Ready to Restart

Be sure to review Section 6 in the Manual for Contacts After Core:  Guidelines for Conducting Lifestyle Classes after Core, before conducting this or other after-core classes.

Class Overview

This six-session class provides an intensified intervention for lifestyle participants who are ready to aggressively pursue additional weight loss and physical activity during a six-week period.  The class objectives are the following:
C	Participants will achieve a weight loss of at least 10 pounds in six weeks by:
C	Minimizing decision making.
C	Following a highly structured daily meal plan of 1000 or 1500 calories (may or may not include Slim Fast).
C	Following a walking program of 30 minutes per day for week 1, 45 minutes per day for weeks 2 and 3, and 60 minutes per day for weeks 4, 5, and 6.  
C	Self-monitoring their weight and graphing it daily.
C	Self-monitoring their physical activity in minutes and steps (using a pedometer).
C	Self-monitoring their eating if it differs from the meal plan.
C	Attending all six sessions and calling their Coach once a week throughout the class.

This class is not designed to appeal to everyone but only to those who are ready to commit themselves to a highly structured, streamlined program with frequent accountability.  	To select participants suitable for the restart class, consider the following questions (do not ask these questions to participants directly, but rather use open-ended questions such as “What do think would be most helpful to you right now to give you a boost toward losing more weight and being more active?”):
C	Does the participant want or need more structure?
C	Does the participant have difficulty making decisions or feel overwhelmed by choices?
C	Does the participant verbalize a readiness to make aggressive changes in his or her eating and activity behaviors?   	
C	After learning the objectives of the restart class, does the participant verbalize a commitment to strictly adhere to the program’s dietary and exercise guidelines, attend all six classes, complete the Daily Log, and call his or her Coach once a week during the program?

You may wish to offer the class once a year with the thought that different participants may be interested in it at different times during their DPP participation.

The sessions are held weekly for six weeks.  The first session may last about 45 minutes to one hour, but the following sessions may be quite short.  Each session should include at least a 30-minute walk as a group.

Note: 
One option in this restart program is for participants to use Slim Fast twice a day throughout the six weeks.  Check to see that you have enough Slim Fast shakes and/or coupons on hand for the number of participants who are interested in the program (each participant would need 84 shakes for the entire six weeks).  If not, call Harry Greene, MD at Slim Fast at (561) 833-9920 or FAX him at (561) 832-3165 as far in advance as possible.  

The program also includes giving each participant a pedometer.  If you don’t have enough on hand, call the Lifestyle Resource Core as far in advance as possible.

Session 1: Fresh Start  

Objectives:
C	Participants will verbalize how they will implement the restart class guidelines for eating and physical activity, self-monitoring, and staying in close contact with their Coach.
C	Participants will demonstrate any skills need to implement the restart class guidelines, such as completing the Daily Log, graphing their weight,  and using the pedometer.

Materials: 	
C	Notebooks containing the following handouts:  1000-1200 Calorie Eating Plan, 1500 Calorie Eating Plan, 1000-Calorie Slim Fast Eating Plan, 1500-Calorie Slim Fast Eating Plan, Weight Graph, Daily Log
C	Slim Fast shakes and powder and coupons
C	Pedometers
Before the session:
C	For instructions and the rationale for using Slim Fast and the pedometers, review the related materials in the Tool Box.  (Note the abstract “Successful Weight Maintenance After Weight Loss: A 3.5 Year Community Study” included in the Slim Fast materials in the Tool Box.)
C	Advertise the class, giving the message that it is not designed for everyone but rather for only those participants who are ready to aggressively pursue additional weight loss and physical activity during a six-week period of  a highly structured, streamlined program with frequent accountability.   You may want to advertise the class using a slogan like “Get Those 10 Pounds Off.”

Plan to exercise as a group before or after the session.

Have participants arrive early to be weighed privately (this is a key part of this course so make sure that the location will allow for weigh-ins).  Distribute the participant notebooks at that time.  
1.	Introductions (have participants give their names, amount of time they have been in the DPP). 

2.	Describe the purpose of the class:  to provide an intensified intervention for participants who are ready to aggressively pursue additional weight loss and physical activity during a six-week period.  This class is not designed to appeal to everyone but only to those who are ready to commit themselves to a highly structured, streamlined program with frequent accountability.  The program is much more structured than the core curriculum and rather than providing choices and flexibility, it is designed to eliminate choices in favor of structure.  This is because many people find it easier to follow a structured plan (no decisions, no choices, almost no self-monitoring unless you deviate from the plan) and because it can be very motivating to work hard for a period and see results.

