What's the 7% Solution? #2

A 7% Solution #2
by Eric Schoch

The Y factor

The YMCA was a good match because it’s everywhere. There are nearly 2,700 YMCAs across the country, with 57 percent of American households within three miles of a YMCA. The YMCA-United Health program is being implemented in seven cities in 2010, adding 25 more cities over the next two years.

“It’s in our DNA to be involved in healthy living,” said Jonathan Lever, national director of Activate America for the YMCA, during the diabetes conference in April. “We have the reach to make a difference.”

In Indianapolis, the diabetes prevention research reported in 2002 was conducted at the National Institute for Fitness and Sport, a highly respected, but not inexpensive, facility next to the Indiana University-Purdue University Indianapolis campus. The study’s lifestyle coaches had master’s degree-level training. The one-on-one counseling was accompanied by incentives for the participants, such as free shoes, water bottles, and modest cash rewards for achieving certain goals.

Moving the program to a community-based organization meant changing some aspects of the program, Ackermann says. There were no more incentives, for example. Dropping them reduced participation of those referred to the program to about 65 percent, down from about 95 percent in the original study. More significantly, the program changed from one-on-one coaching to group sessions of about 10 people.

What didn’t change, Ackermann says, was the core curriculum of 16 sessions, 60 to 90 minutes each, focusing on detailed behavioral strategies to reach a 5 to 7 percent weight loss by carefully tracking and reducing fat consumption and exercising at least 150 minutes a week. These sessions are not simple lectures, but intensive intervention programs with regular assignments and feedback, designed to give people tools they need to change their eating and exercise lifestyles.

The DPP Lifestyle Change Program Manual of Operations, developed in 1996 at the University of Pittsburgh, runs more than 460 detailed pages of advice, facts, and strategies. (For example: Avoid tasting foods when cooking, and if you do it, immediately cleanse your mouth with water or a breath mint. Or: Do some role-playing to practice friendly but firm ways to ask for low-fat alternatives when ordering at restaurants.) So could an intensive, costly, one-on-one diabetes prevention program necessitating behavior change be successfully implemented at a community-based organization in group sessions?

In a word: Yes.

Continued tomorrow!

http://research.iu.edu/magazine/index.php?option=com_content&view=article&id=111:a-7-solution&catid=45:fall-2010-volume-xxxiii-number-1&Itemid=78

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