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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 23 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 25 APPENDIX H Canada’s Food Guide to Healthy Eating