3.	Explain that the goals for the class are simple and aggressive.  (Distribute and review the related handouts as you explain each of the following four goals.) 

1.	Follow an eating plan that will help you clearly and consistently limit your intake for the six weeks of the class.  Choose one of following:
a.	A structured eating plan (either 1000-1200 calories if your starting weight is less than 200 pounds or 1500 calories if your starting weight is more than 200 pounds), or
b.	Drink a Slim Fast shake for breakfast and lunch and eat a low-fat/calorie meal for dinner (to total either 1000 calories or 1500 calories per day depending on your starting weight).

(Make the following points about the eating plans:
C		Trim meats of all separable fats before cooking.  Weights, fat grams, and calories are for cooked meats, weighed without bone.  
C	Any additional foods should be calorie-free (e.g., spices, mustard, black tea or coffee, diet soft drinks).
C	Encourage participants to take:
a.	A daily multivitamin with 100% of the RDAs,  and
b.	A calcium supplement in divided doses with meals to provide a total of 900 mg elemental calcium per day (e.g., one 300-mg. calcium carbonate tablet like Tums or a similar store brand with each meal).  
C	If participants question or complain about the limited food choices in the eating plans, explain that the point of the plans is to follow them religiously so that choices and decisions are eliminated (a large part of why many people succeed using the plans is that the food choices are limited).  Again, this program is not for everyone but for those who are ready to commit to a highly structured program for a six-week period.)

2.	Follow a walking program that will help you clearly and consistently increase your physical activity (for this restart program, we want to encourage you to go beyond the minimum we usually recommend).  To do this:

During week:	Walk every day for:	For a weekly total of:	
1	30 minutes	210 minutes	
2 and 3	45 minutes	315 minutes	
4, 5, and 6	60 minutes	420 minutes	

We are giving you a pedometer as another way for you to see your success in increasing your physical activity.  (Distribute the pedometers and explain how to use them.  Participants are to wear them daily, throughout the day.  For details, refer to the pedometer information in the Tool Box.)

3.	Weigh yourself at home every day and graph your weight.  The goal of this program is to help you lose 10 pounds in six weeks, so you will be charting your progress toward this goal.  (Note: There are two weight graphs, each covering 21 days or three weeks.  Demonstrate using an example and then have the participants complete the vertical axis of both graphs with their starting weight and goal weight, and  then with the one-pound increments between them.  Check each participant’s graph.  Emphasize that participants should weigh themselves on the same scale at the same time each day wearing the same clothing (e.g., first thing in the morning with no clothes on or only underwear).  This helps to avoid questions about whether a change in weight is due to a change in clothing (e.g., shoes versus no shoes, sweater versus no sweater) or contents of the stomach (e.g., weighing after breakfast versus before).  Explain that their weight may go up or down several pounds from day to day due to shifts in fluid balance, and they should not be alarmed by this.  What we look for is an overall trend.  By weighing themselves daily, they will be able to see this trend and respond to it promptly.) 

4.	Stay in close contact with us for support.  This will be done in two ways:
C			Complete the Daily Log and call your Lifestyle Coach once a week to report your daily weight, walking minutes, and steps (pedometer reading).  (Give the participants a specifically scheduled time of day (“call-in hour”) on a day of the week about midway between the sessions during which to call you.)
C			Come to all six of the weekly group meetings.  These will be short meetings.  First you’ll be weighed privately.  Then we’ll talk as a group about what went well during the previous week and what did not go so well, and we’ll problem solve together.  Then we’ll take a walk.

Answer any questions.

After the session:
C	We strongly recommend that you phone each participant two to four days after the class to ask how things are going with the eating plan, walking plan, and self-monitoring, and answer any questions.  Praise their efforts so far, and tell them you look forward to hearing from them during the call-in hour and seeing them at the next session.    

Session 2-6: Fresh Start  

Objectives:
C	Participants will verbalize positive changes related to being in the restart class (e.g., weight loss, increased physical activity, more energy, greater sense of well-being, etc.).
C	Participants will identify problems related to following the restart class guidelines and develop a plan to resolve them.
Materials: 	
C	Same as for Session 1.

