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Transcript
You Can Do It!
Weight Loss Success Stories in Small Care Facilities
August 2004
A document developed
for
Fraser Health Authority
Licensing – Nutrition Program
2
Table of Contents
Introduction
4
What Worked
4
What Didn’t Work
7
The Most Important Element to Successful Weight Loss
8
Appendix A – Case 1
9
Appendix B - Case 2
12
Appendix C – Case 3
15
Appendix D – Case 4
17
Appendix E – Case 5
19
Appendix F – Case 6
21
Appendix G – Case 7
23
Appendix H - Canada’s Food Guide to Healthy Eating
25
The Licensing Nutritionists in Fraser Health gratefully acknowledge Treeva Elliott,
Dietetic Student, for all her hard work in developing this resource.
3
The purpose of this manual is to share successful weight loss stories of
clients in group home settings. Information was gathered by
interviewing staff who assisted clients in achieving weight loss success.
We hope you can use the information to achieve desirable and realistic
resident-focused outcomes in your own homes.
We recognize that every situation is different and that each tip may
not work for your clients. Rather the information is to provide you
with some options to jump start your own weight loss program.
- Thanks -
4
Introduction:
Through multiple interviews with care homes in the Fraser Health Authority, common
elements to successful weight loss began to emerge. Although each home took a
different approach and had different reasons for initiating their efforts, they all had
the similar goal of increasing the overall health of the individuals involved. The
following summarizes what worked, what didn’t work and common barriers to
successful weight loss.
What Worked?
ο Having Everyone on Board: Cohesiveness is essential and must be addressed
prior to beginning a weight loss program. Having all of your staff, family
members, and work or day program staff aware of your efforts, goals and
weight loss techniques will help to ensure that your client is successful in his/her
weight loss.
ο Appropriate Portion Sizes: Appropriate portion sizes are dependant upon the
age, sex, height, activity level and the weight goals for each individual. Cutting
down on the portion sizes being served is a key element when trying to lose
weight. It is important for your staff to be educated and aware of appropriate
portion sizes, and for everyone to be consistent with what they are serving.
How To Reduce Portion Sizes
Without Being Too Noticeable:
°
°
°
°
°
Spread food out on the plate
Use smaller plates
Butterfly your meats (split down the middle and open like pages in a
book)
Purchase smaller rolls or buns
Serve your sandwiches open faced
5
ο Decreasing the Consumption of Baked Goods: Many facilities serve baked
goods as snacks and desserts. While these foods can fit into everyone’s lifestyle,
they do not need to be served everyday. Baked goods are often high in fat and
sugar and may have little nutrition. Serving baked goods less often will allow
more room for more nutritious snacks and fewer calories, which will help to aid in
the your weight loss efforts.
ο Increasing Fibre: Fibre is found in grain products such as whole wheat bread,
as well as in fruits and vegetables. Fibre plays a role in weight loss, as foods high
in fibre are often low in fat, sugar and calories, and because of their ability to
retain and attract water, allows us to feel full longer.
Tips on How to Increase Fibre Intake
°
°
°
°
°
Encourage the individuals in your facility to consume at least 5
servings of whole grains and 5 servings of fruits and vegetables a day
Use whole-wheat bread/ buns or pasta
Use whole wheat flour when baking
Add barley, beans or lentils to soups and casseroles
Read food labels (a high fibre food is one that contains 5 or more
grams of fibre)
ο Increasing Water Intake: Having water available throughout the day will not
only ensure that individuals are properly hydrated, but will also help in your
weight efforts. Drinking water throughout the day limits the amounts of juices
and pops that are consumed, which often are major sources of extra calories that
lead to weight gain.
6
ο Decreasing Fat Intake: Fat is a concentrated source of energy so by
decreasing your fat intake, you will decrease your calorie intake. You can do this
by choosing leaner meats and fish, lower fat milk and milk products, and buying
lower fat dressings and marinades. Making small changes can go a long way - try
offering peanut butter or butter on toast or bread instead of both, or using half as
much as you would normally so that the flavor is still there but the calories aren’t.
ο Increasing the Intake of Fruits and Vegetables: Fruits and vegetables are
a concentrated source of nutrients that are low in fat and calories. Fruits and
vegetables are great as snacks in replacement of baked goods, and should be
part of each meal.
