Fit Food

Introduction

Fit Food is a 6-week weight management pilot programme that was delivered in two leisure centres, one in Fermanagh and one in Omagh, using a lifestyle approach. Community dieticians facilitated the course, with weekly input from fitness staff.

The Community Dieticians in Sperrin Lakeland Trust initiated this pilot programme to reduce the obesity waiting lists in the district. With Chief Dietician support a pilot programme was developed which ran January – March 2003 which was constructed using the SIGN (Scottish Intercollegiate Guidelines Network) guidelines, a holistic approach to weight management, addressing nutritional, behavioural and lifestyle factors.

The Community Dieticians sought the use of the Lakeland Forum, Enniskillen and Omagh Leisure Centre from the District Councils as venues for the ‘Fit Food’ programme whilst the NHS Trust Waiting List Initiative funded the pilot project with £2400. There are plans to incorporate the ‘Fit Food’ programme into a local community obesity clinic in Fermanagh from 2004, as part of the community dietician’s and fitness instructor’s role.

The ‘Fit Food’ project dovetails with the Physical Activity Strategy for Northern Ireland issued by the Department of Health for Northern Ireland which highlights the importance of physical activity and health.

Partners

The partners involved in the project are:

Fermanagh and Omagh District Councils
Sperrin Lakeland Health and Social Care Trust.

Aims & Objectives

The ‘Fit Food’ programme aims to:

‘Treat obesity as a lifestyle condition and focuses on how to make changes to daily food and activity habits that will encourage weight loss’.

The specific learning objectives for the programme are to:

increase awareness and knowledge about the components of a healthy diet
understand the benefits of physical activity
find a suitable activity or exercise
identify barriers to changing food and activity behaviour
obtain support and motivation.

Target audience

Sperrin Lakeland Health and Social Care Trust covers a scattered population of 119,869 people and has one of the highest incidence of coronary heart disease in Northern Ireland. County Fermanagh is also host to the highest incidence of unfit housing in Northern Ireland.

The target audience for the programme were obese men and women on the current dietetic waiting list within the Fermanagh and Omagh districts. They had all been referred by a medical practitioner and had a Body Mass Index (BMI) of over 30. Most had co-morbidities such as hypertension, hyperlipidaemia or type 2 diabetes.

Patients with a psychiatric history were excluded, as were those with severe arthritis, or wheelchair-bound.

The Fermanagh and Omagh residents who met the criteria were sent a letter inviting them to attend the programme, to which 19 responded positively. No specific needs assessment was carried out with the target group prior to commencement but participants were invited to an introductory evening at the leisure centres to discuss the aims and style of the programme.

Methodology

The ‘Fit Food’ Weight Management Programme was piloted in two venues – the Lakeland Forum, Enniskillen and Omagh Leisure Centre during February and March 2003. The course ran for six weeks and was offered free of charge.

The programme was designed around four components using SIGN guidelines:

dietary change
behaviour modification
physical activity
support.

A health check questionnaire was used at the initial session (using the PARQ i.e. Physical Activity Rating Questionnaire) to assess activity/mobility. Each session lasted one and a half hours. The first hour was topic/discussion based, with the fitness instructor facilitating the last half hour. Participants were encouraged to keep a food diary and identify areas of change in their own diet to help them take responsibility for their own diet and any dietary change. Sessions were interactive and informal.

Barriers

The main barrier from the dietician’s perspective was their time to be able to run the course as they had initially to find additional hours to run the pilot programme. Integration of the Fit Food course into the community dieticians' remit is planned as part of a community obesity clinic.

The fitness instructors felt that the timing of the sessions was critical and that sessions during the day when the leisure centres are quieter and may be a less intimidating environment for this type of group who are ‘exercise adverse’.

The challenge for Centre fitness staff was to break down the negative perceptions the group had about exercise. They achieved this by assessing their needs and demonstrating how accessible physical activity was to each of them.

Evaluation

Both qualitative and quantitative data has been collected.

Quantitative:

height, weight and BMI
waist and hip measurements

Qualitative:

evaluation of participant satisfaction with the programme
food and activity behaviour change

Sustainability/future plans

There are plans to incorporate the ‘Fit Food’ programme into a community obesity clinic during 2004 in Fermanagh. Patients referred by a medical practitioner for obesity management will be invited for an initial one-to-one assessment with the dietician.

They will then be offered three choices:

six sessions with a dietician
a place on a Fit Food programme
a prescriptive ‘diet sheet’ with no further follow-up.

The results of these three approaches will be collated and audited by the Audit Department at the Sperrin Lakeland Trust to identify which approach is most effective in managing obesity in the district. The Manager at Lakeland Forum and his staff are keen to expand programmes tailored to vulnerable groups to ensure that these clients can realise the benefits of exercise to their condition.

Lessons Learnt

Be clear about the criteria for inclusion in the ‘Fit Food’ programme to ensure clients gain maximum benefit from attending. Identify and involve the fitness staff at the outset to ensure continuity, ownership and commitment to the programme.

Build in a plan for on-going support beyond the 6-12 weeks of the course. For example, offer continued support via optional "weigh-ins" on a regular basis. Consideration also needs to be given to the continued physical activity support after the course.

Consider training other health care professionals to run the nutrition elements of the course. The participants valued the dietetic input but as dieticians are a limited resource it may be a more effective use of their time to cascade the programme. Regular nutrition updates and input from the dieticians would be built in to this training.

Carry out needs assessments before embarking on the Fit Food’ programme to establish expectations, session timing preferences and gender mixed of group. Standardise resources used in the programme and develop a more professional approach (powerpoint materials etc) which would give the course a broader appeal to other departments and local authorities.

Ensure integration of the programme into a local obesity strategy.

Lead contact:

Contact: Gillian Browne,
Job Title:Community Dietician,
Address:
Sperrin Health and Social Care Trust,
Erne Health Village,
Erne Road,
Enniskillen,
BT74 6NN.
Tel: 028 6634 2444.

Email: GBrown@slt.n-i.nhs.uk

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