CHANGE Your Nutrition Toolkit: Practical Tools for Making ...€¦ · Dr. Paula Brauer, University of Guelph Registered dietitian and epidemiologist, Dept of Family Relations and

CHANGE Your Nutrition

Toolkit:

Practical Tools for Making

Meaningful Dietary Changes

September 12, 2019

Presented by: Rupinder Dhaliwal, RD, FDC Carolyn Marie Tereszkowski, RD, MSc

Nutrition Connections is a centre for nutrition knowledge and collaboration. We support health professionals, community organizations, educators, researchers, and others working in food and nutrition to build capacity, connect, and share information.

• Operating under the Ontario Public Health Association since 1999

• Formerly funded by Ontario’s Ministry of Health and Long-Term Care

• Supported in part by the Helderleigh Foundation

Speaker Bios

Rupinder Dhaliwal, RD, FDC As Director of Operations of Metabolic Syndrome Canada, Rupinder Dhaliwal is currently leading the expansion of a team-based diet and exercise intervention, the CHANGE program, in primary care clinics across Canada.

Her past accomplishments include playing a key role in the development of Clinical Practice Guidelines for Critical Care nutrition, implementation of several multicenter nutrition studies, authorship of scientific publications, presenting at many national and international conferences and being an evidence analyst for PEN.

In 2016, she was awarded “Fellow of Dietitians of Canada” and in 2019 the “Allied Health Award” by the Canadian Nutrition Society. Rupinder has been a member of the Board of Directors of the Canadian Nutrition Society since 2017.

Declaration of Conflicts of Interest: Rupinder is an employee of Metabolic Syndrome Canada, the non- profit organization that created the CHANGE Program

Speaker Bios

Carolyn Marie Tereszkowski, RD, MSc

Carolyn is a registered dietitian with the Loyalist Family Health Team and lead of the CHANGE program at this site near Kingston, Ontario. She also works with Metabolic Syndrome Canada as a primary care consultant to support ongoing development and expansion of the CHANGE program to other primary care clinics across Canada. Although empowering individuals to make lifestyle change through primary care is her passion; her background also includes clinical dietetics at Grand River Hospital in Kitchener, population health and project management experience as a Public Health Nutritionist with the Region of Waterloo, as well as a research background and several scientific publications stemming from a Master of Science in Applied Human Nutrition from the University of Guelph.

Declaration of Conflicts of Interest:

Carolyn assists Metabolic Syndrome Canada with the development and dissemination of resources and provides occasional training and support to RDs delivering CHANGE across Canada. She is remunerated for this consulting work by Metabolic Syndrome Canada.

Outline for today’s webinar

Overview of the CHANGE diet and exercise program

Review implementation in clinics across Canada

Background on development of the NU-CHANGE toolkit

NUtrition toolkit for CHANGE

Showcase of NU-CHANGE toolkit components

Sneak peek of additional resources available to clinics for implementing the CHANGE program

Proud sponsor

CHANGE diet and exercise program Overview

Based on the best evidence from diet and exercise research, the CHANGE Program is a unique lifestyle intervention program created by leading health professionals at Metabolic Syndrome Canada www.metsc.ca

GOALS

1. provide family health clinics with the tools they need to offer effective, lasting lifestyle intervention to patients with metabolic syndrome

2. improve components of metabolic syndrome, diet quality and physical activity levels

3. empower participants to make long-term changes for overall well-being of patients

Is a not-for-profit organization, founded in 2011, created the CHANGE Program

www.metsc.ca

Mission

To improve the long-term health of Canadians through effective diet and exercise lifestyle intervention

How?

Through the widespread dissemination and implementation of their C.H.A.N.G.E. Program aimed at reversing metabolic syndrome, thereby reducing risk of developing chronic diseases

www.metsc.ca or www.metabolicsyndromecanada.ca

What is Metabolic Syndrome?