Plan to exercise as a group before or after the session.  Have participants arrive early to be weighed privately.  Review their Daily Log and weight graph.

1.	Ask participants what went well with their eating and exercise since the last session.  Praise participants for what went well, pointing out examples of skills used such as problem solving, staying away from or changing problem cues or adding helpful cues (food, exercise and/or social cues); talking back to negative thinking; getting back on track right away after a slip; pre-planning; stress management; being assertive; and so on.  

2.	Ask participants to share what was challenging for them.  As the group gives examples, express empathy, use active listening, and communicate respect.  Ask for one or more volunteers to give an example challenge for the group to problem solve together.  Facilitate the problem solving process (describe the problem, brainstorm options, choose the best option, make a positive action plan) and reinforce the group’s participation in the process.  (At the next session, follow-up by asking the volunteers to share their experiences trying the action plan.  As a group, continue the problem solving process if necessary.)

3.	Allow time for discussion and interaction throughout the session but keep the length of the session brief (30 minutes or less).	

4.	Remind participants of their exercise goal for the coming week (see Session 1 for the incremental goals).

At Session 6, discuss with the participants whether they found the restart program helpful and if so, that this may be something they can use periodically if they see their weight going up.  (Explain that one way many people control their weight is to return, as soon as they see their weight increasing, to a more structured and aggressive plan for eating and activity for a period of time.)  Encourage participants to keep off the weight they have lost during the class by gradually adding back calories and increasing the variety of food choices until they return to a more maintenance level (recommend that participants add about 200 calories per day for a week at a time, watch the scale, and adjust calorie intake accordingly).

Answer any questions.  
1000-Calorie Slim Fast Eating Plan

Slim Fast shakes may help you lose weight and keep it off.  Ultra Slim Fast shakes:   

C	Provide a meal that is low in fat and calories.  
One Ultra Slim Fast shake contains 220 calories, 3 grams of fat, 10 grams of high quality protein, 5 grams of dietary fiber, and 18 essential vitamins and minerals.

C	May help you avoid difficult food choices and temptations.  

C	Make food shopping and preparation easier.    

C	Are easy to carry and store. 

Follow this meal plan:

Meal	Plan	Calories	

Breakfast	
Slim Fast Shake	220	

Lunch	
Slim Fast Shake	220	

Dinner
	1.	Low-fat frozen entree (< 300 calories, < 10 grams fat)      
         or 
4 ounces, cooked, of any one of the following, baked or broiled, without added fat:
C	Fish
C			Chicken or turkey, without skin
C	Ham, pork chops (loin or sirloin), or pork roast (loin or sirloin), trimmed
C	Sirloin or round steak, trimmed
C			Roast beef (round or rump), trimmed
2.	1 dinner roll or 1 baked or boiled potato or ½ cup cooked rice  
3.	Tossed salad (no nuts, cheese, olives, or avocado) with 1-2 tablespoons reduced-calorie dressing (any type with 32 calories or less for total amount)
or 3-4 vegetables, cooked and served without added fat
4.	1 medium piece of fresh fruit (e.g., apple, pear,
banana, orange, peach) or 1 cup melon or berries 	<300

100
<100

100	
	Total	1000
	
1500-Calorie Slim Fast Eating Plan

Slim Fast shakes may help you lose weight and keep it off.  Ultra Slim Fast shakes:   

C	Provide a meal that is low in fat and calories.  
One Ultra Slim Fast shake contains 220 calories, 3 grams of fat, 10 grams of high quality protein, 5 grams of dietary fiber, and 18 essential vitamins and minerals.

C	May help you avoid difficult food choices and temptations.  
C	Make food shopping and preparation easier.    

C	Are easy to carry and store. 

