March 2011 - Issue #12
Healthy living switch a tough solo task
Story by Sue Finnis
- More and more Australians are at risk of developing type 2 diabetes
- A study shows people are more likely to reverse this condition by participating in community-based healthy living courses
- The outcomes are being integrated into preventive health programs in Victoria
Community meetings may be just as good for your health as they are for making friends.
Australian preventative health experts say a new Victorian study shows that local group support meetings can have a powerful influence on lifestyle, in particular changes that can help ward off the onset of diseases such as type 2 diabetes.
Most Australians are by now well aware that a healthy diet, weight control and exercise are the keys to reducing their chances of acquiring this disease as they age, but a recent research project has also looked at the influence of regular local support meetings in boosting personal motivation, mood and confidence. In fact, a study run between 2005 and 2009 by the Victorian Department of Health, and evaluated by Swinburne University of Technology, has found community support can almost double the chances of high risk Australians beating-off the disease.
The study found that people who attended regular meetings of a community-based healthy living education and support program had a 43 per cent success rate in reversing their at-risk pre-diabetes condition within six months of diagnosis.
Stark contrast spurs action
In stark contrast, only one quarter of patients medically diagnosed as pre-diabetic and left to tackle their diet, exercise and weight control issues alone or with the sole help of their local GP were able to change their at-risk diabetes status to become medically non-diabetic within the same time frame.
There was also evidence that being depressed, lonely, anxious, socially isolated or having a negative state of mind thwarted efforts to help people ward off diabetes, one of the fastest growing chronic diseases in Australia.
So marked were the contrasting impacts of the community support and the more individual approaches that results are already being incorporated into Australian preventive health thinking and strategies.
The results are also regarded as having financial implications for cost-effective prevention of diabetes in a society in which obesity and sedentary lifestyles are on the rise.
The study involved 300 people from three communities, centred on the Melbourne suburbs of Box Hill and Dandenong, and the rural Victorian city of Shepparton.
All participants had been diagnosed as being at extremely high risk of developing type 2 diabetes in the next five years, testing positive to the condition known as pre-diabetes.
Blood tests showed these patients, most of whom were aged over 50, had impaired glucose tolerance and high levels of fasting blood sugars. This biochemical state was often accompanied by high blood pressure, high cholesterol and a combination of factors known as ‘metabolic syndrome’, typically linked to obesity, poor diet and lack of exercise.
Professor Susan Moore, from Swinburne’s Faculty of Life and Social Sciences, helped the Victorian Health Department design the methodology behind the trial and the surveys completed by participants during the six-month study, including questions about mood, motivation and mental attitude.
The Swinburne team comprised chief investigator Professor Moore, Dr Elizabeth Hardie, Associate Professor Christine Critchley, Professor Mike Kyrios, Dr Simone Buzwell, Dr Naomi Crafti and project manager Dr Naomi Hackworth.
The team also evaluated results from the two different treatment groups – one featuring ‘community healthy lifestyle meetings’, and the other comprising people left to their own devices for six months in the control group.
Professor Moore says a unique feature of the study was that both quantitative and qualitative data about how participants were faring in their attempts to improve their diet, weight, exercise levels and overall health was collected as the trial progressed.
“We decided very early on that we needed to look at what the participants were like, and what their diet and lifestyles were like, both before the program and after it,” Professor Moore says.
“Everyone, even those in the control group, had had the pre-diabetes diagnosis or wake-up call from their doctor, so what we needed to evaluate was if that diagnosis by itself was enough to encourage and motivate participants to take action and change, or if a community ‘healthy living’ group program could be an additional motivation.
“And then we wanted to find out, using psycho-social variables, why people had changed and how much that was to do with their mood, attitude and the ongoing support they received.”
Two-thirds of the participants, all volunteers, were randomly selected for the healthy living intervention group program. The other 100 patients were allocated to the control group reliant on their own actions with little outside assistance beyond their standard GP care.
The Healthy Living Course gathered between six and 12 participants, all diagnosed as pre-diabetic, in a group meeting once a week for the first four weeks.
The basic structure of how to live healthily and improve fitness, diet and weight was communicated in the first four weekly sessions. The groups then reassembled after intervals of three months and six months.
Prior to the first meeting and again at the end of the program, all participants were asked to fill in questionnaires about their levels of stress, anxiety, happiness, mood and readiness to take on lifestyle change, as well as about their level of knowledge of diabetes and what they needed to do.
Even Professor Moore admits she was surprised by the extent to which those involved with the group-based lifestyle intervention programs benefited so much more than those given the current ‘standard care’ treatment for pre-diabetes.
At the end of the study, the same blood tests taken when doctors had diagnosed the participants as being pre-diabetic, revealed nearly half (43 per cent) of those involved in the healthy lifestyle group courses had successfully reversed their condition, becoming non-diabetic.
Only 26 per cent of the control group achieved the same result.
The average weight of those in the lifestyle program group dropped from 81 kg to 78 kg, and their waist circumferences reduced from 97 cm to 94 cm. The weight of the control group changed minimally from 82 kg to 81 kg, while their waist measurements stayed fixed at an average 97 cm.
Words are not enough
Professor Moore now believes simply supplying patients with educational information and emphasising the need for lifestyle change – even if it follows the warning of a pre-diabetes blood result – may not be enough for many people.
Just as important may be each person’s psychological make-up, their motivation to change and their self-belief in being able to alter their medical fate.
Professor Moore also suspects the social aspect of the group support programs could be a key to the excellent outcomes.
“The participants seemed to really enjoy the meetings and the opportunity for social interaction and the support they offered, which was clear by the very few people who dropped out of a program that was six months long. Clearly, the facilitators did a great job at involving everyone and communicating their message in a positive and supportive way.”
The trial reinforced how much the overall cost to the health system of chronic diseases such as type 2 diabetes can be lessened or mitigated by preventative community health programs.
More broadly, the results also suggest that tackling social isolation, anxiety and depression may have the unexpected consequence of improving long-term health outcomes.
Applying the findings
The Victorian Department of Health is taking the findings of the study a step further. Together with Diabetes Australia in Victoria, it is now rolling out similar six-month-long healthy living courses across the state under the banner of ‘Life! Taking Action on Diabetes’, aimed at preventing and reducing the health impact of diabetes.
Victoria is the first state in Australia to implement this approach on a systematic basis.
Professor Jim Hyde, Director of Prevention and Population Health at the Victorian Department of Health, said the findings of the initial study will now inform diabetes prevention and early intervention programs in Victoria.
“As with the Healthy Living Course, the ‘Life! Taking Action on Diabetes’ group course is based on the same principle that building self-efficacy is an essential element of supporting lifestyle change,” Professor Hyde says.
“Relationships developed with the facilitator and other group members build a support network that fosters positive attitudes and increased self belief towards goal attainment, thus helping to reduce the health impact of chronic disease.”