Small Changes

An article by Trevor Simper* and David Johnson**, co-directors of Small Changes (healthcare) Ltd., a social enterprise which focuses on working with overweight and obese adults.

*Trevor Simper is a nutrition/exercise academic at Sheffield Hallam University.

**David Johnson is a consultant in business development.

The Small Changes programme was conceived to assist the obese or “at risk” sections of the population achieve significant, sustainable weight loss whilst addressing and improving other aspects of their lives. It has been delivered as a research project for the past 3 years at Sheffield Hallam University.

The NICE guidelines make clear that NHS supported interventions should promote balanced diet (as per the eatwell plate), promote physical activity as part of the programme and as per the DOH (2004) guidelines, focus on sustainability and help clients make realistic weight loss (0.5-1.0kg per week), which is what the Small Changes programme has achieved. The research produced at Sheffield Hallam, so far (see references) focuses on the short-term (3 month and 6 month) findings and is soon to be followed by a post one-year follow-up study.

Whilst it is useful to assess and record impressive changes to anthropometry: blood lipids, waist size etc we by no means follow the philosophy that this is 'job done'. Making change relatively permanent by achieving 5-10% body weight loss and sustaining this post one-year is what the programme desires. 5-10% weight loss in an overweight obese person is achievable and sustainable. The programme works with sensible evidence based practice, without the promotion or sale ofdiet products or specific diet aids.

The current programme is 12 weeks long. The continual delivery of 12-week programmes is attractive;some quick results have been achieved, large throughput of people and hence impressive numbers of people treated. 12 weeks, however, is not long enough. We are not alone in this view. Perri et al looked at this in a variety of studies in the 1980's and 1990’s and found a clear relationship between length of intervention and it’s impact. These were large-scale methodologically sound studies. We strongly advocate the funding and delivery of one-year weight management programmes? The director of the Dutch obesity clinic (Gerrhit Van De Groot) has also discussed the programme he oversees in Holland which treats for two years, achieving sustained weight loss in over two thirds of the participants.

During the 3 years of the research work carried out at SHU, participants have achieved:

  • A greater sense of wellbeing (Simper et al 2008) *
  • Sustained reductions in energy intake (Simper, O'Keeffe 2009) *
  • Maintenance of weight loss (Simper, O'Keeffe 2009) *

The research programme has done what the literature and guidelines suggested we should: combine behaviour change techniques with advice/education on nutrition and physical activity. We combine skills around nutrition, physical activity and behaviour by having professionals from each of these disciplines involved in the programme and its continuing development. ‘Treatment’ reasonably cannot go on for ever but building up sustainability and self-sufficiency in continuing a healthier lifestyle extends beyond our current 12 week programme. The evidence clearly indicates an increased success rate when delivered over at least 12 months. Our proposed one-year programme will help us deliver significant success in achieving the goal of sustainable weight loss and lifestyle improvement for obese and “at risk” sections of the community.

References

Department of Health (2004) At least five a week - evidence on the impact of physical activity and its relationship to health - a report from the Chief Medical Officer London Department of Health

Harden, CJ. O'Keeffe, J, Paxman JR & T Simper (2008) 'Small Changes' a behavioural change intervention for weight management (POSTER). Tackling Child and Adult Obesity in Sheffield: Evidence, Policy and Practice.

National Audit Office (2001) Tackling Obesity in England London The Stationary Office

Paxman, J O'Keeffe, J Harden CJ & Simper T (2008) Micronutrient intake significantly alters when energy intake is reduced following the 12-week 'Small Changes' intervention for weight management (POSTER). Tackling Child and Adult Obesity in Sheffield: Evidence, Policy and Practice.

Perri et al (1984) Effects of a Multicomponent Program on Long-Term Weight Loss Journal Of Consulting and Clinical Psychology vol 52, No 3, 480-481

Perri et al (1988) Effects of Group Versus Home-Based Exercise in the Treatment of Obesity Journal Of Consulting and Clinical Psychology Vol 65, No 2, 278-285

Perri et al (1997) Effects of Four Maintenance Programs on The Long-Term Management of Obesity Journal Of Consulting and Clinical Psychology Vol 56, No 4, 529-534

Simper, T Harden,CJ Paxman JR & O'Keeffe J (2008) Energy intake is significantly reduced following the 12-week 'Small Changes' intervention for weight management (POSTER). Tackling Child and Adult Obesity in Sheffield: Evidence, Policy and Practice.

Simper, T1, Paxman1, J. O'Keeffe, J2 (2008) Small-group weight management programme using self selected goals improves General Well Being scores. International Journal of Obesity, May S230

Simper, T1. O'Keeffe, J1,2. (2009) Reduced energy intake and maintained loss of weight is observed at 6 months follow up of the 'Small Changes Programme' European Journal of Obesity May Vol2,S2 p228.

If you would like further information please contact either Trevor Simper on or David Johnson on