People living with obesity who attended a personalized, non-judgmental lifestyle modification program improved their cardiovascular and mental health for just 10 weeks, according to a study presented today at EuroHeartCare - ACNAP Congress 2021, an online scientific congress of the European Society of Cardiology (ESC).
Participants lost weight and saw benefits in anxiety and depression and in physical measures, including blood pressure.
"We focus on changing behaviors and improving people’s relationship with food," said study author Ms Aisling Harris, Cardiac and Weight Management Dietitian, Croi Heart and Stroke Centre, Galway, Ireland. "Many participants have tried diets with strict rules and are afraid of foods they cannot eat. Our program does not have a diet or meal plan , and no foods are excluded. Each person sets their own goals, which are reviewed weekly, and our approach non-judgmental, which creates a good relationship and gains trust."
"Obesity develops for multiple reasons and blaming someone for their weight can prevent them from getting medical care and advice," Ms Harris said. "It can lead to emotional eating and feeling too self-conscious to exercise. By identifying each person’s triggers, we can develop alternative coping strategies, all within the context of their work, caring responsibilities, external stress, etc. For some "People, coming to a group like this might be the only social contact they’ve had all week or have had in years. People share experiences and support their peers."
Both overweight and obesity are associated with an increased risk of dying from cardiovascular disease.2 Weight loss is recommended to reduce blood pressure, blood lipids and the risk of developing type 2 diabetes and therefore reduce the likelihood of heart disease. This study examined the impact of a community-based lifestyle modification program on the physical and mental health of people living with obesity referred to a specialist bariatric service at Galway University Hospital. The researchers reviewed data from 1,122 participants between 2013 and 2019.
The 10-week Croí CLANN (Lifestyle Change with Activity and Nutrition) program began with an assessment by a nurse, dietician and physiotherapist and baseline measurements of weight, blood pressure, cholesterol, blood glucose, physical fitness and anxiety and depression levels.
- Personalized goals and a management plan were agreed in collaboration with each patient.
- Participants attended one 2.5-hour session each week for 8 weeks.
- The first 30 minutes were dedicated to one-on-one goal setting.
- Next was a 1 hour exercise class led by the physical therapist.
- A 1-hour health promotion talk followed on topics such as healthy eating, portion sizes, reading food labels, emotional versus physical hunger, stress management techniques (e.g., meditation), physical activity, sedentary behavior, cardiovascular risk factors and making and maintaining changes.
- Participants wore activity trackers and kept food diaries to identify triggers for emotional eating.
In the last week, patients had an end-of-program evaluation with the nurse, dietician, and physical therapist to observe the results. They were then returned to the hospital.
At baseline, the average body mass index (BMI) was 47.0 kg/m2 and 56.4% of participants had a BMI greater than 45 kg/m2. Additionally, 26.7% had type 2 diabetes and 31.4% had a history of depression.
- More than three-quarters of participants (78%) completed the program.
- Psychosocial health was assessed using the 21-item Hospital Anxiety and Depression Scale (HADS), where 0-7 is normal, 8-10 is mild, 11-15 is moderate, and 16-21 is severe.
- Anxiety and depression scores decreased by 1.5 and 2.2 points, respectively, over the course of the program.
- The proportion with an anxiety score greater than 11 at baseline was 30.8% and decreased to 19.9%; for depression, the corresponding proportions were 21.8%, falling to 9.5%.
- The mean body weight reduction was 2.0 kg overall, and 27.2% of participants lost more than 3% of their starting weight.
- The proportion achieving recommended physical activity levels increased by 31%. There were significant reductions in total cholesterol, low-density lipoprotein (LDL) cholesterol, and blood pressure.
- The proportion of people with high blood pressure fell from 37.4% at the start of the study to 31.1% at 10 weeks.
- In those with type 2 diabetes , the proportion reaching the recommended blood sugar target increased from 47.6% to 57.4%.
Ms Harris concluded: "Almost eight in ten people completed the programme, suggesting that the content and format were acceptable. We saw improvements in all health and psychosocial outcomes over a relatively short period, suggesting that this could be a service delivery model for other centers."
