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Dr Cheryl Flanagan PhD RD

Do health behaviour messages correspond with health behaviour change in a weight management programme? Health Communication Research Conference 30 th March 2012. Dr Cheryl Flanagan PhD RD. Cost of obesity in Northern Ireland. Costs of treating obesity £3m

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Dr Cheryl Flanagan PhD RD

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  1. Do health behaviour messages correspond with health behaviour change in a weight management programme?Health Communication Research Conference30th March 2012 Dr Cheryl Flanagan PhD RD

  2. Cost of obesity in Northern Ireland • Costs of treating obesity £3m • Lost earnings due to premature death £22m • Lost earnings due to illness £47m • Total economic cost 2007-08 £350m • Indirect Costs of overweight and obesity estimated to be £7.4 billion Health Communication Message Review Criteria The Health Communication Unit at the Centre of Health Promotion University of Toronto, November 2002

  3. Caused - Health Related Behaviours FatStores

  4. Weight Management - across the life course Prevention Intervention Maintenance

  5. Prevention – increasing awareness • An annual budget of  £2 million to implement the 1998-2002 Physical Activity Strategy • DHSSPS - IFH Partnerships and HAZs from 2002-03 to 2008-09 of £23.55 million • DHSSPS - £750 000 annually to supporting the delivery of the Fit Futures plan since 2007 • DHSSPS - £1 million per year to support physical activity, nutrition and healthy schools programmes • Budget for disease prevention and health improvement increasing by 36% since 2005/06 from £38.1 to £47.1million • The current Programme for Government allocates £7.2 million over 3 years to tackle obesity / implement the Fitter Future for All framework

  6. Despite our efforts •  6 in 10 adults do not engage in the recommended level of physical activity (30 minutes of exercise 5 days a week) •  8 in 10 adults eat less than 5 portions of fruit & vegetables a day Are these the right markers for weight management?? (Sources: Northern Ireland Continuous Household Study 2005 – 2010;

  7. Scale of the problem • In Northern Ireland levels of obesity are rising quickly. Since 1994 obesity has increased by 75% in men and 41% in women (Source: BHF UK coronary heart disease statistics 2009-10) • It is no longer the norm to be a healthy weight:  6 in 10 adults have a weight problem (63%)  1 in 4 are obese (89,000 / 26%) > 1 in 3 are overweight (216,000 / 37%) (Source: Health and Wellbeing Survey 2005/06)

  8. What does the future generation here look like? • 3.8% of P1 children 1997/98 were obese,13% overweight (17%) • 5.3% of P1 children 2007/08 were obese,17.2% overweight (22.5%) • 21% of Year 8 children measured in 2010/11 were obese (n  500) (Source: http://www.ninis.nisra.gov.uk/mapxtreme/DataCatalogue.asp?button=Health; Child Health System)

  9. Impact of Public Health Messages • Interpret & apply according to own health and wellbeing • Perception of stigma • Focus on physical rather than emotional health consequences • Stigma & blame attached to the simplicity of messages • Lack of realistic solutions • Lack of recognition around the complexity the issue • Need to encourage healthier behaviours for all size individuals (Source Lewis et al. “I don’t eat a hamburger and large chips every day!” A qualitative study of the impact of public health messages about obesity on obese adults, 2010)

  10. Intervention - obesity often viewed as personal failure ……….. Mrs Dympna Pearson Behaviour Change Training (BCT)

  11. Attitudes towards obesity Research shows that: Society is very judgemental towards overweight & obese people Healthcare professionals tend to be even more judgemental than the rest of society (WHO 2000) Mrs Dympna Pearson Behaviour Change Training (BCT)

  12. Healthcare Professionals • Many HCPs express frustration with: • Non-compliant patients • Patients who are less than truthful • Patients who are not motivated • Patients who expect a magic wand • Those who won’t take responsibility • Lack of time, the system… Mrs Dympna Pearson Behaviour Change Training (BCT)

  13. Traditional Advice giving Patients becomes passive Patient becomes a recipient to expert knowledge Usually combined with persuasion Reduces patient autonomy Generates resistance Mrs Dympna Pearson Behaviour Change Training (BCT)

  14. Providing Information Has a place but….evidence clearly shows that giving knowledge alone does not necessarily lead to a change in behaviour (Glanz 1985, Contento 1995, Roe 1997, Thorogood 2001) Mrs Dympna Pearson Behaviour Change Training (BCT)

  15. Individual level What influences change? ‘If you are told what to do, there is a good chance that you will do the opposite!’ (Miller & Rollnick 2002) Mrs Dympna Pearson Behaviour Change Training (BCT)

  16. Maintenance • Rarely considered – are we setting clients up to fail?

  17. Caused - Health Related Behaviours FatStores

  18. Behaviour Change There is overwhelming evidence that changing people’s health-related behaviour can have a major impact on some of the largest causes of mortality and morbidity. NICE (2007) Mrs Dympna Pearson Behaviour Change Training (BCT)

  19. Behavioural Approach The main principles of this approach include the modification of current behaviour patterns, new adaptive learning, problem solving and a collaborative relationship between client and therapist (HDA 2003) Mrs Dympna Pearson Behaviour Change Training (BCT)

  20. A behavioural model Mrs Dympna Pearson Behaviour Change Training (BCT)

  21. What is Motivate • Motivate is a behavioural approach to weight management developed in response to the pressing need for an effective weight reduction services • Uses evidence-based practice delivered by specifically trained professionals. • Performance subject to independent audit and review • Program delivered under the auspices of the Managed Obesity Network in the NHSCT • Consists of a 6-month program combining 1 to 1 and group sessions • Measures effectiveness using biochemical, clinical, and psychological indices of patient benefit

  22. Maintenance & Sustainability Large scale studies have shown that a behavioural approach is effective in achieving weight loss however sustaining weight loss has proven more difficult Motivate offers follow up after intensive intervention Motivate clients - preliminary results 12 months after completion 6kg weight loss is sustained NICE (CG43 2006) recommends that maintenance is a distinct yet central part of weight management http://www.nwcr.ws/

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