1. “Effects of the Croí CLANN structured lifestyle modification programme on anthropometric and metabolic characteristics in severely obese adults”
Irene Gibson
Nurse Lead & Programmes Manager
Honorary Clinical Fellow NUI Galway

2. Background
Consistent with global trends, the prevalence of overweight and obesity has increased steadily in Ireland over the past three decades1, 2. This is a public health concern because of the associated morbidity and mortality from diseases like type 2 diabetes, for which the population attributable risk from obesityis 50 to 80%3, 4

3. Background
Six in 10 adults (18-64yrs) are either overweight or obese (NANS 2011)
Almost 1 in 4, 7 year olds are overweight or obese (Childhood Obesity Surveillance Initiative, 2012).
In the ROI the direct & indirect costs of overweight & obesity in 2009 were estimated at €1.13billion.(Safefood, 2013)
Prevalence of diabetes expected to increase by 37% over next 10 years
Prevalence of CVD expected to increase by 30% over next 10 years
The population shift in BMI has led to a particularly dramatic rise in the prevalence of severe obesity6. For these individuals (conventionally defined as those with a BMI ≥40 kg m-2 or ≥35 kg m-2 with co-morbidities such as type 2 diabetes), relatively intensive “bariatric” interventions need to be adopted7. These include intensive dietary restriction8 and bariatric surgery9.

4. Background
Few studies have described the effects of structured lifestyle programmes specifically in bariatric patients
Lifestyle modification is fundamental to obesity treatment
Croí CLANN commenced in October 2010
The population shift in BMI has led to a particularly dramatic rise in the prevalence of severe obesity6. For these individuals (conventionally defined as those with a BMI ≥40 kg m-2 or ≥35 kg m-2 with co-morbidities such as type 2 diabetes), relatively intensive “bariatric” interventions need to be adopted7. These include intensive dietary restriction8 and bariatric surgery9.
no previous study has examined the effects of multidisciplinary lifestyle modification programme that does not include a prescribed diet in bariatric patients.F

5. What is Croí CLANN?
Aim - to provide an efficient and effective multidisciplinary lifestyle intervention to patients who are currently waiting in excess of two years for assessment of their obesity.
10 week community based intensive-lifestyle programme
Led by a multidisciplinary team of Nurse Specialist, Dietitian, Physiotherapist/Physical Activity Specialist
Referrals – Bariatric Medicine
Recruitment Criteria – bariatric
patients ≥18 years with a BMI ≥40 kg m2
Outcome focused

6. Individual Assessment
Nurse
Medical History
Smoking Habit BP
Cholesterol
Diabetes
Medications
Psychosocial Health
Dietitian
Diet History
BMI, Waist Circumference
Physiotherapist/Physical Activity Specialist
Habitual activity patterns
Barriers to exercise
Physical limitations
Functional Capacity
Risk stratification
Behaviour change strategy
Individual Goal Setting
Education
Personal Record Card & Resource Pack

7. Comprehensive Programme
Patient attends for 2 hrs once per week
Individual review
Structured, minimal equipment exercise session
Health promotion sessions
Social support

8. Outcomes
August 2012 –June 2013, 127 individuals were referred to the programme with a response rate of 80%
Programme completion was high at 92%
Males 38%, Female 62%,
Mean age years, age range 24-72years
33% of patients were from regions outside of Galway

9. Significant improvements in: Weight, BMI, Waist Circumference Lipids, .
Outcomes
Significant improvements in:
Weight, BMI, Waist Circumference
Lipids,
Physical fitness
Psychosocial health
No improvements observed in:
Glucose & Hba1c
Blood Pressure

10. Patients Feedback
“I was surprised at how much I enjoyed the exercises and have joined other Croi classes since completion”
“I learnt how to control my eating habits and for the first time realised the damage I was inflicting on myself”
“Felt completely at ease, non judgemental, learnt a lot and am using knowledge and tools I learnt”
“I had a fantastic time on the programme, I really enjoyed it, I changed my whole lifestyle of health eating and exercise”
1. Over recent years it has become clear that:
knowledge & attitude may be necessary precursors of behaviour change but in isolation, don’t have the direct impact on the individual’s behaviour & the supporting evidence is equivocal.
[ Williams (1995) suggests the importance of knowledge and attitudes has been overemphasised & Blaxter (1990) found that although attitudes did appear to exert some influence on behaviour, their effects largely disappeared when social class and income were taken into account.]
2. Due to the underlying complexities between knowledge & attitude as well as socio-economic determinants, behaviour change is a very complex area.
It is not easy changing behaviour
it’s not easy to make the decision to change a HR behaviour
3. Models & theories have been used to explain & support knowledge…….. & interventions based on these models & theories have generally been used at three levels: individual, community, population.

11. Conclusion
Demonstrates the effectiveness of applying an integrated care approach to the management of obesity
Complements the existing services available at GUH and is having a positive impact on reducing the bariatric service waiting list
This programme is acceptable to obese patients.
Offers a unique opportunity to formally assess the benefits and feasibility of this type of intervention on severely obese Irish adults -a randomised controlled trial is warranted.

12. Acknowledgements
HSE-funding the programme through a grant aid agreement
Croí Team - Jenni Jones, Claire Kerins, Caroline Costello, Katie Cunningham, Jane Windle
GUH- Dr. Francis Finucane & Helena Griffin
CLANN programme participants