Weight Management Program - Diabetes Education and Cardiac Rehabilitation Collaboration

Northern Sydney Central Coast Area Health Service

Abstract

The health and financial burden of obesity is proving to be an increasing challenge to health services. Obesity is a significant risk factor for both diabetes and heart disease.
Weight management for this group is an effective treatment and complication prevention strategy; however, weight management intervention can be challenging, as resource demand is extremely high. The Diabetes Education Centre (DEC) and Cardiac Rehabilitation (CR) recognised a need to develop a more structured approach to improve weight management within this high risk patient group.

Working collaboratively, DEC and CR developed a group program utilising existing resources, skills and expertise to provide a weight management service with the aim of sustained weight loss of 5-10% within 12 months.

Participating in a series of education sessions and exercise classes, patients were clinically assessed at baseline, 4months, 8 months and 12 months.

Weight loss >5% was achieved by 37.5% of participants at twelve months assessment. This was coupled with improved participation in physical activity, wellbeing and better food choices.

Aim

For DEC and CR staff to work collaboratively to provide an effective and time efficient service for weight management in this patient population aimed at a weight loss of 5-10% within twelve months.

Nature of the Problem

There is substantial evidence that sustained moderate (5-10%) weight loss can improve obesity-related metabolic and CVD risk factors and reduce the progression to type 2 diabetes^1,2,5. Moderate weight loss lowers blood pressure and improves glycaemic control, lipid profiles, inflammatory, haemostatic and fibrinolytic factors.  In addition, increasing physical activity levels, an important component of weight loss programs, is associated with improved cholesterol, reduction in blood pressure and inflammatory markers, improved endothelial function and reductions in all-cause mortality⁵. Physical activity combined with a healthy diet and moderate weight loss of 5-10%, has been shown to reduce the incidence of Type 2 Diabetes (T2DM) by 58%^3,4.

The health and financial burden of obesity is proving to be an increasing challenge to health services. Obesity is a significant risk factor for both diabetes and heart disease.
The decision for the two departments to collaborate was to combine resources and develop an effective, efficient program to assist both client groups with their weight loss efforts.

Extent of the Problem

Both DEC and CR have a large percentage of clients that are overweight and obese. DEC offered individual appointments for these patients where they may consult the dietitian and/or the psychologist. CR continued to offer exercise services for their clients, but the support and intensive input required to facilitate weight loss was lacking. Resource constraints for both DEC and CR have made it difficult to maintain appropriate weight management services for this group.

Strategic Importance

Strategically this project has provided an opportunity for both departments to be involved in a program that actively works to prevent disease and complications. Strategic Direction 1 states “effort is needed to increase protective factors such as good nutrition (and) physical activity”. This program targets these issues specifically and has used existing resources more effectively to achieve the program goals and produce a clinically significant outcome.

Planning and Implementing Solutions

A group program, incorporating education sessions (conducted by CR nursing staff and exercise physiologists and DEC dietitian and psychologist), structured exercise program and planned clinical assessments, was devised and piloted using the existing resources available at the DEC and CR.

The weight management program (WMP) was conducted at Royal North Shore Hospital. Participants were eligible if they had recently been registered with the Diabetes Education Centre (DEC) and/or North Shore Cardiovascular Education Centre (NSCEC) with T2DM or coronary heart disease (CHD); Body Mass Index between 27 to 35 kg/m2, able to participate in regular physical activity (assessed by 6-minute walk test), and willing to participate in the full program (assessed at initial interview). Patients were excluded if they had a psychiatric disorder, significant intellectual disability, cognitive deficit or insufficient spoken and written English to be able to participate in the intervention or complete the associated questionnaires.

Outcomes and Evaluation

Two programs between 2006, 2007 were conducted with a total of 24 participants. Weight loss >5% was achieved by 37.5% of participants at twelve months assessment. This was coupled with improved participation in physical activity, wellbeing and better food choices.

Sustaining Change

Following from this pilot quality activity, a third intervention study group is being planned. Ethics approval will be sought and assistance is being provided by UTS.

Collaboration between departments will continue with an ethics submission and funding proposal to continue and maintain the resources to continue to provide this service to patients in this group.

Sustaining clinical change including weight loss maintenance has been addressed by incorporating behavioural change strategies into the program.

Future Scope

The Weight Management Program has provided an opportunity for separate departments to collaborate, share resources, skills and expertise to develop an effective and innovative approach to a shared problem.

The development of specific objectives, indicators and evaluation would also allow the program to be utilised by other Health Services in a similar way.

References

1. Despres J P et al. Treatment of obesity: need to focus on high risk abdominally obese patients. BMJ 2001;322; 716-720
2. AIHW, 2004; Heart Stroke & Vascular Disease. Australian Facts
3. he Diabetes Prevention Program Research Group: Reduction in the incidence of T2DM with lifestyle intervention or metformin; NEJM 2002; 346:393-4-3
4. Tuomilehto J et al: Prevention of T2DM by changes in lifestyle among subjects with impaired glucose tolerance (FINNISH Diabetes Prevention Study) NEJM 2001; 344:1343-50
5. Van Gaal LF et al; The beneficial effects of modest weight loss on CVD risk factors; Int J Obes Relat Metab Disord, 1997 Mar; 21 Suppl 1:55-9

Contact

This project was entered in the 2008 NSW Health Awards, Making Prevention Everybody's Business category.

More about the 2008 NSW Health Awards