Tips to Increase Fruit and Vegetable Intake
°
°
°
°
°
°
Make sure a variety of fruits and vegetables are accessible all day
Pack fruits and vegetables as part of a bagged lunch for day programs.
Keep of copy of Canada’s Food Guide on your fridge.
Serve vegetables and fruits with homemade low fat dips and dressing.
Try to incorporate fruits and vegetables at each meal and snack.
Try new recipes for salads using a variety of fruits and vegetables
ο Increasing Physical Activity: Incorporating physical activity into the daily
routines of the individuals in your facility is key. The amount or intensity of
physical activity will vary depending on their mobility.
Try incorporating a variety of different activities to
keep the individuals in your facility moving.
7
ο Providing Motivation and Education: Ongoing motivation and education on
why the individual needs to lose weight and why certain foods can no longer be
consumed in excess, will help to keep the individuals in your home on board.
Motivation can come in the form of graphing weight loss and making it visible for
the individual to see how they are doing, or demonstrating for the individuals how
much they have lost in a week or a month by using different weighted bags.
Motivation can also come in the form of showing the client how their clothing sizes
have changed. Providing continual encouragement by clapping or having the
other members in the house congratulate them when they meet each weight loss
goal may also provide needed support.
ο Choosing Rewards and Social Activities That Are Not Centered
Around Food: So much of what we do now days involves food, and choosing
social and reward activities that are not centered on food may be one of the most
difficult tasks to tackle. Rewards can come in the form of spending time with an
individual’s favorite staff member, or getting the opportunity to choose that day’s
activity or walk destination. Food should be viewed as an everyday activity and
not as a reward. For social activities, try having more fruits and vegetables and
lower fat foods. You can still provide less nutritious high fat foods, but limit the
amounts, such as having only one bowl of chips instead of 3, and provide more
nutritious alternatives if the individual is still hungry.
What Didn’t Work?
ο Saying No: Telling the individuals in the facilities “no”, in terms of what they
couldn’t have or do, did not work. Using “no” often results in feelings of
deprivation and denial. Instead of telling the individual that they can’t have
something, try expressing to them why they can’t, and offer them alternatives.
8
The Most Important Element to
Successful Weight Loss
Every home identified the one key obstacle to successful weight loss:
Lack of Consistency
It is crucial that everyone works together to stay on track with the weight loss
regime. The actions of one unsupportive person can counteract everyone else’s efforts.
It is important to be consistent in terms of what foods are provided, as well as portion
sizes, motivation and education techniques. In order to ensure that everyone is on
board with the weight loss program it may be essential to bring it up at your weekly
meetings and to chart successes and downfalls in your daily records.
Closing Remarks:
It is important to remember that weight loss does not happen over night. Aim for
slow gradual weight loss, taking small steps at a time. Charting the individual’s
weight and outlining your efforts in your nutrition care plans helps you monitor
success and determine what is working and what is not working. Initially the
individuals in your facilities may be reluctant to participate and ultimately it must be
remembered that it is their decision. However, with motivation, encouragement,
education and consistency, more often than not the individual will become more
motivated as they begin to like their new look and added energy.
During interviews, staff remarked they noticed definite positive changes after the
individuals lost the weight. These benefits included:
°
°
°
°
°
°
°
°
An overall increase in health and feelings of wellness
An overall increase in the ability to move and agility
An increase in positive attitudes, and self esteem
A decrease in constipation
Increased energy and activity levels
Increased in flexibility and overall strength
Increased ability to sleep
Decrease in blood pressure
Lastly, as in everyday life, the individuals in your facility are not strictly bound to
their weight loss regime. As birthday parties, holidays and other special occasions
come up, remember…it’s “moderation, not elimination”!
9
APPENDIX A - Case #1
Personal Information:
What:
A mental health home with 10 male persons in care, 8 of whom have
had a gradual weight loss over the past couple of years.
Weight Loss: The average weight loss is 1-2 kg per month.
Mobility:
For the most part the majority of the residents have enough mobility that they
can walk assisted or unassisted daily, but are unable to do rigorous exercise.
Previous Eating Habits:
The previous nutrition and eating habits of the individuals at this particular facility were
poor. Some of the staff were under the impression that in order to provide good care to their
clients, they had to feed them well, often giving large portions of food. The facility often
served meals that where high in fat and calories, and baked goods for snacks. Sometimes
baked goods would be served up to three times a day.
What did they do?