When 3 of these are present:

• High blood pressure (≥ 130/85 mm Hg, or receiving medication)

• High blood glucose levels (≥ 5.6 mmol/L, or receiving medication)

• High triglycerides (≥ 1.7 mmol/L, or receiving medication)

• Low HDL-Cholesterol (< 1.0 mmol/L in men or < 1.3 mmol/L in women)

• Large waist circumference (≥ 94 cm in men, ≥ 80 cm in women; ranges vary according to ethnicity)

www.metabolicsyndromecanada.ca

Why Metabolic Syndrome? …is a health crisis hiding in plain sight

According to a 2014 study published in Chronic Diseases and Injuries in Canada (Rao at al, 2014), 19.1% of all Canadian adults — nearly 1 in 5 people — have Metabolic Syndrome (Natalie et al. CMAJ, 2011)

11

Can be NP/delegate

Kinesiologist or physio/OT/Other

Why is CHANGE so different?

6 Keys to Success

What makes the CHANGE Program effective?

Family Doctor A team approach

Personalized diet-exercise plan

Gradual intervention

Close follow-up over 12 months

Flexible to meet different needs

Evidence from CHANGE Program

The CHANGE Program:

• is feasible in a Primary Care setting

• resulted in a reversal in MetS in 19% patients by month 12

• reduced the components of MetS in 42% patients by month 12 (regardless of wt. loss)

• reduced the 10-year risk of CVD

– Risk reduction was highest in those with high risk score at baseline

Jeejeebhoy et al CMAJ Open March 2017 http://cmajopen.ca/content/5/1/E229.full

CHANGE Patient Experiences

CHANGE across Canada Clinic Implementation

2017-present Loyalist FHT

Walkerton FHT Northumberland FHT

2018-present North Peel FHT

Wise Elephant FHT Queen Square FHT

Central Brampton FHT Halton Hills FHT Haliburton FHT Haldimand FHT

~300 patients

CHANGE Implementation

www.changealberta.net www.changebc.net

CHANGE Implementation in ON

Halton Peel expansion funded by

CHANGE Partnerships created

Local gyms Quebec Breast Cancer Foundation

Communities of Practice

CHANGE Program Evaluation

Compared to baseline, at 3 months and 12 months

reversal of metabolic syndrome (defined as less than 3/5 criteria)

changes in metabolic syndrome components

• BP, BS, HDL-C, Trigs, Waist Circumference, Weight

• Medications: blood glucose lowering, lipid and antihypertensives/diuretics

changes in predicted cardiovascular risk according to the PROCAM risk score (Assmann G et al Circulation. 2002 Jan 22;105(3):310)

changes in diet (med diet score)

changes in quantity and quality of fitness levels

patient experiences (www.metsc.ca)

CHANGE: Diet Quality changes

2.1 2.2

2.3

2.9

0

0.5

1

1.5

2

2.5

3

3.5

3 monthsCMAJ Open 2017

12 monthsCMAJ Open 2017

3 monthsON FHTs

12 monthsON FHTs

Increase in Mediterranean Diet Score points compared to baseline

ON FHT: Based on data as of August 2019 and will evolve as more patients added to program

CHANGE: Physical Activity Levels

Based on data as of July 2019 and will evolve as more patients added to program

Development of NU-CHANGE Nutrition Toolkit for CHANGE

Dr. Paula Brauer, University of Guelph

Registered dietitian and epidemiologist, Dept of Family Relations and Applied Nutrition University of Guelph

Work includes obesity services in team-based primary care. She is currently focusing on studies to manage metabolic syndrome and promote vegetable consumption using nudge approaches.

Has been active in promoting primary health care reform in Ontario and was a member of the Canadian Task Force on Preventive Health Care 2010-15.

A pioneer in primary care dietetics in Canada, she advised the Singapore Ministry of Health on their allied health services in primary care.

• Integral part of the NU-CHANGE Team

• Led the preliminary work

• Development of the Dietary Care Map

• MetSC Component Factsheets

Dr. Paula Brauer, PhD, RD, FDC

Why a toolkit needed?

