Obesity poses a major public health challenge. It increases the risk of heart attacks, stroke, Type 2 diabetes, high blood pressure, high blood cholesterol and some cancers.
Sydney's North Shore Cardiovascular Education Centre has joined forces with the Royal North Shore Diabetes Education Centre to develop a pilot program of weight management for patients with heart disease and diabetes. This work is supported by the North Shore Heart Research Foundation.
Obesity, diabetes and heart disease
The increase in obesity and diabetes among Australians has been referred to as the ‘cardio-diabesity' epidemic. The Baker Heart and Diabetes Research Institute has reported that 4 million Australians (26% of the adult population) are obese.
Around 275 adults develop diabetes every day, according to the Australian Diabetes, Obesity and Lifestyle study (AusDiab). Over two-thirds of all cardiovascular disease deaths in the study occurred in people with diabetes or a family history of diabetes.
Weight problems in heart patients
Weight management is the current focus for the Cardiovascular Education Centre.
For several years the Centre has offered exercise and rehabilitation to heart patients. The program is very successful, and nationally recognised. So far it has been effective at improving all risk factors except one: obesity.
‘About 70% of those entering our program are overweight or obese, and yet 68% remain so at completion – this reflects national figures,' says Clinical Nurse Consultant, Ann Kirkness. ‘We also know that 85 to 90% of patients with Type 2 diabetes are overweight.'
Weight is now the next point of focus for the Centre.
Moderate weight loss reduces risks
Evidence suggests that overweight people with diabetes and heart disease gain significant benefits from major changes in their lifestyle, combined with moderate weight loss.
Research shows that the best long-term outcome is the result of diet, exercise and behavioural changes, backed up by ongoing support.
The weight management program
The pilot program was developed by Ann Kirkness and her colleagues within the NSCEC and the Diabetes Education Centre. The aim of the program was to achieve 5¬–10% weight loss over 12 months, and to increase levels of physical activity.
There were 24 participants in the first study. They received practical insight into healthy eating, and exercise programs tailored to their needs and abilities. After an assessment, patients participated in four education sessions and a minimum of 20 exercise sessions, at the physiotherapy gym at Royal North Shore Hospital. Education sessions covered the health risks associated with being overweight, diet and exercise – with a focus on weight management.
Staff then helped patients to explore and identify realistic goals and potential barriers. The next step was to develop skills to achieve and sustain these lifestyle changes.
Participants had follow-up assessments every four months, with the option for ongoing support.
Results
Results to date have been encouraging. Participants achieved statistically significant reductions in weight and waist circumference, and increases in physical activity levels.
The program has been revised and strengthened, based on the pilot study and feedback from the participants. The project involves a collaborative team from the NSCEC, the Diabetes Education Centre and Faculty of Nursing. Midwifery and Health, UTS. The team have now begun the next stage - a randomised controlled trial. The ‘Healthy Eating, Exercise Lifestyle Program’ (HEELP), has been designed for people with a history of either heart disease or diabetes The trial began in January 2009 and recruitment is due to be completed in August 2011. Results will be published once trial data is analysed.