After talking to a licensing nutritionist the facility became aware of what it meant to have
standardized portion sizes. The licensing nutritionist also reviewed the menus and provided
suggestions for improvement. BMI (Body Mass Index) calculations were done for each
individual, which determined that all were overweight, initiating the need for change.
-
Portion sizes were decreased (this required immense amounts of education of the staffthey also recognized that staff each had there own ideas about how much to serve,
which needed be regulated).
-
Baked goods were decreased, and replaced with fruit (this was a gradual change due to
resistance from residents).
-
Increased the intake of vegetables, by incorporating more salads into the menu (the
residents now like salads, and although it raised the budget a bit, staff say that it was
worth it).
-
Replaced dessert with a variety of fruits, served in different ways (eg. Fruit salad or
instead of apples, oranges and banana’s residents were given choices between kiwi,
papaya, and pears).
-
Increased the amount of fibre in the diet (high fibre cereals, whole grain products etc.)
-
Decreased the amount of higher fat/calorie desserts
-
Changed from whole milk to 2% (tried 1% but clients didn’t accept it)
-
Incorporated more water into the diets of the residents, as part of meals as well as in
between meals.
10
-
Eliminated second helpings
-
Incorporated more physical activity ( walking 4 blocks a day in the mornings, low impact
exercise every morning for 10 -15 minutes, some play horse shoes in the backyard, some
have the opportunity to go to various parks or malls (depending on the weather) to walk
for 1- 2 hours/ day)
-
Do not promote sitting down and watching TV.
What factors affected whether or not weight loss was successful?
Initially the facility found it difficult to get everyone to do the same thing. Consistency
was a big problem and it took a long time to train the staff and make them aware that
they are not doing their residents justice by overfeeding them. Initially there was some
resistance in terms of staff compliance. It was determined that if all the staff weren’t
motivated and willing to help the residents to lose weight, the residents would sense this
and weight loss would be less successful. The staff were encouraged to attend a Meals and
More/ Portion Size workshop to become better educated regarding the importance of
weight loss and maintenance.
What was the primary factor motivating the clients to lose the weight?
The clients in this particular home were unable to get food themselves, nor were they
able to serve themselves, and as such would eat what ever was put in front of them. In
this case the role of the staff was the primary factor in the weight loss of the clients.
Did everyone’s meal change: Yes
What were some road blocks, and how were they overcome?
For the most part the only road block was compliance of the staff. Some of the staff were
resistant to the idea of cutting back on snacks and meals as they believed that this wasn’t
providing good care for the residents. The staff were educated on the importance of
proper nutrition, and portion sizes.
Did the client’s weight plateau? Was this discouraging?
The clients gradually lost weight. One particular client lost too much weight and was put
on a supplement drink to increase his weight, but once regained, he was taken off the
supplement and has since remained stable.
What recipes, cookbooks or other resources did you use?
-
Licensing Nutritionist
Buying lower calories dressing, or experimenting and making their own
Staff experiments with recipes, and meals
Closing remarks:
-
Found that making small changes was more accepted than trying to make big changes
Recognized the importance of having everyone on board and aware of the overall goal
11
-
Record weight month to month, so that staff and persons in care are able to know how
they are progressing - written in communication book
It takes a collective effort
What happened as a result of the weight loss?
-
Found a decrease in the number of colds, persons in care were getting
An increase in the overall health of the persons in care
The persons in care are now able to move more and be more active
Attitudes have changed, as the clients are more positive and cooperative with staff
Decrease in constipation due to increase in fibre, water, fruits and vegetables, and
whole grains
Increase in self esteem
Smaller pant sizes, can wear clothing that never were able to before
12
APPENDIX B- Case #2
Personal Information:
What:
Two particular individuals were successful in losing weight at this facility (43
year old male, and a 67 year old female). Both have been steadily losing
weight over a period of two years.
Weight Loss: Male: 42 pounds
Female: 37 pounds
Mobility:
Male: limited mobility
Female: good mobility
Previous Eating Habits:
The nutrition of the two individuals prior to the weight loss was considered to be quite poor.
The female would access the fridge frequently, often picking foods that were less nutritious,
and loaded with fat and calories. The male client ate whatever was provided, and therefore
the issue was with what he was getting fed rather than what he was feeding himself.
What did they do?
The staff held a meeting with the two individuals. Both recognized the need to lose weight.