Follow this meal plan:

Meal	Plan	Calories	
Breakfast	Slim Fast Shake	220	
Lunch	Slim Fast Shake	220	
Snack	1 medium piece of fruit		100	

Dinner
	1.	Low-fat frozen entree (< 300 calories, < 10 grams fat)      
         or 
4 ounces, cooked, of any one of the following, baked or broiled, without added fat:
C	Fish
C			Chicken or turkey, without skin
C	Ham, pork chops (loin or sirloin), or pork roast (loin or sirloin), trimmed
C	Sirloin or round steak, trimmed
C			Roast beef (round or rump), trimmed
2.	1 dinner roll, plain, or 1 baked or boiled potato, or ½ cup cooked rice 
3.	2 teaspoons margarine
4.	Tossed salad (no nuts, cheese, olives, or avocado) with 1-2 tablespoons reduced-calorie dressing (any type with 32 calories or less for total amount)
or 3-4 vegetables, cooked and served without added fat
5.	1 medium piece of fresh fruit (e.g., apple, pear,
banana, orange, peach) or 1 cup melon or berries 	<300

100

100
<100

100	
Snacks	1 oz. hard pretzels or 3 cups plain air-popped popcorn
1 medium piece of fruit	100
100	
	Total	1500	
1000-1200 Calorie Eating Plan

Meal	Plan	
Breakfast
(200-250 calories)	A.	½ cup unsweetened juice (any type with 60 calories or less) 
(e.g., orange, apple, or pineapple juice)
1 cup unsweetened cold cereal 			
(any type with 100 calories or less) (e.g., Bran Flakes, Cheerios, Special K, Total) or b cup cooked hot cereal (e.g., oatmeal or cream of wheat)

½ cup skim milk 
or  
B.	1 English muffin or two slices of toast (do not substitute bagels)
 2 teaspoons jelly or jam
1 medium piece of fresh fruit (e.g., apple, pear, banana, orange, peach) 
or 1 cup melon or berries	
Lunch
(300-350 calories)	A.	1 sandwich:
2 slices bread
3 ounces tuna (canned in water), or oven-roasted turkey
or chicken breast

1 tablespoon fat-free mayonnaise or mustard
  1 medium fresh fruit or 1 cup melon or berries
or
B.   1 frozen entree (e.g., Lean Cuisine, Healthy Choice, 
Wt. Watchers, Budget Gourmet) with less than 300 calories and less than 10 grams fat
   Tossed salad (no nuts, cheese, olives, or avocado)
  1-2 tablespoons reduced-calorie dressing (any type with 32 calories or
less for total amount)	
Dinner
(500-550 calories)	1.	Low-fat frozen entree (< 300 calories, < 10 grams fat)      
    or  4 ounces, cooked, of any one of the following, baked or
broiled, without added fat:
C	Fish
C			Chicken or turkey, without skin

C	Ham, pork chops (loin or sirloin), or pork roast (loin or sirloin), trimmed
C	Sirloin or round steak, trimmed
C			Roast beef (round or rump), trimmed
2.	1 dinner roll, plain or 1 baked or boiled potato 
or ½ cup cooked rice 
3.	Tossed salad with 1-2 tablespoons reduced calorie dressing  (see guidelines
above)
or 3-4 vegetables, cooked and served without added fat
4.	1 medium piece of fresh fruit or 1 cup melon or berries 	

Sample Menus 
for 1000-1200 Calorie Eating Plan

Day 1

Breakfast
½ cup unsweetened apple juice
1 cup Cheerios
½ cup skim milk 		Fat (g)
	0
	0
	0		Calories
	58
	110
	43	
Lunch
2 slices bread
3 ounces tuna (canned in water)
1 tablespoon fat-free mayonnaise
1 medium pear	
2
1
0
1	
140
99
12
98	
Dinner
Healthy Choice Chicken Enchiladas
Dinner roll
Tossed salad (2 cups)
2 tablespoons fat-free Italian dressing
1 cup strawberries	
8
3
0
0
0	
280
108
28
32
46	
														Total:		  15		    1054

Day 2

Breakfast
1 English muffin
2 teaspoons strawberry jam
1 medium banana	Fat (g)
1
0
0	Calories
134
32
96	
Lunch
Lean Cuisine French Bread Pizza 
Tossed salad (2 cups)
2 tablespoons fat-free Italian dressing 	
9
0
0	
300
14
32	
Dinner	
4 ounces broiled pork chop (loin), trimmed
½ cup cooked white rice
½ cup broccoli
½ cup carrots
½ cup corn
1 medium apple	
12
0
0
0
0
0	
243
103
26
35
66
81	
														Total:	  	  22		  1162 

