InSHAPE Together participants helped each other adopt healthier lifestyles
Hazel Balch has always cooked for two. Even when there was only one.
"I've always liked to eat," the 70-year-old from Swanzey said. "But since my husband died - it's been 15 years - I've still been cooking for two ... and eating for two."
Last summer, Balch joined 29 other people participating through Keene's Monadnock Covenant Church in a new program called InSHAPE Together (from Individualized Self Health Action Plan for Empowerment). The aims of the project, conducted by the Prevention Research Center at Dartmouth, were to find solutions to the obesity epidemic and to identify barriers to getting healthy.
Specifically, researchers wanted to find out what happens to success rates when people have a support network for getting healthy.
"I feel like when we started, we thought of healthy eating and physical activity as secondary goals," said Rudy Fedrizzi, Director of Community Health Clinical Integration at Cheshire Medical Center/Dartmouth-Hitchcock Keene and InSHAPE Together's lead investigator. "We'd rather have (participants) come together as a group because we knew that the power of connection and helping relationships would help them stick to whatever habits they developed."
Balch said she had always been a little overweight. She started trying to get healthier, she said, after doctors told her that her blood sugar was high. She'd lost 10 pounds before joining the InSHAPE Together. Since joining, she's lost another 45 pounds, taken 30 points off her blood sugar count and found a new friend.
"I had to lose weight, and I basically live alone," Balch said. "So I thought that this would be a way to do that and to connect with someone. And I do have a friend that I made as part of the group. We go to the Y together twice a week, and we're going to try to increase it to a third time. And we do things together, and we sit together at church. I didn't even know her before the program started."
Regionally, teams were set up in Keene, Manchester and St. Johnsbury, Vt. Each team was composed of about 30 people ages 12 and older, with two groups of 30 in Manchester. The only criteria for being in the study was that participants before starting the program had to be active less than three days a week or not at all. Members committed to meeting meet once a month.
Between meetings, participants were to track their activity and nutrition. They were encouraged to eat according to the USDA My Plate criteria - which, in a nutshell, requires that half of daily food consumption consist of fruit and vegetables - and to exercise. They were provided access to a nutritionist, an exercise coach and four to eight members of their team designated as their support network.
During her time in the group, Balch said, she learned to cut her portion sizes in half by saving some of her food for the next day. She said she also made chicken and fish for her main sources of protein.
The biggest change for Keene's Norman Mathias, 82, was movement. His hobbies of photography and computer games don't require much movement, he said, so he had not been very active in recent years. He said that as a result of InSHAPE Together, he and his wife became more active and as a result regained muscle and flexibility they had lost.
At group meetings, participants shared information about their own lives, their social circles and their community, explaining how those influences either helped them stick to their goals or made it harder to do so. From that information, researchers are trying to glean changes that individuals and communities can make to help people make healthy choices.
The final results of the project won't be available until sometime in the late spring or early summer, but generally speaking, Fedrizzi said, he definitely saw improvements in the Keene group.
"I think that this group would consider themselves cohesive and friends," he said. "And that's likely what's going to help them stick with whatever healthy habits they've developed. We very much wanted them to understand that you don't do this on your own, that it's not about will power and that it's OK to have two steps forward and one step back. And I think watching the group, they seem to be resilient around disappointment. They don't give up when life gets in the way of what they intended."
Breanna Redding, project coordinator for InSHAPE Together, said of the 30 original participants, 28 stuck with the program, with each meeting averaging 15 or 16 people. At the last meeting, on March 17, 18 people showed up. Redding said it's hard to pinpoint what would have helped the people who didn't see it through.
"I still think it's the self-motivation," she said. "Some people just need a little bit more.
"It's been boggling my mind for months now ... but maybe there is just one extra step. Maybe it's that one extra call, one extra letter or trip to their house."
More than weight loss
The researchers also point out that though participants' weights and body mass indexes were recorded, weight loss wasn't the primary goal of the project. The idea, they said, was that the process would help participants become more active, eat healthier and create positive social networks that would help them maintain their lifestyle, and that the participants would become agents of healthy change in their communities.
As far as Mathias and many others in the group are concerned, the project has done just that.
The research so far supports their conclusion.
Statewide data from 70 participants who completed midpoint assessments revealed that 53 percent experienced a decreased BMI, and 67 percent increased their six-minute-walk distance.
Participants reported increased feelings of social support for exercise (47 percent), increased number of days with vigorous activity (50 percent) and decreased barriers to exercise (64.3 percent). More than half reduced their sedentary time (62.9 percent). A whopping 87.9 percent reported making lifestyle changes because of IST.
"I would still be sedentary if it weren't for this program," Mathias said. "I'd say what the program has done for me is made me feel better. I still don't always want to go to Silver Sneakers (an exercise program at the YMCA) in the morning, but I know that when I come home an hour and a half later, I'm going to feel better. So I have to say, 'Come on, body; get up and go.' My body says, 'Who me?' And I say, 'Yeah, you.' And we get up and go."