TRIM LIFESTYLE PROGRAM

1. TRIM LIFESTYLE PROGRAM Lynchburg Family Medicine Residency Dr Stacey Hinderliter, Dr Jennifer Cunningham, Dr Shital Patel

2. TRIM-Training Residents in Modifying- Lifestyle • Childhood obesity project at LFM residency to identify and treat overweight or obese children • Children above the 85th percentile for BMI are offered enrollment • Partly funded by AAFP AIM HI

3. Objectives • Identify overweight and obese children: • Measure height and calculate BMI at all office visits not just preventive visits • Educate families about 5-3-2-1-0 Healthy Lifestyle • Visit Powerpoint and Healthy Lifestyle notebook • Educate residents about obesity prevention and treatment • Resident involvement in program development • Resident training and evaluation

4. 6 monthly office visits with the patient’s primary care physician • Primary care physician provides intensive individual family education and counseling

5. Each visit was created by resident/faculty teams • Residents trained and tested as each visit was developed • Each visit incorporates one step of the 5-3-2-1-0 Healthy Lifestyle

6. Families were encouraged to keep track of the changes they made in Healthy Lifestyle notebook • Incentives were provided at each office visit to encourage patients to complete the program

7. 5-3-2-1-0 Healthy Lifestyle • • 5 servings of fruits and vegetables daily • • 3 healthy meals a day: home-cooking • • 2 hours or less of screen time: TV, computer, video games • • 1 hour physical activity: sweat • • 0 or almost 0 drinks containing sugar www.dukehealth.org : 5-3-2-1-almost none healthy lifestyle

8. Visit 1-Zero Sugary Drinks • How to read labels • Other names for sugar • Healthy servings • Water bottle • Sugar free drink mix • Sugar free drink ideas

9. Visit 2-1 Hour of Physical Activity • One hour can broken up into small bits • Weight lifting of 1-2 pounds OK for children • Don’t have to be on a team • Pedometer: 2000 steps = 1 mile • Soft balls

10. Visit 3-5 Servings of Fruits & Vegetables • Whole fruits and vegetables vs juice • Fiber in the diet • How to get fruits and veggies into meals and snacks • My Plate-fill ½ plate with fruit/veggies • $5 grocery gift card and recipes

11. Visit 4-TWO HOURS of SCREEN TIME • What is a screen? • No TV in child’s bedroom or during meals • Effects of TV on BMI, attention and behavior problems • BMI higher from watching TV vs reading a book • Cards, jump ropes, frisbees, games etc.

12. Visit 5- 3 Healthy Meals a Day: Home Cooking • Benefits of healthy meals • Review of My Plate-Protein, Grains and Starches • Eyeballing healthy portions • Involve child in grocery shopping and meal preparation • $10 grocery gift card, measuring cup, recipes

13. Visit 6- Let’s Review5-3-2-1-0 Healthy Lifestyle • Changes made by family based on each step of Healthy Lifestyle • Review reading food labels • Reinforcement of My Plate and eyeballing portions • Gift certificate for children’s museum, skating, or bowling

14. Motivational Interviewing How to get your patient to want to do what you want them to do

15. Definition • Patient centered directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence • Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change 2nd edition, New York: Guilford Press, 2002

16. Four Guiding PrinciplesRULE • Resist arguing and persuasion • Understand your patient's motivation • Listen to your patient • Empower your patient

17. What it is not • Not arguing • Not offering advice without the patient's permission • Not doing most of the talking • Not giving a “prescription”

18. How to do it • Establish rapport • Set an agenda • Get permission • Ask open-ended questions • Use reflective listening

19. How long does it take a physician to interrupt a patient? ABOUT 15 SECONDS!

20. More tools • Consider pros and cons • Determine degree of interest and confidence • Provide a menu of choices • Provide information, let patient interpret it • Summarize and close the deal

21. Pros and cons • What’s good about_______? • What might happen if you don’t change ________? • How would changing_______ affect your family? • What’s bad about_________?

22. Giving information • Ask permission-May I tell you about _____? • Provide nothing but the facts- Being overweight can cause_______. • Let patient interpret it- What does this mean to you?

23. Can you make a change? • Limit sugary drinks to 1-2 times a day • Use 1% or fat free milk • Drink more water- can try flavored water or sugar free drink mix. On a scale of 1-10: • How interested are you in making a change? • How confident are you that you can make a change? • Why did you choose a low number? • What would it take to choose a higher number?

24. Can you make a change? • Be active everyday • Be active for 1 hour a day • Split activity into smaller parts: • 30 minutes twice a day • 15 minutes 4 times a day • Be active as a family 1-2 times a week On a scale of 1-10: • How interested are you in making a change? • How confident are you that you can make a change? • Why did you choose a low number? • What would it take to choose a higher number?

25. Can you make a change? • Offer fruits and vegetables at snack time • Fill ½ your plate with fruits and vegetables at meals • Try new fruits and vegetables • Limit juice to once a day On a scale of 1-10: • How interested are you in making a change? • How confident are you that you can make a change? • Why did you choose a low number? • What would it take to choose a higher number?

26. TRIM Lifestyle results 111 overweight and obese children

27. TRIM Lifestyle Results

28. TRIM Lifestyle Results

29. BMI changes in TRIM graduates

30. TRIM Lifestyle Users

31. TRIM Lifestyle Future • Option of Mini-program-3 visits • Family can choose what works best for them • Improve training for each new resident class • More focus on Motivational Interview Methods • Community Outreach

33. Any questions?