Lifestyle interventions for diabetes prevention continue to have benefits for patients 10 years down the track, according to recently published data from the Diabetes Prevention Program.

We can benefit from better tools and teams to support us in this task.

What tools have you found useful?

In the interests of ‘Sharing Generously and Stealing Shamelessly’, here is a preliminary list of some resources and ideas.

As suggestions come in, we’ll share them on this site.

Diabetes Life

Victorian pratices will know that Diabetes Life is a major diabetes prevention campaign of Diabetes Australia (Victoria) supported by the Vic government.

They have a number of resources available to download or to have sent to you. In particular, they have a neat online risk calculator

Dieting for Weight Loss

Which diet achieves the best results?
The NEJM (and the Health Report) have recently sort for the answer.

Report in stepUp.org.au.

That’s a mere 4 million steps.

Our clinic began our virtual journey last Friday.

We are well on our way to the first checkpoint, Zhangye.

There has been little thanks for my contribution of 16,900 steps (Rebecca our exercise physiologist has 74,000, and Alison has 62,000 – after four days!)

The Great Wall of China is the latest 10000steps.org.au workplace challenge.

You provide each member of your practice team with a pedometer, and they enter their step count each day on the 10000steps.org.au website.

Although of course we never actually leave Alstonville, the site keeps track of our teams collective (virtual) progress – and points out sites of interest along the way.

We’ll keep our patients involved by displaying the map of our journey in the waiting room, and perhaps invite them to join a patient vs staff challenge.

Come on, get in the Olympic spirit. Any other clinics like a race?

Sign up at http://10000steps.org.au

Aussie Aussie Aussie

In a previous post we forshadowed an open-source GP-based collaborative lifestyle project for patients to improve their fitness and lose weight.

Thanks for all the feedback I have received.

The project is based on what we have learned about system change.
Improvements are best made in incremental steps, measuring as we go to make sure that change is an improvement.

We aim to make it easier for us to help our patients improve their lifestyle in a sustainable way.

The project will use all the skills we have in our practice teams – doctors, practice nurses, receptionists, practice managers, exercise physiologists, dietitians and diabetic educators.

We had a tentative title of ‘FancyName’. The current leading contender for a new title is …………

“The stepUp program”
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It is envisaged that it will work something like this. (remember this is an ‘alpha’ work in progress and the final outcome will depend on your contributions and suggestions)

A patient presents to you, their GP, requesting advice about health, or fitness, or weight loss.
“Ah ha”, you say, “you’ve come to the right place. I can enroll you in our ‘stepUp’ program.

You outline the program to them. You tell them to ask the desk to make an appointment to see Leanne (your nurse) about the stepUp program.
You say “Take this *stepUp card* with you, have a read, fill in the form attached and bring it with you when you come to see her.
Don’t worry, step by step we’ll get you in good shape”.

The program then is systematic. Each week (?fortnight ?month) the stepUp enrollee comes and sees a member of your team for their new personalised *stepUp card*

Each *stepUp card* has one change in each of three categories that they are to make for that period – “Eat Better, Do More, Think Healthily”

ie One change will be dietary – “Eat Better”(eg This week, substitute wholegrain bread for white bread. Wholegrain bread has a low Gi etc etc)
One change will be activity – “Do More” (eh This week, wear your pedometer gain and increase your steps each day by 1000 from your readings last week)
One change will be in healthy thinking “Think healthily” (eg This week, think of a person that you know who is always fit and healthy. Imagine what they would do in any circumstance and what they would eat during the course of the day”)

Patients will continue on the program for as long as it takes (and as many ideas as we can all come up with), making just three small changes each time.

The program will learn as it goes – patients will evaluate each card at the end of the week. make suggestions, and the activities associated with that card will be improved.

There will be a stepUp wiki (like wikipedia) where practices can add their own ideas for stepUps, or adapt/improve/extend other’s suggestions.
You will then be able to download a set of *stepUp cards* and instructions to make a systematic lifestyle medicine program in your practice.

