People who are very overweight are often shy and self-conscious about going to mainstream exercise and cookery classes that might help them lose weight and learn to eat more healthily. So the introduction of cookery demonstrations and tailored exercise classes for those attending – or who have attended – the weight-management clinic at St Columcille’s Hospital in Loughlinstown, Co Dublin, is a useful development.
Every week, physiotherapists Colin Dunlevy and Emer O’Malley hold an hour-long drop-in exercise class for patients and former patients. “You’ve got to make the exercise classes enjoyable so people will come. It’s not about fast, high intensity ‘no pain, no gain’ type of exercises that you see on television. Everybody moves at their own pace and we’ve lots of breaks,” says Dunlevy.
“In fact, I think TV exercise programmes are destructive for people with weight issues. The first thing we have to do is to encourage people to change their relationship with exercise if it means hardship and struggle. It’s about starting small and keeping exercise on your daily agenda,” says Dunlevy.
Encouraging participants to consider how they can incorporate small amounts of exercise into their day is the key; for example, walking around the house during the ad break when watching television.
Step counters are used to monitor progress. Susan Lyons attends the exercise classes and has found the step counter a useful way to increase the amount of walking she does each day. “I’ve been going to the exercise classes for seven or eight weeks now. It’s not strenuous. We do a warm-up and a cool-down afterwards. The movement game on the X-box is fun,” she says.
“A lot of patients have to overcome pain to exercise: 90 per cent of people in our group have some form of mechanical pain in their back, knees, feet or hips so addressing this pain by frequent movement without overdoing it is important,” says O’Malley.
Getting adequate sleep is another factor in pain reduction and exercise frequency. “Half of our group are short sleepers. When you’re not sleeping enough, it plays havoc with your appetite. You’re not in the humour for exercise and your daily routine can be chaotic.”
The dietitians at St Columcille’s Hospital have scheduled fortnightly cookery demonstrations on the same day as the exercise classes so that people can learn about healthy foods and cooking methods before partaking in the exercise programme.
In a bright kitchen at the back of the Weight Management Unit, dietitian Natalie Wallace cooked a light chicken korma and spicy carrot and chickpea pitta pockets for a group of nine people.
Wallace says chicken korma can be high in calories if you use jars of korma sauce, and even higher in calories if you buy it from a takeaway. Instead, she cooks in water not oil, uses 0 per cent fat Greek yogurt instead of coconut milk and makes her paste from chopped onion, garlic and ginger with a small amount of korma paste, adding fresh coriander at the end. No salt or cooking oil are added at any stage of the cooking, the chicken portions are kept to about 90g per person and the korma is served with wholegrain rice.
Carmel Lynch says she finds the cookery demonstrations very useful. “I’ve learned to weigh meat, rice and pasta and stick to the portion size. I have also started to cook with ginger and to cook chicken and vegetables for stir-fries in water rather than oil but it’s very easy to slip back into bad habits, which is why these classes are helpful.”
David O’Connor says that he finds the recipes very good to use at home. “We are all here because we are overweight and many of us eat far too much meat so controlling portion size has been important for me.”
The participants chat among themselves about what helps, while Wallace makes and cooks the chicken korma.
Karen Gaynor, a dietitian at the hospital, started the cookery demonstrations on a pilot basis three years ago and the interest developed from there.
“The aim of the cookery demonstration is to show portion size for different food groups, to use herbs and spices from the garden at the hospital instead of jars of sauce, and to show cooking methods such as using a nonstick pan without oil,” she explains.
Some of the produce for the cookery demonstration comes from three raised beds of delicious-looking vegetables and herbs which landscape gardener Simon Chambers built and maintains at the hospital.
“We’ve carrots, turnips, cabbage, purple flowering broccoli, leeks and kale and we’ll put in onions and garlic over the winter. Everyone comments on the garden. It would be great if patients could be involved in the gardening work too.”
Psychological support
Clinical psychologist Ruth Yoder provides psychological support for patients at the Weight Management Clinic. This includes a drop-in mindfulness meditation class and one-to-one sessions. “The mindfulness classes appeal to those who do a lot of mindless eating by grazing or eating more than they intended without remembering that they ate that much, or even the taste of what they’ve eaten,” says Yoder.
At the one-to-one sessions, Yoder encourages patients to “learn how to move out of the emotional mind into the rational mind when making food choices”.
“The attachment to food as a comfort starts very early in life, filling a need that hasn’t been filled. For example many comfort eaters didn’t have validation from their mothers and this lack of validation often means they grow up ill-equipped to read their own emotional state. Food can become a more reliable source of comfort than the primary relationship.”
Yoder says a lot of people who are extremely overweight use snacking as a hobby, so encouraging them to seek pleasure in other interests is helpful.
The multidisciplinary approach at St Columcille’s Weight Management Clinic is one of only two in Ireland.
Prof Donal O’Shea, consultant endocrinologist at the clinic, says the multidisciplinary approach to severe obesity is the only one shown to work.
“We now realise that for 90 per cent of people, weight gain is 90 per cent irreversible.
“A small number of people can lose a lot but the vast majority cannot. You can achieve 10 per cent weight loss with lifestyle and drugs, and 30 per cent with lifestyle and surgery.
“A motivated patient working one-to-one with a dietitian, physiotherapist and psychologist over a year is the evidence-based intervention for severe obesity, and that’s what we try to deliver at the clinic in Loughlinstown.”