Most CHANGE participants • Middle-aged, live alone or with 1 other person

• May or may not have cooking skills

• Cooking for a reason; not really for fun

• Willing to make some changes for health

• More interested in convenience, taste

• Do not seek variety

• Like more “traditional” foods that are familiar

Gaps in resources identified

• basic cooking skills

• use of familiar pre-prepared foods

• those that have a hard time following existing recipes

• affordable ($3-$10 per portion) recipes

• quick and easy Canadianized versions of Mediterranean style recipes (prep time of < 30 minutes)

NU-CHANGE: Nutrition Toolkit for CHANGE

Goal To create an innovative NUtrition Toolkit for the CHANGE Program which includes: Recipes Videos Online repository of resources Training of Registered Dietitians (RDs) Participant usability testing

Desired Outcomes

To support the adoption of diet principles for treating Metabolic Syndrome

To provide both public resources to help the public and dietitians not involved in CHANGE, as well as private resources for those involved in implementing the CHANGE program

Preliminary Work

1. Preliminary Work: Student thesis projects at the University of Guelph

• Literature search on use of videos in nutrition counselling

• Key informant interviews with CHANGE dietitians on resource needs

2. Recipe Development: Collaboration with the Food Innovation and Research Studio (FIRSt) at George Brown College (GBC)

• Recipe and video development by GBC

• Review, selection, and tasting of recipes by registered dietitians

• Usability testing of videos by registered dietitians with CHANGE participants

Testing and Feedback

3. Final Video Development by GBC

• Feedback from CHANGE participants incorporated

• Eight recipe videos finalized and posted to YouTube

4. Online Resource Repository

• Review of existing CHANGE resources

• Feedback gathering from registered dietitians in the CHANGE program

• Dietitians of Canada evidence-based pathways (PEN) review to ensure resources reflect most current evidence

NU-CHANGE Resources

Public Resources Eating the Mediterranean Way

Practical tool for adopting lifestyle change

Breaks behavior down into actionable goals

• Things to try to do every week

• Things to try to do every day

Checklist format encourages gradual lifestyle change

• Pick one or two strategies to work on

• Monitor progress by reviewing checklist

• Set new goals

Why the Mediterranean Dietary Pattern?

• A traditional dietary pattern

• Includes a variety of whole foods rich in nutrients, fibre, and healthy fats

• More plant-based foods, fish, fruits and vegetables

• Limited processed/packaged foods

• Evidence for the Medi Dietary Pattern from the PREDIMED study

• Prevent and help manage chronic conditions such as:

• Diabetes

• Heart disease and stroke

• High blood pressure

• Dementia

• Aligns with other whole foods approaches (Canada’s Food Guide)

• Easier for people to adapt to and stick with – not weight loss focused

Public Resources Eating the Mediterranean Way

Public Resources Recipes (12)

Public Resources Videos

Videos (8) Kitchen Hacks Video (1)

Public Resources Nuts and Your Health

Public Resources How much is in your coffee?

Public Resources Dietitians Quick Reference Guide

Public Resources Dietitians Quick Reference Guide

Dietary Management Care Map for Registered Dietitians

• Guide to diet counselling for metabolic syndrome

• Process for providing care

• Evidence-based strategies

• Behavioral techniques

• Joint goal setting , self-direction and self-monitoring

• Approaches for addressing individual risk factors

Public Resources

MetSC Component Factsheets (6)

Public Resources MetSC Component Factsheets

Public Resources MetSC Component Factsheets

Where to Find the Resources

Public toolkit on MetSC website

www.metabolicsyndromecanada.ca

https://www.metabolicsyndromecanada.ca/change-program/resources

Resources for CHANGE only

Available online for use by Dietitians offering the CHANGE program

Updated Dietary Guidelines

• Overall approach to diet change

• Counselling strategies

• Nutrition assessment

• Goal Setting

• Individualized Diet Plan

• Follow up

• Documentation

Enhanced Group education curriculum

• PowerPoint slides for weekly group sessions

Updated resource list

• Resources that supplement the curriculum

Questions

Annual Forum

www.nc-forum.com

Thursday, November 14th, 2019

Thanks to Helderleigh Foundation and FiRSt George Brown College for the great collaboration From the NU-CHANGE MetSC Team Rupinder Dhaliwal, RD, FDC MetSC

Dr. Paula Brauer, PhD, RD, FDC University of Guelph

Carolyn Tereszkowski, MSc, RD Loyalist Family Health Team

Thanks for joining us!

For outstanding questions about the CHANGE Program or resources

Contact

Rupinder Dhaliwal, RD, FDC

Director of Operations

[email protected]

613 484 3830

metabolicsyndromecanada.ca