Although they knew they were gaining weight, they were unaware of what was causing the
weight gain. It became the role of the staff to educate the clients as to why they were
gaining weight, emphasizing that it was not only what they were eating but also their
decrease in physical activity.
The manager and the two clients decided to attend Weight Watchers™. The clients enjoyed
the meeting and joined Weight Watchers™ that night. Upon joining Weight Watchers™ it
then became the staff’s duty to ensure that the residents were following the diet plan, and
sticking to the portion size regulations.
-
Weight Watchers™ promotes journal writing, which forced the clients to pay attention
to what they were eating. The staff promoted the use of the journals by ensuring that
the two wrote in them each day.
-
Initially the staff started weighing and measuring all foods to follow the serving sizes
promoted by Weight Watchers™, but after a while became familiar with what a serving
size looked like and were able to serve without measuring.
-
Staff began to experiment by pulling ideas from Weight Watchers™ cook books, and
changing recipes that they already had ( example: using low fat sour cream/ yogurt or
vegetable/ chicken stock in mashed potatoes instead of butter or cream)
-
Staff stopped letting the individuals serve themselves and instead staff served food to
them
-
Eliminated second helpings cooked just enough of the meat so that there wasn’t enough
for seconds, while making extra of vegetables and fruits, so that if the individuals
wanted seconds all that was left for them to eat was vegetables.
13
-
More inventive with how they served fruit and vegetables eg making unique salads, or
desserts, and by offering fruits and vegetables that were less common, forcing the
clients to try something different.
-
Eliminated junk food in the house so that if clients would only have healthy foods to
choose from.
-
Started using egg substitutes (whites only) and switched to light Becel™
-
Limited the amount of juice available to the individuals while increasing water (gave
bottles of water to residents when they went to day programs)
-
Posted the individual’s food diaries/ checklist on the fridge so that they could keep
track of what they were eating.
-
Incorporated more exercise - walking the sea wall, walking to coffee shop instead of
driving, started bowling, and swimming,
-
Moderation during special occasions eg at a party or special event the individuals were
given the option of a hot dog or a hamburger not both. They were still allowed cake, but
just one slice (they didn’t totally cut treats out so they didn’t feel deprived or
punished).
-
Provided motivation for the residents - Weight Watchers™ offers gold stars at certain
weight loss goals, they also clap when someone loses weight, which provided incentive.
-
Changed size of plate from large to a medium plate, so that the individuals felt as
though they were getting more food, when in fact weren’t.
-
Tried to stick to whole wheat foods instead of white.
-
Decreased the amount of processed foods they were buying, took some principles from
the Glycemic Index diet and incorporated them into their meal plans
-
Got the individuals involved with the cooking
What factors affected whether or not weight loss was successful?
-
Attitudes of the staff, and what they put into the eating habits of the individuals.
What foods they had in the fridge in reach of the individuals.
Day programs, the majority of the persons in care go to day programs, and as such are
not always under the supervision of the staff in terms of dietary intake.
The individuals in this facility have their own money so if they are away at day program
have the ability to buy their own food
The individuals don’t know the difference between diet and regular pop; they thought
that a bag of chips and a chocolate bar are small so they are OK to have
At the day program some staff members actually push persons in care in wheelchairs
when they have the ability to use a walker.
What was the primary factor motivating the clients to lose the weight?
-
The increased feelings of wellness, and energy
14
Did everyone’s meal change: Yes
Did the client’s weight plateau? Was this discouraging?
-
No, they have been losing weight on a steady basis
What recipes, cookbooks or other resources did you use?
-
Weight Watchers™
Low GI Cook Books
Closing remarks:
-
staff found on overall increase in flexibility, and physical strength
increased energy
increased ability to sleep
can now do up their shoes with out requiring help
ability to wear clothes that they once where never able to wear
felt better
decreased rates/ occurrence of constipation
increased overall health
15
APPENDIX C- Case # 3
Personal Information:
What:
The individual is a 60 year old female.
Weight Loss: Over 100 lbs.
Mobility:
Improved since weight loss.
Previous Eating Habits:
The manager rated the eating habits of this individual as extremely poor. The person in care
loved junk food, fried food, and ate lots of food before she went to bed. She also was
consuming large amounts of butter on her food.
What did they do?
