After CoreStrategies

SDPI DP Grantee MeetingMarch 10, 2006

Denver, CO

What is After Core?

• Provide participant support after 16 Core sessions

• Assist participants in achieving and/or maintaining goals

• Critical to helping prevent diabetes

• Affirms that we understand the cycles of behavior change

-15 -10 -5 0 +5

05

1015

20Hazard Rate for Developing Diabetes As

A Function of Weight Change From Baseline

Haz

ard

rat

e p

er 1

00/y

r

Mean weight change from baseline (kg)

Average Risk

Intensive Lifestyle Group

DPP After Core Goals

• Reach and/or maintain weight loss goals

• Reach and/or maintain activity goals

• Retain participants in program

DPP Requirements for

Contacts After Core

• Whatever needed for adherence to goals• Contact at least monthly, and see

participants in person at least every two months (most participants desired/needed more frequent contact)

• Three group sessions offered per year– Healthy eating, activity, behavior

• Encourage individualization

DP SDPI Grant Requirements for

After Core

• Goal: Continue progress toward goals or maintenance of goals

• Encourage monthly (minimum quarterly) follow up with participants after the 16 week curriculum

• Manual for Contacts After Core– In person visits, phone contact, group

activities/classes– Individualize topics needed, including behavioral,

physical activity, healthy eating

DPP Principles for

After Core Planning

• Design the participant contact schedule based on the participant’s recent pattern of adherence

• Transition participants from weekly visits slowly and ONLY if high levels of adherence persists

• Be prepared to begin seeing the participant weekly again if needed based on the ongoing pattern of adherence

DPP Principles for After Core Planning (continued)

• Be proactive. Schedule an appointment right away if you discover a downward trend in adherence based on data

received between visits by phone or mail • Design the schedule based on the

participant’s preference, keeping any retention issues in mind.

After Core In-Person Visits

• Greet• Weigh-in, collect activity minutes and discuss• Review homework and action plans made at

previous contact• It is important that sessions don’t become

loosely organized on “how are things going?” but should have a definite focus such as – Introducing a new topic as planned– Reviewing a topic from an earlier session if needed

After Core In-Person Visits (cont.)

• Complete a problem solving/action plan worksheet that corresponds with the topic covered and review tools

• Schedule next contact

After Core Mail Contacts

• The purpose of mail contacts is to have the participants inform their coach about their progress in weight loss and physical activity

• Should be tailored to each participant in order to best support adherence

• Other contacts like notes of encouragement or greeting cards are good for retention but were not considered a mail contact unless they were reporting requested information back to coach

After Core Phone Contacts

• Set date/time for call ahead of time

• Ask participant to have completed home assignments available for the call i.e. home weights or exercise minutes

• Problem solve together any barriers

• Make a plan and follow-up

Remember that in the DPP…

Weight loss often took longer in our population

• Biggest losers and maintainers–Met goal at < 6 months–Met goal at 15 months

• Best weight loss data in the country at one of our sites after 2 ½ years

• Maintenance better than average

Percent of Participants who Achieved 7% Weight Loss Goal at End of Core Curriculum and at Study End

0

10

20

30

40

50

60

70

Caucasian African-American

Hispanic-American

Asian-American

AmericanIndian

Session 16 (p<.0001)

Final Visit (p=.11)

Ethnic group

Maintaining weight loss is at least as difficult as

the initial loss

-8

-6

-4

-2

0

0 1 2 3 4

Years from Randomization

Weig

ht C

hang

e (kg

)

Lifestyle

Weight Change in the DPP

NEJM, 2002

Physical activity is important for weight maintenance

Percent of Participants Who Achieved Exercise Goal Percent of Participants Who Achieved Exercise Goal

at End of Core Curriculum and at Final Visitat End of Core Curriculum and at Final Visit

0

10

20

30

40

50

60

70

80

90

Caucasian African-American

Hispanic-American

Asian-American

AmericanIndian

Session 16 (p=.38)Final Visit (p<.002)

Ethnic Group

Frequent contact remains important

Accountability is key

Summary • Weight loss may take longer in our

population

• Maintaining weight loss is at least as difficult as the initial loss

• Physical activity is important for weight maintenance

• Frequent contact remains important

• Accountability is key

Examples of Methods to Keep Track of Data

The Keys to Success of the DPP remain throughout

Coaching

Team Approach

Relationships with Staff and Family

Ongoing Intervention

Individualization

Self Monitoring

Provide Tools to Achieve Goals

Clearly Defined Goals and

Expectations

Summary of Keys to Success

• Coach and team approach

• Relationships with staff and family

• Ongoing intervention

• Individualization

• Self monitoring

• Provide tools to achieve goals

• Clearly defined goals and expectations

Tools to Target Time

• Cautionary Weight

• Target Five

• Immediate Follow-up

• Consistent Relationship

Tools to use for After-Core

For Participants

For the Coach

Planning After Core for Groups

• Frequent contact remains important• Variety• Competition• Goal driven, incentive based• Toolbox• Build on your and your participant’s history• Target individual for classes i.e. those not at

exercise goal invite them to group exercise session

After Core Campaigns

• Specific goals that are reinforced– Weight loss– 150 minutes activity each week– Record keeping– Class attendance

Ideas for Group Campaigns

“Don’t Gain, Maintain”Holiday Campaign

• Overview– Use the handouts “Getting Ready for the

Holidays” and “ Lifestyle Balance on Vacation”

• Strengths– Accountability– Weigh-In Dates after major holidays– Incentives for maintaining weight

“Winning At Losing”

• Overview– Behavioral Class– How and why people keep off the weight– Dieting pitfalls

• Strengths– Group Cohesiveness– Enjoyed Competition

“DPP Spring Training”

• Overview:– Combo Class– Planned Menus– 2 Four Week Cycles

• Strengths– Individualized menus– Structure

Think Positive

• DPPOS class attendance about 30%

• 65% maintaining some weight loss after 8 years

• Use your energy toward success

The Mysteries of the DPPAfter Core

• Where can the information be found?– Website Address

http://www.bsc.gwu.edu/dpp/index.htmlvdoc– After Core Manual (2)