Friday, 12 June 2015

Change


I'm currently co-leading a nutrition pilot project at our clinic. Eight employees have voluntarily joined our pilot, graciously willing to overhaul their approach to food and change what they are eating. There are a variety of goals within the group. Some people want to lose weight. Some want to lose body fat. Others are interested in reducing inflammation and joint pain. Many want to have more energy and to feel good. Most are interested in "being healthy" and reducing their risk of diseases like diabetes, heart disease and cancers. 

Regardless of the different goals, the intervention is essentially the same. We guide people to consistently eat whole foods in the right amounts at the right time. This includes the elimination of almost all processed food as well as added sugar. We tweak the macronutrient balance and specifics to individual need and response. 

Our project is founded on Precision Nutrition principals, an evidence-based program written by experts in both nutrition and fitness (click here to see Precision Nutrition). No need to reinvent the wheel - the details of what to eat are provided by the PhDs in nutrition. We supply participants with the help to make changes in their routines until they have established new, healthier habits so they can fuel their bodies and their lives with nutritious food. 

We are almost at the end of the initial twelve week pilot and already our heads are reeling. I can tell you that at the half way mark we were already measuring some astonishing outcomes. People lost weight, reduced girth, dropped body fat, gained energy, reduced or eliminated joint pain, decreased blood pressure readings and so much more. Everyone looks different. They have energy. They smile more. Their skin glows. 

But what really makes our heads spin is that every single person in this group has embraced change. And we truly weren't sure if that was going to happen. Weeks before the pilot started as we wrote the lessons and devised the program plan we would ask each other "is this going to work?" Although Precision Nutrition writes nutrition programming for lots of people, their background is working with athletes and active people. Sports nutrition. We needed to make sure that our program could work for everyday folks living in Trent Hills.  

Our pilot group are fairly diverse. Ages range from low thirties to mid sixties. People are at various stages of parenting and work in different roles and professions. Some people live alone others live with large young families. More importantly, within the group there is a fairly typical plethora of ongoing challenges: illness or death in the family, personal health issues, marriage/separation/divorce, work changes, financial issues, moving, and plain old busy-run-off-your-feet issues. 

We anticipated problems. We thought that people would struggle. We were prepared for rebellion. But to a person this group have fundamentally changed how they are eating and living and done so with grace and humour. They are remarkably positive and very supportive of each other. They ask for help and figure out solutions and have remained committed throughout the program. 

So what we've learnt so far in this pilot is that the capacity for change is present in a lot of people. Our group are more than capable. If given the right support and facilitation they seem to be downright excited to make change. We could be on to something here. 

And this is contrary to what we expect in health care. You hear many many practitioners, myself included, lament that we cannot get people to change their behaviour. We're drowning in a tsunami of lifestyle disease, much of which could be staunched if we could only get people to change what they eat, to exercise, to quit smoking, and to reduce alcohol consumption. 

But here's the thing - in primary health care we suck at helping people to change their behaviour. In the 7 to 12 minutes that we spend with patients we blurt out that they should "eat better" "lose weight" "consider exercise" but we don't tell them HOW to do that. And that's mostly because we don't know. We rarely have advice on how to change behaviour and in many cases we don't know specifically what changes to make. It's no secret that primary health care providers get little to no training on topics like nutrition and generally we aren't skilled at behavioural change. Our "system" of health care sure doesn't help when we need to see 20 to 45 patients a day just to keep things rolling. 

We must change our approach in health care. We must learn how to help people change their behaviours. We must partner with people outside of our professions and outside of the traditional health care sector who are good at this type of work. We must collaborate with people who are knowledgeable in the sciences like nutrition as well as those who are skilled in the art of understanding people and how to help them change. 

In Ontario these days there is a lot of discussion about chronic disease management programs. Family Health Teams are mandated to offer them.  Local Health Integration Networks (LHINs) develop them. Various agencies and organizations in the system provide them. Is it working? I honestly don't know. Programs seems to be geared at monitoring diagnosed disease and providing health information. And that's good. But if knowledge transfer alone worked we'd all be slim, active, non-smokers and chronic disease would be a theoretical concept. We don't just need education - we need motivation and facilitation. More to the point we need expertise in prevention.  How about helping people to avoid getting diabetes, heart disease and COPD in the first place? 

I'm fortunate enough to work with a team who value prevention and are open to experimentation and innovation (inflicting vegetables on people shouldn't be that scary but it is!). I'm grateful for the nutrition experts and personal trainers that I have worked with and learned from to develop some expertise in this field. And I'm truly thankful for that group of women at my clinic who have been willing to work with us and try this pilot project out. 

I'm hopeful that we will be able to report some impressive data at the end of the pilots. If all goes well there will be sufficient evidence to support ongoing programming of this nature. We would like to be able to offer this kind of service to our patients and truly make prevention part of the primary health care service that we provide. I promise to keep you posted. 

Thanks for reading Getting Healthy With NP Sam. Comments welcome - please click the pencil icon below. 

1 comment:

Pat Davis said...

Well done. Exciting results! Think about schools. . . .captive audience & surprisingly receptive. Come on Ontario, get smart.