-
Changed foods she was eating
-
Stopped buying junk foods
-
Decreased the amount of sauces used and served
-
Cut portion sizes (for buns and bagels, would slice out a bit from the inside)
-
Spread food out more on the plate to make it look like she was having more food
-
Allowed the client to have butter or peanut butter, but not both
-
Educated staff and the individual about the amount of fat in food, and compared it to
pads of butter
-
Switched to a lower fat milk (1%)
-
Switched to diet pop
-
Made her aware and responsible for her weight loss/gain
-
Reinforced her achievements in weight loss by giving her 5 lbs bags of sugar to allow her
to understand how much she has been losing
-
Started incorporating more salads, using parmesan and lemon juice instead of dressing,
with limited amounts of oil
-
Increased the amount of fruits and vegetables (snacks)
-
Incorporated more water in the diet
-
Constantly reminded staff of portion sizes
-
Found that simply saying no, did not work (realized that they needed to explain why the
were saying no)
16
What factors affected whether or not weight loss was successful?
-
Attitudes of the staff- it is important to have everyone aware of the overall goals
Having healthy foods available
Providing knowledge and educating the person in care about weight loss, and making
them aware of their successes
Encouragement
What was the primary factor motivating the clients to lose the weight?
- The increased feelings of wellness, and energy
Did everyone’s meal change: Yes
What were some road blocks, and how were they overcome?
-
One staff member thought it was easier to give in to the client’s wishes, rather than
advise her on what is healthy and what is not, often resulting in poor food choices
Had to overcome the clients love or high fat foods
The client visited her sister’s house, where she indulged in unhealthy foods
One staff member would take the client out for pizza whenever she wanted, and didn’t
understand why there was a need for her to lose weight
Did the client’s weight plateau? Was this discouraging?
-
The staff at this facility charted the weight loss weekly and noticed several plateaus.
However, rather than being discouraging, it was a source of motivation to try something
different.
What recipes, cookbooks or other resources did you use?
-
Used Canada’s Food Guide to Healthy Eating as the main resource for portion sizes
Closing remarks:
-
The individual has better overall feelings of health, and can get out of bed without help
Increased ability to move and do things for herself
17
APPENDIX D- Case #4
Personal Information:
What:
A 67 year old female who has been losing weight for 3 years.
Weight Loss: Over 50 pounds.
Mobility:
Mobility is ok. She can walk slowly unassisted.
Previous Eating Habits:
The staff reported the individual’s previous eating habits as “crappy”. The client ate many
high sugar, high fat foods, resulting in uncontrolled diabetes. The client was depressed, had
weight gain, and high blood sugar levels.
What did they do?
Initially the staff was educated on the importance of diet to control both diabetes and weight
gain. The staff became aware of the importance of having a regulated diet and incorporating
exercise in the maintenance of blood sugar levels.
-
The staff began using proper portion sizes
-
Increased fibre
-
Increased water intake
-
Stopped serving sugar sweetened drinks
-
Switched to a lower fat milk - skim milk instead of 2%
-
Stopped offering seconds
-
Limited/ omitted the use of desserts
-
Started incorporating walking (2x daily)
-
Incorporated other forms of physical activity, such as gardening.
-
Started cooking some of the meals and snacks with Splenda™ or using Equal™
What factors affected whether or not weight loss was successful?
-
Attitudes of the staff
The accessibility to foods that were high in fat and sugar
What was the primary factor motivating the clients to lose the weight?
-
The increased ability to walk
The client wanted to lose enough weight and stabilize her health so she could travel
18
Did everyone’s meal change: Yes
What were some road blocks, and how were they overcome?
There where a few key issues that needed to be addressed in order for there to be weight loss
success:
-
Compliance (no more sneaking around for high fat/high sugar foods)
Education of the staff to ensure that everyone is on board
Had to educate purchaser/buyer on how to buy healthy foods and how to read food
labels
Did the client’s weight plateau? Was this discouraging?
-
Was continually up and down, which sometimes was discouraging, but motivated them
to try harder or to try something new.
What recipes, cookbooks or other resources did you use?
-
Had a standardized menu that was used.
Closing remarks:
-
Staff found on overall increase in flexibility, and physical strength
Increased energy
Increased ability to sleep
Ability to wear clothes that they once where never able to wear
Felt better
Was able to walk more and do the things she wanted to do
19
APPENDIX E- Case #5
Personal Information:
What: This facility had all four of their clients with weight issues. The facility chose to focus
on maintenance of the individual’s current weight, rather than weight loss. This was
done through diet changes and increasing physical activity.
