Record Card(NUT 08/L)

ALCOFACTS - A Guide to Sensible Drinking (ALC 28/L)

Sensible Drinking (ALC 06/L)

What’s in a Drink? The Straight Facts About Alcohol (ALC 05/L)

Are you Getting the Balance Right? What is a Portion. (NUT 76/L)

Just what you have been Weighting For.(NUT 80/L)

Brief Description

Small card to record weight and waist measurements each week. Also has a BMI chart to help calculate Body Mass Index (BMI)

This booklet gives details about alcohol, what is a unit, drinking and driving, effects of alcohol and knowling your limit.

Alcohol and sensible limits. How many units are in a drink? What happens when we drink too much?

Alcohol and how it effects us. How much is too much? Alcohol and Scotland Law

This leaflet explains what a ‘healthy’ portion of everyday foods should be.

This booklet gives a step by step guide to losing weight.

Available From

Health Information and Resources Service (HIRS), 9 Gladstone Place, Stirling Tel: 01786-434756 View Catalogue and order via www.nhsforth-valley.com/healthpromotion/hirs/OnlineCata-logue.htm

HIRS as above.

HIRS as above.

HIRS as above.

HIRS as above.

HIRS as above.

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RESOURCES TABLE

‘Check the Labels’(NUT 05/L)

Food Labels - More Informed Choices

Eatwell. Your Guide to Healthy Eating(NUT 02/L)

Physical Activity and Weight Loss(PAC 09/L)

Getting Fitter is Easier Than You Think(PAC 01/L)

Hassle Free Exercise(PAC 05/L)

Brief Description

Guide on how to read the information on food la-bels and eating healthily to reduce the risk of obesity, heart problems, diabetes, cancer & stroke.

Booklet takes a closer look at the information on food labels.

A5 Booklet - Attractive, easy to read leaflet explaining the importance of healthy eating. Also includes tips on food shopping and hygiene. Simple recipe suggestions.

A5 Booklet - Provides information on the benefits of physical activity and how it can weight loss. Suitable activities are highlighted, with issues around safe practice being mentioned.

This leaflet encourages the reader to become more moderately active for a total of 30 mins or more each day.

This booklet will help you take the first step by building more activity into daily routines and im-proving your health.

Available From

HIRS as previous.

Food Standards Agencyemail: [email protected]: 0845 606 0667

HIRS as previous.

HIRS as previous.

HIRS as previous.

HIRS as previous.

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RESOURCES TABLE

Snack Food Model Display Swap + Save(NUT 72/K)

Eating for Health - Floor Mat and Food Models(NUT 73/K1)

Brief Description

This resource contains a wide range of healthy and unhealthy food models. Sugar and fat cubes supplied with this resource, can be used to visually illustrate quantities of sugar and fat within individual snacks and drinks. This resource box also contains a swap + save display. This shows how much overall calories can be saved by making more sensible + healthier snack choices.

A tool for teaching nutrition and healthy eating. This kit contains a range of plastic food models from the five main food groups. It also contains a large floor mat which illustrates a plate divided into proportionate food groups.

Available From

HIRS as previous.

HIRS as previous.

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REFERENCES

1. House of Commons Health Committee Report on Obesity, HMSO, May 20042. National Audit Office. Tackling Obesity in England, 2001. The Stationery Office3. Energising Lives: A Guide to Promoting Physical Activity in Primary Care, NHS Health Scotland, 2008.4. Healthy Eating, Active Living: An Action Plan to Improve Diet, Increase Physical Activity and Tackle Obesity (2008 - 2011). The Scottish

Government, 2008.

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Documents

How to run your own community weight management programme! · PDF fileHow to run your own community weight management programme! ... and produced by NHS Forth Valley Community