The *stepUp* program will be ‘open source’, which means that it will be owned by all of us to use at no charge.

You’ll be able to start contributing your ideas ‘real soon now’ (within the week) at <http://practiceimprovement.com.au>

I look forward to your suggestions.

Happy Christmas,

I seem to be having a lot of conversations with patients about weight loss. We really want them to think about being fitter – many are only concerned about being fatter.

People, including health professionals who should know better, promote one fad after another. It is frustrating to see our patients lose weight, only to find that after some months they are bigger than before they started – and with less cash in their pockets.

It is no surprise that any diet people choose seems to work initially.

The book “Perfect Mess” describes the series of studies undertaken at the Hawsthorne plant of the Western Electric Company. These studies demonstrated that worker output improved when any change was introduced. Even meaningless changes had an effect – like turning the lights up and then later turning them down. People tend to work harder when they know they are being observed. It is the clipboard that matters most.

Successful weight loss, of course, as our colleague and GPSpeak medical editor Andrew Binns points out, requires the motivation to commit consistently to healthier choices.

It’s a pity it’s not as easy as Dr Rudi’s diet – “Eat less” or even the advanced diet “Eat less, do more”.

It requires sustained behaviour change.

I have been trying to track down a picture book I once owned about a land in which the king had to be able to jump to the very top of the castle. When it became time for the king to retire, he sought someone who could take his place. One little boy started at the bottom, and jumped one step by one step till he reached the top. In time, this wise boy became the new king.

In the collaboratives we have learnt about successful change management – incremental change, measuring what you’re doing, being systematic, being creative.

I am sure that using these principles we could collectively come up with a GP-based program that promoted genuinely healthier lifestyle changes, as well as sustainable weight loss.

We have excellent baseline resources to use like Lifescripts, Andrew’s series of articles in GPSpeak, and a lot of collective knowledge about behaviour change. Of course we will call our program by some fancy name. I’ll use FancyName® for the time being for illustrative purposes.

I imagine it works like this.

Kevin has heard of FancyName® and comes to see us, his GP, about weight loss. We chat about aims and goals and enrol him in the GP collaborative healthy lifestyle program, FancyName®.

We perform some baseline measurements and then give him a FancyCard®, which has on it the one change he is to make that week. This change is easy.

Perhaps week one he has to measure his weight each morning and night. (He finds his weight varies enormously – the lesson being that he shouldn’t take any notice of small fluctuations up and down and that weight is not the best way to monitor health and fitness).

He returns next week and sees the practice nurse, who gives him a pedometer and another FancyCard®, which suggests that he measure his steps each day.

When he sees us in week three we give him a new FancyCard® that suggests he have a fibre cereal each morning.

(I’m not an expert on weight loss, unlike Andrew, who has written ‘The Expert’s Guide to Weight Loss’. I think that there were three key factors shared by people who successfully lose weight – they have breakfast each morning, exercise every day and have a low fat diet.)

Week four he has to increase his steps by 1000 each day. Week five we introduce the concept of low GI foods.

Anyway, you get the idea. Our patient jumps to the top of the castle one step at a time.

Collectively, we produce a hundred or so simple steps that patients can adopt incrementally to achieve lasting improvements in their lifestyle. We use this program to manage these patients systematically and proactively, using our practice teams, including exercise physiologists and dieticians. We support their gradual adoption of changed behaviours. Instead of talking to them at length about fat intake, energy balance, low GI foods etc, we give them one simple task each week. We measure how they go, and how we go, and share information on what works well, and modify the program with this shared data.

I’m sure many practices already have such a program. I know that Tintenbar has an excellent activity program.

Anyone up to making suggestions for our collaborative effort? What should the real name of FancyName® be? What would you recommend for the weekly changes that go on the FancyCard®? I’ll collate the responses and share them. Email tony@lemlink.com.au.