Previous Eating Habits:
-
Poor
What did they do?
This particular facility had three main area of focus: healthy diet, exercise, and daily routine.
In order to meet these areas of focus the staff had to be educated on the overall goals of
weight maintenance. The staff tried to meet these areas of focus by:
-
Increased the intake of water (made it easily accessible, as individuals could serve
themselves, without asking for help)
-
Decreased the intake of juices and pop, by making them less accessible
-
Ensured that a menu plan is followed with limited substitutions
-
Ensured that everyone is getting proper portion sizes (in regards to Canada’s Food Guide
to Healthy Eating)
-
Limited the amount of fast food, restaurant food that is consumed.
-
Chose lean meats (chicken/ turkey/fish) while limiting red meats, to cut down on fat
-
Incorporated lots of vegetables and fruits (motivated persons in care to consume them
by buying seasonal to ensure variety, and making them easily accessible, as they are
always out on the counter)
-
Had standardized shopping lists in which groceries are bought once a week.
-
Ensured that recipes are followed appropriately
-
Avoided treats\ and activities that centre around food
-
Educated staff on the amount of fat, sugar, and calories in foods
-
Incorporated a daily exercise routine in which they go hiking daily (45 minutes)
(encouraged staff to attend the hike as well), had a treadmill and an exercise bike
available all the time
-
Encouraged the individuals to incorporate light weights into daily exercise routine (have
a small gym)
-
Ensured that each person in care is involved in house work (understand that physical
activity can come in all forms)
20
-
Limited the amount of television that is watched
-
Weighed weekly, and charted progress to show persons in care where they were as a
source of motivation.
What factors affected whether or not weight loss was successful?
-
Staff enthusiasm and consistency
What was the primary factor motivating the clients to lose the weight?
-
Seeing the weight charts, and seeing their progress
Did everyone’s meal change: Yes
What were some road blocks, and how were they overcome?
Initially the individuals did not want to change their eating and physical activity habits and
were weary about the changes. However now they are glad they did as their energy levels
and motility have been vastly improved.
-
-
Family was seen as the number one road block. They didn’t see the need to lose weight
to improve the client’s health, and would buy the clients junk food and often take them
out to eat.
Christmas and holidays pose a challenge for weight maintenance and is often the time in
which there is weight gain
Did the client’s weight plateau? Was this discouraging?
-
The clients in this facility have been losing weight/maintaining on a steady basis
What recipes, cookbooks or other resources did you use?
None
Closing remarks:
-
Staff found on overall increase in flexibility, and physical strength
Increased energy
Ability to wear clothes that they once where never able to wear
Felt better
Decreased rates/ occurrence of constipation
Increased overall health
21
APPENDIX F- Case #6
Personal Information:
What:
47 year old male with weight loss and weight gain.
Weight Loss: 30 lbs.
Mobility:
Good mobility.
Previous Eating Habits:
Previous eating habits of the man were poor, as it was found that hotdogs and hamburger
meat products where being consume on a regular basis. The man was slightly overweight and
was on medication to control his high blood pressure. Weight loss began in 1997, due to the
efforts of one particular staff member. The weight loss stopped when the staff was
transferred in 1999 due to a lack of continued awareness and efforts of the remaining staff.
The weight was gradually lost again and now the staff is working on maintaining his current
weight within his ideal weight range.
What did they do?
Physical activity was increased and caused weight loss, providing motivation to make more
substantial changes, such as revising the menu.
-
One particular staff member became interested in this man’s weight and the desire for
him to lose weight and started taking him on walks
-
Instead of taking the bus or driving to get a coffee and a muffin the staff member and
the resident would walk to get it (took about 30 minutes each way)
-
The menu was revised and there was more incentive change other habits
-
Portion sizes were decreased and standardized
-
Water consumption was increased
-
Incorporated more fruits and vegetables and whole grain products
What factors affected whether or not weight loss was successful?
-
Attitudes of the staff, and what they put into the eating habits of the persons in care.
On the walk to the store/bakery/coffee shop staff would educate the man about the
importance of physical activity and how walking to the shop instead of driving allowed
him to eat the food without gaining weight
What was the primary factor motivating the clients to lose the weight?