1500 Calorie Eating Plan

Meal	Plan	
Breakfast
(200-250 calories)	A.	½ cup unsweetened juice (any type with 60 calories or less) 
(e.g., orange, apple, or pineapple juice)
1 cup unsweetened cold cereal 			
(any type with 100 calories or less) (e.g., Bran Flakes, Cheerios, Special K, Total) or b cup cooked hot cereal (e.g., oatmeal or cream of wheat)

½ cup skim milk 
or  
B.	1 English muffin or 2 slices toast (do not substitute bagels)
 2 teaspoons jelly or jam
1 medium piece of fresh fruit (e.g., apple, pear, banana, orange, peach) 
or 1 cup melon or berries	
Snack
(100 calories)	1 medium piece of fresh fruit (e.g., apple, pear, banana, orange, peach) 
or 1 cup melon or berries	
Lunch
(300-350 calories)	A.	1 sandwich:
2 slices bread
3 ounces tuna (canned in water), or oven-roasted turkey
or chicken breast

1 tablespoon fat-free mayonnaise or mustard
  1 medium fresh fruit or 1 cup melon or berries
or
B.   1 frozen entree (e.g., Lean Cuisine, Healthy Choice, 
Wt. Watchers, Budget Gourmet) with less than 300 calories and less than 10 grams fat
   Tossed salad (no nuts, cheese, olives, or avocado)
  1-2 tablespoons reduced-calorie dressing (any type with 32 calories or
less for total amount)	
Dinner
(600-650 calories)	1.	Low-fat frozen entree (< 300 calories, < 10 grams fat)      
    or  4 ounces, cooked, of any one of the following, baked or
broiled, without added fat:
C	Fish
C			Chicken or turkey, without skin

C	Ham, pork chops (loin or sirloin), or pork roast (loin or sirloin), trimmed
C	Sirloin or round steak, trimmed
C			Roast beef (round or rump), trimmed
2.	1 dinner roll, plain or 1 baked or boiled potato 
or ½ cup cooked rice 
3.	2 teaspoons margarine
4.	Tossed salad with 1-2 tablespoons reduced calorie dressing  (see guidelines
above)
or 3-4 vegetables, cooked and served without added fat
5.	1 medium piece of fresh fruit or 1 cup melon or berries 	
Snacks
(200 calories)	1 oz. hard pretzels or 3 cups plain air-popped popcorn
1 medium piece of fruit	
Sample Menus for 1500 Calorie Eating Plan

Day 1
Breakfast
½ cup unsweetened apple juice
1 cup Cheerios
½ cup skim milk 		Fat (g)
	0
	0
	0		Calories
	58
	110
	43	
Snack
1 banana (8")	
0	
96	
Lunch
2 slices bread
3 ounces tuna (canned in water)
1 tablespoon fat-free mayonnaise
1 medium pear	
2
1
0
1	
140
99
12
98	
Dinner
Healthy Choice Chicken Enchiladas
Tossed salad (2 cups)
Dinner roll
2 teaspoons margarine
2 tablespoons fat-free Italian dressing
1 cup strawberries	
8
0
3
8
0
0	
280
28
108
68
32
46	
Snacks
1 ounce hard pretzels
1 medium orange 	
0
0	
108
62	
														Total:			      23	    	       1388

Day 2
Breakfast
1 English muffin
2 teaspoons strawberry jam
1 medium banana	Fat (g)
1
0
0	Calories
134
32
96	
Snack
1 medium peach	
0	
37	
Lunch
Lean Cuisine French Bread Pizza 
Tossed salad (2 cups)
2 tablespoons fat-free Italian dressing 	
9
0
0	
300
14
32	
Dinner	
4 ounces broiled pork chop (loin), trimmed
½ cup cooked white rice
2 teaspoons margarine
½ cup broccoli
½ cup carrots
½ cup corn
1 medium apple	
12
0
8
0
0
0
0	
243
103
68
26
35
66
81	
Snacks
3 cups air-popped popcorn
1 medium pear	
1
1	
92
98	
															Total:	  	  	  32	       1457 

Name                                                                   Eating plan                                                           

Daily Log, Week         
Walking schedule:

During week:	Walk every day for:	For a weekly total of:	
1	30 minutes	210 minutes	
2 and 3	45 minutes	315 minutes	
4, 5, and 6	60 minutes	420 minutes	

Date	Weight (lbs):  Remember
to graph your weight, too.	List any extra foods and/or amounts you ate:	Minutes
walked	Steps

			

			

			

			

			

			

			
																				Total: