TRIM LIFESTYLE
PROGRAM
Lynchburg Family Medicine
Residency
Dr Stacey Hinderliter, Dr Jennifer Cunningham, Dr Shital Patel
TRIM-Training Residents in
Modifying- Lifestyle
► Childhood
obesity project at LFM residency
to identify and treat overweight or obese
children
► Children above the 85th percentile for BMI
are offered enrollment
► Partly funded by AAFP AIM HI
Objectives
► Identify
overweight and obese children:
 Measure height and calculate BMI at all office
visits not just preventive visits
► Educate
Lifestyle
families about 5-3-2-1-0 Healthy
 Visit Powerpoint and Healthy Lifestyle notebook
► Educate
residents about obesity prevention
and treatment
 Resident involvement in program development
 Resident training and evaluation
►6
monthly office visits
with the patient’s
primary care physician
► Primary care physician
provides intensive
individual family
education and
counseling
►
►
►
Each visit was created by
resident/faculty teams
Residents trained and
tested as each visit was
developed
Each visit incorporates one
step of the 5-3-2-1-0
Healthy Lifestyle
► Families
were encouraged to keep track of the
changes they made in Healthy Lifestyle notebook
► Incentives were provided at each office visit to
encourage patients to complete the program
5-3-2-1-0 Healthy Lifestyle
►•
5 servings of fruits and vegetables daily
►•
3 healthy meals a day: home-cooking
►•
2 hours or less of screen time: TV, computer,
video games
►•
1 hour physical activity: sweat
►•
0 or almost 0 drinks containing sugar
www.dukehealth.org : 5-3-2-1-almost none healthy lifestyle
Visit 1-Zero Sugary Drinks
► How
to read labels
► Other names for sugar
► Healthy servings
► Water bottle
► Sugar free drink mix
► Sugar free drink ideas
1 Hour of Physical Activity
Visit 2-
•One hour can broken up into small bits
•Weight lifting of 1-2 pounds OK for
children
•Don’t have to be on a team
•Pedometer: 2000 steps = 1 mile
•Soft balls
5 Servings of Fruits &
Visit 3-
Vegetables
•Whole fruits and vegetables vs juice
•Fiber in the diet
•How to get fruits and veggies into meals and
snacks
•My Plate-fill ½ plate with fruit/veggies
•$5 grocery gift card and recipes
TWO HOURS of
SCREEN TIME
Visit 4-
•What is a screen?
•No TV in child’s bedroom or during meals
•Effects of TV on BMI, attention and behavior
problems
•BMI higher from watching TV vs reading a book
•Cards, jump ropes, frisbees, games etc.
Visit 5-
3 Healthy Meals a Day:
Home Cooking
•Benefits of healthy meals
•Review of My Plate-Protein, Grains and
Starches
•Eyeballing healthy portions
•Involve child in grocery shopping and
meal preparation
•$10 grocery gift card, measuring cup,
recipes
Visit 6- Let’s Review
5-3-2-1-0 Healthy Lifestyle
Changes made by family based on each
step of Healthy Lifestyle
► Review reading food labels
► Reinforcement of My Plate and eyeballing
portions
► Gift certificate for children’s museum,
skating, or bowling
►
Motivational
Interviewing
How to get your patient to want
to do what you want them to do
Definition
► Patient
centered directive method for
enhancing intrinsic motivation to change by
exploring and resolving ambivalence
► Miller WR, Rollnick S. Motivational
Interviewing: Preparing People for Change
2nd edition, New York: Guilford Press, 2002
Four Guiding Principles
RULE
►Resist
arguing and persuasion
►Understand your patient's
motivation
►Listen to your patient
►Empower your patient
What it is not
► Not
arguing
► Not offering advice without the patient's
permission
► Not doing most of the talking
► Not giving a “prescription”
How to do it
► Establish
rapport
► Set an agenda
► Get permission
► Ask open-ended questions
► Use reflective listening
How long does it take a physician to
interrupt a patient?
ABOUT 15 SECONDS!
More tools
► Consider
pros and cons
► Determine degree of interest and
confidence
► Provide a menu of choices
► Provide information, let patient interpret
it
► Summarize and close the deal
Pros and cons
► What’s
good about_______?
► What might happen if you don’t change
________?
► How would changing_______ affect your
family?
► What’s bad about_________?
Giving information
► Ask
permission-May I tell you about
_____?
► Provide nothing but the facts- Being
overweight can cause_______.
► Let patient interpret it- What does this
mean to you?
Can you make a change?
Limit sugary drinks to
1-2 times a day
► Use 1% or fat free milk
► Drink more water- can
try flavored water or
sugar free drink mix.
►
On a scale of 1-10:
► How interested are you
in making a change?
► How confident are you
that you can make a
change?
► Why did you choose a
low number?
► What would it take to
choose a higher
number?
Can you make a change?
Be active everyday
► Be active for 1 hour a
day
► Split activity into
smaller parts:
►
 30 minutes twice a day
 15 minutes 4 times a
day
►
Be active as a family 12 times a week
On a scale of 1-10:
► How interested are you
in making a change?
► How confident are you
that you can make a
change?
► Why did you choose a
low number?
► What would it take to
choose a higher
number?
Can you make a change?
Offer fruits and
vegetables at snack time
► Fill ½ your plate with
fruits and vegetables at
meals
► Try new fruits and
vegetables
► Limit juice to once a day
►
On a scale of 1-10:
► How interested are you
in making a change?
► How confident are you
that you can make a
change?
► Why did you choose a
low number?
► What would it take to
choose a higher
number?
TRIM Lifestyle results
111 overweight and obese
children
TRIM Lifestyle Results
TRIM Lifestyle Results
BMI changes in TRIM graduates
TRIM Lifestyle Users
TRIM Lifestyle Future
► Option
of Mini-program-3 visits
 Family can choose what works best for them
► Improve
training for each new resident
class
► More focus on Motivational Interview
Methods
► Community Outreach
Any questions?