-
The man was very self-motivated, and always wanted to be involved,
Unfortunately food was an incentive, ie if he could walk to a coffee shop or bakery and
get food then he would go
22
Did everyone’s meal change: Yes
What were some road blocks, and how were they overcome?
-
Initial weight loss success in 1997 was due to the efforts on one staff who would talk the
client on walks. When the staff left in 1999, walks stopped and all weight loss stopped
as well. When the staff returned in 2002, she began walks again and weight loss
occurred again. However, this time other staff were on board and supportive.
Did the client’s weight plateau? Was this discouraging?
-
Weight was initially lost in 1997 and then regained, and then lost again in 2003. Weight
fluctuations were due to lack of consistency and staff support.
What recipes, cookbooks or other resources did you use?
None
Closing remarks:
-
Increased energy
Ability to wear clothes that they once where never able to wear
Felt better
Increased overall health
Client no longer needs blood pressure medication
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APPENDIX G- Case #7
Personal Information:
What:
66 year old female who lost significant weight over 4 years and is now
maintaining.
Weight loss: Over 150 pounds.
Mobility:
Poor due to excess weight.
Previous Eating Habits:
It was found that this particular individual had rather poor eating habits. She was able to
open the fridge and therefore often snacked throughout the day choosing food items that
were high in fat, sugar and calories.
What did they do?
Initially there was resistance on part of the individual, as she did not understand why she
wasn’t able to eat foods that she was eating before. In this case the individual did not have a
choice regarding the need to change her eating habits as she had serious life-threatening
health issues due to her excess weight. To jump start their weight loss regime, the home
came to an understanding amongst the staff and the individual about what she could and
could not eat.
-
Switched to a lower fat/ fat free yogurt and froze it instead of serving ice cream
-
No longer allowed the individual to eat out of the fridge, and no longer allowed to buy
junk food when out of the house
-
Became very strict on portion sizes/educated the staff on how much she should be
served
-
Started an exercise routine, where she began walking a lot, and eventually got a
treadmill for her to walk on (1.5 hours a day)
-
Constantly monitored and educated on why she was needing to lose weight, and how
well she was doing
-
Educated her on what proper food choices were
-
Switched to low fat dressings, and dips, as well as choosing low sugar food items
-
Increased the amount of vegetables that were being consumed
-
Increased/ switched to whole wheat bread
-
Started cooking with leaner meats and using higher fat meats less often
-
Eliminated baked goods/ cookies and began using lighter choices of desserts and snacks
24
-
Incorporated a routine into the weight loss program, with reference to meal times and
exercise schedules.
What factors affected whether or not weight loss was successful?
-
Having everyone, including staff, family and others that were close or spent time with
the individual, involved and aware of the overall goal
Consistency – not sending mixed messages about what she was or wasn’t allowed to eat
Educating the individual about proper food choices help to explain why she was or
wasn’t allowed to consume certain foods
What was the primary factor motivating the clients to lose the weight?
-
Individual did not have much of a choice initially due to the severity of medical
conditions
Main incentive was to achieve the highest quality of life possible
Once she starting losing weight, she was very happy with how she looked, and received
many compliments which helped motivate her even more
She became an inspiration to others as she reached her goal of losing 150 lbs
Did everyone’s meal change: Yes
What were some road blocks, and how were they overcome?
-
The main road block was ensuring that everyone was on board with the weight loss
program, due to the initial resistance from the individual
Initially friends and family didn’t support the weight loss as they felt food was all she
had
Holidays were difficult due to the multiple social events that are centered on food
Did the client’s weight plateau? Was this discouraging?
Throughout the past four years this particular individual’s weight went up and down. Her
weight often increased when she went on holidays or away for the weekend, which meant
that they had to be extra vigilant with the weight loss program when she was at the facility.
What recipes, cookbooks or other resources did you use?
-
Used a diabetic cookbook to find new low sugar recipes and add variety to the menu
Closing remarks:
-
-
Initial resistance was overcome when the individual felt a sense of accomplishment
Having everyone on board, including external health professionals such as the nurse,
dietitian, hygienist etc was essential
Contant support and reinforcement was a must
Developing a routine that met all their needs was a key to success
Quality of life has drastically improved - increased ability to do certain activities
Client is able to fit into clothing that she was never able to fit into before
Overall increase in self esteem.
More social than she has ever been
Leg wounds that were believed to be untreatable have healed
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APPENDIX H
Canada’s Food Guide to Healthy Eating