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Section 9.4 WLM LG Session Outline
G10
Group Session 10
SESSION AT A GLANCE
Key Behavioral Strategies:
Stress management
Relaxation techniques
Self assessment
Cognitive methods
Participant behavioral objectives
Before the next group session, the participants will:
1. Practice relaxation or stress-reducing strategies when noticing symptoms of stress
2. Revisit portion estimates and practice measuring portions if necessary
3. Continue recording eating and physical activity habits daily and analyze nutrients for 3-4
days
Process objectives and session content:
At this session, participants will:
1. Discuss what stress is and their stress levels
2. Explore strategies for reducing stress
3. Review portion control as a method of calorie reduction
Topic/Agenda (2 hours)
DO IT! ~30 MINUTES
CHECK IN ~30 MINUTES
Weight Loss Target
TRY IT! DISCUSSION/ACTIVITIES ~30 MINUTES
Managing stress
My portion estimates
NEXT STEPS ~30 MINUTES
WELCOME AND AGENDA
1.
2.
3.
4.
Simple refreshments available
General welcome
Collect attendance and weight data forms
Negotiate and agree on agenda for the session
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DO IT! ~30 MINUTES
Note: Review the “Do It!” purpose document from the leader’s guide and select an appropriate
Do It! activity from the list of options.

Have participants complete Form 205: Vigorous Physical Activity
Safety alert!
Remind the group to exercise at a moderate level – their perceived level of
exertion should be “fairly light to somewhat hard.” They should feel like
they are working but still be able to carry on a conversation. This is not a
competition. Encourage participants to respect each others’ fitness levels.
CHECK IN ~30 MINUTES
Topic for this week’s Check-In: Are you on target for weight loss?
 Distribute the Personal Feedback Reports (PFR) to participants (printed at Site)
 Discuss weight loss targets for week 10 and 15
 Use the PFR for participants’ to reflect on current status compared to target
Sample Script:
We are half way through the intervention now and it is time to give you your personal
feedback reports or PFRs to help you assess your progress-to-date so you know what you
need to do to be eligible for Phase 2 Maintenance. Today’s “weight loss target” is -8
pounds*. Your personal target may be different from ours. Take a moment to look at your
report.
How are you doing?
What is working?
What isn’t working? What is getting in the way?
Based on what you see on your report, what might you do differently this week?
Your next “weight loss target” is –12 pounds at G15. We will print another PFR for you to
review at G15. That gives you 5 weeks to reach the goal of –12 pounds or your own
personal target.
*NOTE: The weight loss targets reflect the Triage Guidelines located in the Intervention
MOP Chapter 9.3.2.
Optional check-in topics from last week, if time permits.
 Family support and communication
 Family meals
 Exercise with the family
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TRY IT! DISCUSSION/ACTIVITIES ~30 MINUTES
Note: The following Try It! activities are suggestions only. Choose only appropriate Try It!
activities based on time available and the needs and preferences of your group. Do not feel
compelled to cover all the material.
1. Managing stress
This activity assists participants in understanding the concept of human stress and how stress can
negatively affect diet, physical activity and health. It also provides instruction to participants for
promoting relaxation

Use the Stress Fact Sheet as an outline and give a brief overview on stress. Encourage
participants to give their views and offer personal accounts of the human stress
experience. Sample discussion questions to help participants get started:
- How would you define stress?
- What are some symptoms of stress?
- How do you know when you are stressed?
- What happens to your eating habits when you are stressed? What about your
exercise routine?
- What can you do to reduce stress?
Sample discussion approach:
Everyone experiences stress from a variety of life events. Some of these events are more
within our control than others. Our experience of stress is not necessarily caused by the
events in our lives, but by our interpretation (thoughts) and response (action) to these
events. Our reaction to stress can also be affected by how much support we feel we are
getting from those around us. If we feel appreciated and loved by the people around us,
we tend to be better able to cope with stressful life events. Stress can also be impacted by
personal skills such as our ability to solve problems or our skills at managing our time.
Let’s hear about your personal experiences with stress.
1. How would you define stress?
2. What are some symptoms of stress?
3. How do you know when you are stressed?
4. What happens to your eating habits when you are stressed? What about your
exercise routine?
5. What can you do to reduce your stress?


Record participants response on a flipchart or chalkboard.
Summarize the discussion:
Stress can disrupt diet and physical activity programs. Dealing with stressors can get in
the way of taking time to eat the right foods or engage in physical activity. Stress can
also put us in a bad mood or decrease our confidence in our ability to meet our dietary
and physical activity goals. Stress has been a common reason given for relapse in diet
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and physical activity programs. Improving one’s ability to manage stress may increase
the likelihood of continued success in WLM.

Discuss strategies for managing stress. Ask: What do you currently do or can you do to
manage the stress in your life? Write the suggested strategies on a flipchart and consider
typing them up to distribute at the next session.
Alternative: Have participants think about someone they know who is a good stress
manager. What are the characteristics that you associate with a good stress manager?

Direct participants in the Progressive Muscle Relaxation exercise or some other form a
relaxations, such as a tape with guided imagery.

Encourage participants to practice relaxation exercises whenever they feel stressed to
help them relax and reduced their stress level. Have participants record an action plan for
managing stress.
2. My portion estimates
This activity can help participants understand portion control as a method of calorie reduction.








