NCHPAD Predoc Julianne Clina transformed State of Slim to a format that can be utilized by people with disabilities – the emblem of what CEDHARS Director Dr. Jim Rimmer calls inclusion science.
State of Slim is a 16-week commercially available weight-loss program with a diet plan broken up into three phases. In nature, the diet is high in protein and emphasizes non-starchy vegetables and whole grain carbohydrates.
“We call it a transformation class, not just a weight-loss class because we work through a lot of reframing to a positive mindset – changing your physical environment, your social environment to be more conducive to your lifestyle and behaviors,” Clina said.
Clina used the NCHPAD Adaptation Framework and GRAIDs Process to retrofit the program to be inclusive of people with disabilities, which took about a year and a half. She tediously went through each handout for the entire program and adapted protocols to allow participation for every level of ability.
A large portion of this class is spent critically thinking about participants’ bigger purpose and digging into the why behind the motivation to lose weight and improve health. The program then works to align lifestyle behaviors with this purpose to encourage this healthy lifestyle. For example, Clina shared that in this round of the program, several participants have a “why” of being a good example to their children and making their children proud. So, tying aspects of the program, such as physical activity or healthy eating, to their purpose can mean going for family walks or cooking healthy meals together. The goal is to create weight loss sustainably and create lifestyle habits that support the transformation.
Throughout the adaptation process, Clina met with Lakeshore Foundation information specialists Kelly Bonner, Rebecca Cline and Cara Williams to strategize the most effective accommodations for all of the disability spectrum. It was key, though, for her to be able to interact with members of the disability community, which she gained great insight from.
“When I spent the time meeting with people with disabilities, it was really integral to troubleshoot with the population I was going to work with,” Clina said. “There’s been a lot of things that I’ve learned from my participants that I never would have known could be solutions.”
Clina also frequently checked in with Dr. Holly Wyatt and Dr. Jim Hill, creators of State of Slim, to ensure the new adapted protocols carried the same intent as the original program strived for.
“It provides a way for everyone to do some aspect of the activity – that’s the idea behind what we do.”
The first step in using the NCHPAD adaptation framework is to define the core components of the program and are absolutely essential. For State of Slim, Clina said one of these elements is weekly weigh-ins.
“Evidence has shown over and over again that people who weigh in more frequently do better with weight loss and weight-loss management,” Clina said. “I know not everyone loves stepping on the scale, but that is what the science is saying, so that’s what we do in the program.”
But, this presented a problem for people who use wheelchairs. Wheelchair-accessible scales typically cost upward of $1,000, so people who use wheelchairs often only weigh themselves at the doctor’s office, where accessible scales are prevalent. Thankfully, over the course of adaptation, Clina was able to find affordable scales to purchase and send to the participants.
Clina also adapted the exercise portions of State of Slim to accommodate people with mobility limitations.
Clina has been involved in four prior State of Slim classes for the general population, but this disability-geared class has been the most active group of participants with thousands of engagements in the Facebook group in the first month. Attendance in weekly classes has been nearly perfect.
“Everyone that I talked with on my phone screening said, ‘I never thought there would be an accessible program for me to do this,’” Clina said. “It’s really special to hear that they feel they are heard and understood in this program. They feel they’re becoming a part of something they’ve never had the opportunity to before, and that’s empowering.”
Emphasizing the disability community’s desire for inclusive programs, Clina has a growing waitlist of three classes, and she will be leading another State of Slim Everybody class, starting in July. If interested in being a participant, people can email Clina at jclina@uab.edu.
“The weight is just one component,” Clina said. “I’m seeing a lot of improvements in confidence; I’m seeing improvements in social relationships. I think it has a lot to do with the mindset parts of the program.”
