Effect of Managing Problematic Eating Behaviours With Dietary Management on Chronic Disease Self-management
Condition: Hypertension; Type 2 Diabetes
MeSH terms: Chronic Disease
Study type: Interventional

Summary: 
      Dietary management is an integral aspect of self care for many chronic diseases. Craving
      Change™ is a standard program already offered at many Family Health Teams (FHT) to patients
      interested in being more mindful of their food choices. The program helps patients understand
      why they have difficulty with modifying behaviours associated with diet, addresses the impact
      of emotion on eating behaviour and provides affect regulation strategies. Existing literature
      shows that emotion has a strong effect on food choice and that emotion regulation can lead to
      improvements in food choice. Craving Change™, however, is currently not selectively offered
      at FHTs to patients deemed to be at higher risk of cardiovascular disease and has not been
      evaluated in that context. For this study, we propose to 1) Selectively target patients at
      higher cardiometabolic risk; and 2) Evaluate an effect of the program (as modified to address
      chronic diseases) through a pilot Randomized Controlled Trial (RCT). If found to be
      effective, the modified Craving Change™ program, called "Beyond the Fork: A health-centred
      approach to managing chronic disease", could be broadly implemented within Family Health
      Teams.
    

Detailed description: 
      This study is specifically focusing on Diabetes Mellitus Type 2 and Hypertension as these are
      chronic conditions in which dietary management is not only an integral part of managing the
      condition, but can also be a major factor in poor outcomes. Many of the current approaches
      and interventions used for treating these conditions provide patients with information about
      "what" eating behaviours to change and "how" to change them, such as through DEP (Diabetes
      Education Program) and CDSM (Chronic Disease Self-Management, aka Stanford).

      The new intervention proposed in this study will be primarily based on material from the
      Craving Change™ program; the focus of which is to provide patients with an understanding of
      "why" it is difficult to change problematic eating behaviours. The new information that will
      be added is specific to chronic disease management. The original Craving Change™ program
      provides patients with information about how the environment, the physical body and emotional
      reactions can contribute to problematic eating behaviours thus increasing difficulty in
      changing those behaviours. The Craving Change™ program also provides patients with tools for
      overcoming the identified obstacles from the environment, physical body and emotional
      reactions in order to facilitate behaviour change. Patients who have a diagnosis of Diabetes
      Mellitus Type 2 and/or Hypertension and who are poorly controlled, are often required to make
      dietary changes to improve those conditions and often struggle to make the necessary dietary
      behaviour changes. By providing these patients with a behavioural intervention that uses the
      main components of the Craving Change™ program along with additional information specific to
      chronic disease management, the overall aim is to help patients improve control over the
      chronic condition with which they have been diagnosed.

      As this is a feasibility study, the main goal is to determine if patients who are diagnosed
      with chronic disease(s) can be recruited successfully, stay in the program and experience a
      change in their perceptions of eating behaviours as a result of learning various strategies
      offered in the program. Specifically, this study is focusing on whether the strategies
      learned improve emotion regulation, which in turn could facilitate behaviour change. Our
      primary outcome measure is the EEQ ("Emotional Eater Questionnaire"); which is a validated 10
      item questionnaire measuring the degree of interaction between emotion and food choice.

      This study is a Randomized Control Trial. The setting is 3 Family Health Teams in the Greater
      Toronto Area. Eligibility criteria includes rostered status to the Family Health Team, no
      previous participation in a program using Craving Change™, diagnosis of Diabetes Mellitus
      Type 2 and/or Hypertension, and 2 of 3 high A1c / BP / LDL. Patients are identified using
      Electronic Medical Records (EMRs) and those patients meeting criteria are sent an EEQ via
      mail. Patients consenting to participation are invited to intake at which blood pressure
      (BP), height/weight/waist circumference (ht/wt/wc) is measured and patients are randomized to
      immediate participation in the program or to wait list control. After 6 weeks EEQ is
      re-administered, and BP, ht/wt/wc is measured again.
    

Intervention name(s): Lifestyle counseling
Intervention type(s): Behavioral
Intervention description(s): Six week program to address problematic eating
Other intervention name(s): Group program using Craving Change(tm) material
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment