The KU Diet Program:

Making Choices and Losing Weight

All information from this presentation, including teaching materials, can be

obtained at www.diet.ku.edu

Funded by:Kansas Council on DD

US Administration on DDUniversity of Kansas

Our Team:Richard and Muriel Saunders

Joe DonnellyDebra SullivanBryan Smith

Brian EricksonBrianne Guilford

Mary Rondon

Did You Know?

Overweight or ObeseHeight = 5' 3"

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Previous ResearchPublished weight loss interventions with adults with IDD have shown poor results

Previous approaches have generally been in the form of weekly presentations about healthy food choices, cooking methods, and the benefits of exercise

Previous interventions have been of relatively short duration

Health Care Costs

Medical care for obese people cost $1,429 more per person each year than persons of normal weight

Extra costs are due primarily to treatment of diabetes, hypertension, and cholesterol

Newsweek, August 17, 2009

Our Participants

Enrollment in 6 counties

79 Participants following initial meeting

75 Completed 6-month diet phase

20% have Down syndrome

96% have mild or moderate ID

Living Arrangement

Alone with some supports 25%

With a family member 24%

Home/apartment of 2-3 23%

Home/apartment of >3 21%

With spouse with IDD 7%

Baseline; N=77Height = 5' 3"

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Avg.Participant

Intervention Type

Home-based; caregiver present 43

Office-based; participant only 32

Methods

Food Preference Assessmentand

Stoplight Chart

Stop Light Food Ratings

Lower calorie Somewhat more calories Even more calories- Avoid or limit servings

Vegetables

Fruits

Broccoli Apples Celery Apricots Carrots Bananas Cauliflower Blueberries Celery Blackberries Corn Cantaloupe Cucumber Cherries Green beans Fruit Cocktail (in its own juice) Peppers Grapefruit Potatoes baked or mashed (w/skim milk, little butter)

Kiwi friuit

Potatoes fried Oranges Spinach Peaches Sweet potatoes Pineapple Tomatoes Raspberries Dairy Bread and Pasta Cheese (regular) Bagels Cream cheese or cheese (fat free)

Bread & buns

Cottage cheese (low fat) Cornbread Cream Cheese (regular) Muffins, rolls, biscuits Milk (skim or soy) Macaroni, spaghetti, noodles Ice cream or frozen yogurt (low fat)

Pizza, fresh or frozen

Our Diet Plan

Teach a HIGHER VOLUME, LOWER CALORIE diet (1-hour initial training).

Daily: 5 or MORE servings of fruits and

vegetables3 meal replacement shakes/smoothies2 frozen entrees of <300 calories each

Entrees: Choose any item below or any other entrˇe that has less than 300 calories. MichelinaÕs Lean Gourmet

Smart Ones

Glazed Chicken Turkey/Mushroom Gravy Layered Lasagna Grilled Mandarin Chicken Beef Stroganoff Chicken Oriental Roasted Sirloin Creamy Parmesan Chicken Pepperoni Pizza Stuffed Turkey Breast Chicken Alfredo Slow Roasted Turkey Beef Pepper Steak/Rice

Shrimp with Pasta Five Cheese Pizza

Oriental Beef

Lean Cuisine

Healthy Choice

Swedish Meatballs Turkey Breast Spaghetti/Meat Sauce Spaghetti Baked Chicken Breaded Chicken Breast Panini Chicken Enchilada Cheese Lasagna Grilled Whisky Steak Chicken Fettuccini Sesame Chicken Chicken Enchilada Grilled White Chicken Beef Parmesan Turkey Breast Meat Loaf with Gravy Roasted Chicken/Fettuccini

Points of view represented in this material do not necessarily represent official Kansas Council on Developmental Disabilities or Administration on Developmental Disabilities policy.

Self-Recording of Food and Beverage Energy Intake

Self-Recorded Weight

Weight Record

Mon Tues Wed Thur Fri Sat Sun Mon Tues Wed Thur Fri Sat Sun

228 228 228 228 228 228 228 228 228 228 228 228 228 228 227 227 227 227 227 227 227 227 227 227 227 227 227 227 226 226 226 226 226 226 226 226 226 226 226 226 226 226 225 225 225 225 225 225 225 225 225 225 225 225 225 225 224 224 224 224 224 224 224 224 224 224 224 224 224 224 223 223 223 223 223 223 223 223 223 223 223 223 223 223 222 222 222 222 222 222 222 222 222 222 222 222 222 222 221 221 221 221 221 221 221 221 221 221 221 221 221 221 220 220 220 220 220 220 220 220 220 220 220 220 220 220 219 219 219 219 219 219 219 219 219 219 219 219 219 219 218 218 218 218 218 218 218 218 218 218 218 218 218 218 217 217 217 217 217 217 217 217 217 217 217 217 217 217 216 216 216 216 216 216 216 216 216 216 216 216 216 216 215 215 215 215 215 215 215 215 215 215 215 215 215 215 214 214 214 214 214 214 214 214 214 214 214 214 214 214 213 213 213 213 213 213 213 213 213 213 213 213 213 213 Name Wks__5-8 Year__2007

Monthly Meetings: Diet

Re-take weight and waist measurements

Obtain recollections of foods eaten in the past 24 hours (analyze later for nutritional content)

Count vegetables, fruits, smoothies and entrees eaten

Discuss progress and problems

Review last month’s calories from 24-hr recall

Our Exercise Plan

Provide pedometers and encourage increased walking

Encourage other forms of exercise

Monthly Meetings: Exercise

Total steps taken

Count periods of other exercise

Monthly Meetings: Incentives

$5.00 per 100,000 steps, tracked on a game board

$0.05 per healthy item consumed and $0.05 to savings account

Pay savings balance for 1 BMI pt lost.

Award certificates, stickers, bragging cards

High-fives all around for trying/success

Results at 6 Months

Average weight loss for the 75 completing the diet phase was about 13 lbs, or more than 6% of their average baseline weight.

Average at 6 Months; N=75Height = 5' 3"

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Avg.Participant

Comparisons

Weight loss by males was no different than weight loss by females

Weight loss by those we saw at Kansas Elks was no different than those seen in their homes in NE Kansas

Individuals with Down syndrome lost a few pounds less than the average

Residence Comparisons

Individuals in all types of residence lost weight Those in homes or apartments of 2-3 lost the most weight: ~18 lbsThose living with a spouse with IDD or in large group homes lost the least weight, but the samples are too small for firm conclusions

Results at 12 Months

Average weight loss for the 46 completing the maintenance phase was about 19 lbs, or more than 9% of their average baseline weight.

Average at 12 Months; N=46Height = 5' 3"

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Avg.Participant

Average at 18 Months; N=12Height = 5' 3"

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Average Participant

The Most SuccessfulHeight = 5' 3"

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10BiggestLosers

Characteristics of Big Losers

Personally invested and often someone in circle of supports was also invested

Assisted in buying/cooking

Kept timely, thorough weekly records

Rarely snacked on red light foods

Weighed self frequently

Enjoyed the monthly positive feedback

What is Important?

Choice, Independence, ControlParticipants had more choices

- in the grocery store

- in food selection at mealtime

- in when to eat

- in how much to weigh

Supported Routines

The diet became a consistent routine, supported by others

Consistent routines are essential to any long term behavior change

Projection

Our average participant would need 3 years to reach a weight in the normal range.

Thus, real success is about permanently changing how you eat, rather than dieting for a short period of time.

Conclusions

The caregiver must be made aware when the diet(er) is not supported

Ultimately, the adult with IDD “drives” the effort, not someone else

The interventionist must have status, but not be judgmental