Facilitate a discussion about the benefits of portion control. Ask: Why is it important to
monitor portion sizes? What are the benefits of measuring portions?
- Smaller portions allow for meeting individual needs while controlling overall
intake
- Portion control helps reduce caloric intake
- Smaller portions help you include higher calorie foods in a more managed way
- Accurate monitoring of portion sizes is an important strategy to weight control
Display foods listed on the Portion Estimation Worksheet (measure an amount at least
twice what you think most people will eat to allow participants to choose the amount
they usually eat)
Have participants work individually or in small groups (depending on the size of the
class)
Participants choose a food item and place an amount they usually eat on a plate, in a
bowl or cup
Have participants measure the amount of food and record it on the Portion Estimation
Worksheet
Have participants use the Food and Fitness Guide to compare the number of servings in
the portion of food they chose to the actual serving sizes listed in the Food and Fitness
Guide and calculate the difference in calories between the two amounts
Debrief. Ask: What did you learn from doing this activity? What might you do
differently to manage your portion sizes to help you achieve your weight loss goals?
What changes have you made in the past to help you control your portions? How have
these changes worked for you?
Have participants record their action plan for controlling portion size
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NEXT STEPS ~30 MINUTES
1. Plan for the Week
Participants write a weekly action plan on the inside cover of the diary in at least the following
two areas:
--stress management
--portion control
--participant choice
2. Tracking (Self-Monitoring): STANDARD
The recommended tracking for the week is:
a. Write down all the food you eat and drink every day.
b. Calculate the calories from the foods you eat and drink, total, and summarize for at
least three days.
c. Keep track of servings of fruits and vegetables each day.
d. Keep track of the servings of low-fat dairy each day.
e. Write down the minutes of exercise above your normal routine.
3. What to expect next week
- Bring your food records for discussion at next session.
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Fact Sheet on Stress
The term stress comes from the field of engineering and was coined in the 1940’s
by Dr. Hans Selye. He used the term to refer to a group of bodily changes that
occurred in individuals in response to stressors. Stress that is intense or prolonged
can result in disease by negatively impacting bodily systems (i.e., causing
headaches or stomach problems) or by decreasing our immunity to infections and
other disease processes.
Today people often use the term stress to refer to life events that place demands on
them. These events can involve major life events such as a divorce, the death of a
friend, or loss of one’s job. Minor life events such as arguments with your
spouse, driving in heavy traffic, or being unable to complete the tasks you want to
accomplish for the day can also be a source of stress.
Stress can disrupt diet and physical activity programs. Dealing with stressors can
get in the way of taking time to eat the right foods or engage in physical activity.
Stress can also put us in a bad mood or decrease our confidence in our ability to
meet our dietary and physical activity goals. Stress has been a common reason
given for relapse in diet and physical activity programs. Improving one’s ability to
manage stress may increase the likelihood of continued success in WLM.
Our experience of stress is not due simply to the events in our lives but also
involves how we react to these events. Our reaction to stress is affected by how
much support we feel we are getting from those around us. If we feel appreciated
and loved by the people around us, we tend to be better able to cope with stressful
life events. Stress can also be impacted by personal skills such as our ability to
solve problems or our skills at managing our time.
We can improve our ability to manage stress by: (1) identifying early when stress
is becoming a problem, (2) being able to relax, and (3) learning to manage our time
(activities) so we do not take on too much responsibility and scheduling
pleasurable activities.
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Progressive Muscle Relaxation Exercise
This exercise involves tensing and relaxing groups of muscles. Begin with the muscles
of the hands and arms. Tense the muscles and hold for a count of 10. Relax all at
once and allow the muscles to continue relaxing. Notice the difference between the
feelings of tension and the feelings of relaxation when you release the tension. Allow
the relaxation response to continue for a count of 10. Allow the muscles to relax more
each time you exhale. Repeat the procedure with the same muscle group. Follow the
above procedure with the remainder of the muscle groups.
Muscle Groups
1.
Muscles in the hands and arms.
Make a tight fist and tense your
bicep muscles.
2.
Facial muscles.
Close your eyes tightly, wrinkle your nose and make
an exaggerated smile.
3.
Neck muscles.
Bend your chin forward while pulling back with your
head.
4.
Muscles of the chest, shoulders and back. Take a deep breath while
arching your back and extending your chest.
5.
Thigh muscles.
Bend toes forward away from your head while tensing thigh
muscles.
6.
Muscles of the calves and feet.
Bend toes backward toward head and tense
calf muscles (not too tense to avoid cramping).
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Portion Estimation Worksheet
Instructions:
1. Place the amount of this food you usually eat on a plate, or in a bowl or cup.
2. Use the measuring tools provided by your leader (cups, spoons, scale, etc) to measure the
exact portion size of the food item you chose.
3. Use the Food and Fitness Guide (FFG) to compare your amount to the actual serving size
a) How many servings did you choose?
b) What is the difference in calories?
c) What might you do differently to change the amount you now eat to help with your
weight loss?
Displayed foods
Your portion
Actual
serving size
in FFG
Number of
servings in your
portion
Difference
in calories
Pasta, cooked
Rice, cooked
Salad with dressing
Baked beans
Fat-free milk
Mixed vegetables
Mashed potato
Orange juice
Ice cream
Cereal
Popcorn
Grapes
Salt-free nuts
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