11/11/22 Ancora Health
‘Together we want to achieve more with combined lifestyle interventions’
Why SLIMMER and Ancora Health are teaming up
Since 2019, the Netherlands has implemented ‘combined lifestyle intervention’ programs (known as GLI programs) to help people prevent developing weight-related health conditions. The costs are reimbursed as part of mandatory basic health insurance. But although thousands of people have enrolled in a GLI, not all target groups have been reached yet. In the new partnership ‘SLIMMER powered by Ancora’, the regional municipality GGD North and East Gelderland, the organization responsible for SLIMMER, and Ancora Health are working together to do something about this.
We spoke with Josien ter Beek, Program Manager SLIMMER, and Rahul Gannamani, Co-founder of Ancora Health, to find out more.
Tags: GLI, combined lifestyle intervention, obesity, overweight, lifestyle
Excess weight and obesity are very common health problems. In the Netherlands, about half of the adult population is overweight and in the whole of Europe the number rises to almost six in ten. Moreover, 14% of the Dutch population is obese.
The consequences are huge, both individually and collectively. Research shows that being overweight is linked to more than 200 disorders, including type 2 diabetes, cardiovascular disease, joint complaints, depression and infertility. Overweight people are often less able to participate in society.
Combined lifestyle intervention (GLI)
Besides the personal suffering of people who have health problems, the increasing number of overweight people is putting pressure on an already overburdened healthcare system.
Being overweight also has indirect social costs, such as absenteeism due to illness and incapacity for work. Hence, the arrival of the combined lifestyle intervention (GLI) program was very welcome.
A key benefit of GLI is that it can be reimbursed from people’s basic health insurance if they are obese, or overweight combined with other health risks. During a two-year GLI program, participants learn new lifestyle habits. Thousands of people have already successfully completed a GLI program.
Yet as it turns out, the return from the participation in GLI programs has fallen somewhat short of expectations. Only about one percent of the target audience has taken up the opportunity to enroll in GLI so far.
Operated by the municipality GGD North and East Gelderland, one of the existing GLI programs is called SLIMMER. It was devised based on a scientific study that showed that the risk of type 2 diabetes could be greatly reduced if people exercised more and ate healthier. The study was translated into a lifestyle program in the Academic Workshop AGORA, a collaboration between Wageningen University together with the municipality GGD North and East Gelderland. The name of the study was the ‘SLIM study’; from this the SLIMMER combined lifestyle intervention program was born.
After the first groups of users went through the program, the positive health results seen in the initial study were also achieved in the real world. SLIMMER was therefore immediately one of the first approved GLI programs to be introduced in the Netherlands. Professionals such as certified lifestyle coaches, physiotherapists and dietitians can offer the program to participants after receiving training from SLIMMER.
Last year, GGD North and East Gelderland and Ancora Health jointly investigated how the SLIMMER program could also be offered in a digitally supported form. Under the name ‘SLIMMER powered by Ancora’, they developed an implementation that leverages the advantages of digitalization while conserving the scientific foundation of SLIMMER (such as contact hours with coaches and other participants).
Josien ter Beek, Program Manager SLIMMER, and Rahul Gannamani, Co-founder of Ancora, talk about the collaboration and why the two parties chose each other.
Q. What are the key features of SLIMMER?
Josien: “The SLIMMER program has two phases: an intensive nutrition and exercise program of six months and an 18-month maintenance program. The program includes individual appointments with coaches as well as group meetings. The topics we cover are nutrition, exercise, sleep, stress and relaxation. Participants are also guided on how to access local exercise initiatives [such as walking groups].”
“At its core, SLIMMER is based on science. For example, we know that social support is an important precondition for lifestyle change. This is reflected in our program as we organize weekly contact moments where participants connect with a group of like-minded people. Other proven tools such as positive feedback, motivational interviewing and the formulation of action plans are also part of SLIMMER. We use a tailor-made approach: in addition to group contacts, there are also individual contacts so that the participants can work towards achieving their own goals.”
