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