Q. You’ve been running this for 3.5 years and counting. What are the results?
Josien: “We’ve achieved consistent results in scientific and practical terms. Participants achieve a sustainable weight loss of an average of 3 kilos, in addition to improvements in various metabolic health factors. 78 percent indicate that they have started to exercise and play sports more. In addition to being more physically active, they also do more muscle and bone-strengthening activities. Moreover, they seem to take pleasure in being active. On diet, we see that people start to eat significantly more fruit and vegetables. All of this translates into improvements in their sense of wellbeing, quality of life and perceived level of health. Participants become better able to actively ‘participate’ in society and are more likely to take part in associations or volunteer work.”
Q. What convinced you to join forces with Ancora Health?
Josien: “Although we reach many people, there are also target groups we’ve found more difficult to penetrate. For example, significantly more women than men participate in SLIMMER, and young people and workers are underrepresented. Until now, almost all GLI programs are done with face-to-face meetings. By also offering the program digitally together with Ancora, we give greater choice and flexibility. In addition, we respond to the opportunities offered by digital tools for lifestyle improvement, which have so far been little used in GLI programs.”
“Another consideration is that many participants who started SLIMMER so far have a fairly high BMI. Often, these are people with chronic complaints who already need long-term care. It would be nice if we could reach more people at an earlier stage of their condition, so that we can prevent problems from arising in the future. It’s vital that there are [GLI] options for this.”
Q. Right! And for Ancora’s part, what drove you to join forces with SLIMMER?
Rahul: “With its digitally-enabled approach, we at Ancora have been able to help more than 1000 people towards better physical and mental health. Realizing that with this approach we can also play a role in the GLI, we researched the existing offer. SLIMMER emerged as a strong program fitting well with our prevention philosophy. Both of us believe in a holistic approach in which experts from multiple disciplines help each individual. Another important quality of SLIMMER is that it starts with an intensive coaching phase of 6 months, followed by a maintenance phase to properly retain the skills learned.”
“Like Ancora, SLIMMER has a strong scientific foundation, with results that have proven themselves in practice. With our partnership with GGD North and East Gelderland, we are building deeper integration with the local [health] facilities available within municipalities, such as the physical activity offering and social district [health and lifestyle] teams. That is important, because lifestyle changes happen in the neighborhood where you live, shop, walk and play sports.”
Q. What added value does SLIMMER powered by Ancora bring to the table?
Rahul: “Together we will achieve more: by removing the barriers for people to participate, ensuring that the program can be done from the home environment. We will send participants a free wearable and digital weighing scales so that they can keep track of their results using our mobile app.”
“An important difference with the digitally supported approach compared to an approach with face-to-face meetings is that it becomes easier to give [timely] feedback to participants. Seeing their results in our app allows them to see how they’re doing every day. Technology makes care continuous instead of periodic. This helps the participants to develop important micro habits, together with their coach.”
Q. What are the benefits of micro habits?
Rahul: “We know that lifestyle changes are sometimes difficult to sustain. But it often works by taking small steps: micro habits.”
“That is why it is necessary that participants receive a lot of feedback to know if they are on the right track. Plentiful feedback also means that the program can be tailored to the specific situation and health goals of every participant. We gradually learn more about their individual behavioral profile and what they encounter. Using that knowledge, we can select the correct micro habits that benefit each participant and work on them in a targeted manner. That increases the chance of success.”
Q. What are you expecting from SLIMMER powered by Ancora?
Rahul: “We are delighted to work with SLIMMER. With our joint efforts, we will ensure that the SLIMMER protocol is safeguarded, with the benefits of digitalization complementing the existing successful SLIMMER approach. We are ready to help many people to improve their health! We receive many enthusiastic responses from coaches who enjoy being able to offer digitally supported coaching in addition to their existing face-to-face work. In addition, we receive a lot of positive feedback from healthcare groups because we can help them to reduce the existing waiting lists for GLI. SLIMMER powered by Ancora fits in perfectly with the regional networks in which care groups do their work.”
Josien: “This is not only an important program for alleviating existing health problems, but also for preventing them. SLIMMER was partly created due to a demand in public health, and the preventive options of the program are in line with the work of the GGDs. With the collaboration with Ancora, we are thus taking an important next step.”
Josien ter Beek
Josien ter Beek is a public health advisor and project leader SLIMMER at GGD North and East Gelderland
Rahul Gannamani is a doctor, co-founder and head of health engagement at Ancora Health.