The Complete Health Improvement Program (CHIP) is a lifestyle modification course designed for groups of adults (aged 18 or older) in any community or workplace setting. It is a premier lifestyle intervention targeting chronic disease that has been offered for more than 25 years. This program aims to improve nutrition and reduce cardiovascular disease (CVD) risk factors by educating participants about the medical benefits of adopting healthy eating and physical activity behaviors.
Origins and Development of CHIP
Hans Diehl, the first director of research at the Pritikin Center, developed CHIP. Inspired by the outcomes of the program at the Pritikin Longevity Center, Diehl recognized the limitations of residential programs, including their cost and the "artificial" living environment. He developed a volunteer-run education program that could be offered in the community. The first CHIP was presented in Creston, British Columbia, in 1988. In 1997, Dr Diehl recorded the program before a live audience in Kalamazoo, Michigan.
Core Components of the CHIP Curriculum
The CHIP curriculum includes a series of eighteen 45-minute educational lectures on downloadable video files. The lectures are delivered by several health experts in a group setting in 90-minute sessions that incorporate facilitated discussions and a series of three health risk assessments. The sessions are held at regular intervals over 12 weeks.
Lecture Topics
Lecture topics include:
- Modern medicine and health myths
- Atherosclerosis
- Coronary risk factors
- Obesity
- Dietary fiber
- Dietary fat
- Diabetes
- Hypertension
- Cholesterol
- Exercise
- Osteoporosis
- Cancer
- Lifestyle and health
- The Optimal Diet
- Behavioral change
- Self-worth
Participant Materials and Activities
Participants are given a textbook and workbook containing assignments with learning objectives to accompany each lecture. During the group discussions, participants review the information presented in the lecture, focusing on what information was new to them, what they liked or disliked, and what they will do differently going forward. All sessions are led by a trained and certified presenter, whose task is to manage the process rather than provide content, encourage regular exercise, provide a small number of food samples and, in some cases, cooking demonstrations.
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Dietary and Exercise Goals
Participants are encouraged to follow preset dietary and exercise goals. The dietary goals consist of adopting a more plant-based diet emphasizing as-grown, unrefined food such as whole grains, legumes, vegetables, and fresh fruits and maintaining a diet that is low in fat (less than 20% of energy), animal protein, sugar, and salt; very low in cholesterol; and high in fiber. The exercise goal comes from the Surgeon General's Report on Physical Activity and Health and consists of working toward walking or exercising for at least 30 minutes daily. After completing the course, participants are encouraged to join a CHIP alumni support organization to help them maintain their new eating and exercising behaviors.
Program Structure and Delivery
In the original clinical trials of CHIP, participants met in a group four times weekly for 2-hour sessions across 4 weeks of program curriculum delivery. The program included a series of sixteen 1-hour educational lectures by the developer, Dr. Hans Diehl, on the importance of healthy lifestyles, nutrition, and physical activity in reducing risk factors associated with hypertension and cardiovascular disease, supplemented by four 1-hour question-and-answer sessions by a dietician and medical professionals on prevention, arrest, and reversibility of chronic diseases. All sessions in the original clinical trials were led by one or more members of a team of trained presenters (typically a registered dietitian, physical therapist, and medical doctor), who provided live, hands-on education, answering participants' questions about lecture topics and workbook assignments and giving cooking and exercise demonstrations.
Effectiveness and Benefits of CHIP
The CHIP intervention has shown benefits for the management of chronic diseases and has been described by the American College of Lifestyle Medicine as “achieving some of the most impressive clinical outcomes published in the literature.” The clinical effectiveness of CHIP has been documented in more than 25 peer-reviewed publications in medical and scientific academic journals.
Physical Health Improvements
Within a month on the program, there was an average six-pound weight loss, and blood sugars, cholesterol, and blood pressures dropped enough for many participants to drop their antidiabetic, cholesterol-lowering, and blood pressure-lowering medications. CHIP participants were eating even fewer calories more than a year after finishing the educational program.
Mental Health Improvements
People didn’t just lose weight and improve their physical health; they achieved significant improvements in feelings of stress and sleeping disorders. After four weeks on the program, there was a greater than 50 percent drop in reported insomnia, restless sleeping, easy emotional upset, and feelings of fearfulness or depression. The psychological well-being of the CHIP participants might have been positively affected by increasing feelings of empowerment, making strides toward reducing their body weight, and improving other health indicators. As they start eating better and making strides, feelings of despair and failure may be replaced by a growing sense of accomplishment, increased social support, and a new sense of hope.
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Scientific Studies and Results
A quantitative, summative program evaluation was performed to measure the outcomes of CHIP. A program evaluation is a systematic collection, analysis, and report of data about the merit and worth of a program’s outcomes. The outcomes examined were the participants’ blood glucose levels, blood pressure readings, and weight measurements. A paired t-test was utilized to compare pre and post data sets to determine the influence of CHIP on blood glucose levels, blood pressure readings, and weight measurements.
Study Sample
The sample consisted of 73 participants from a CHIP, conducted at MercyOne Clinton Medical Center in midwestern US. Pre and post program biomarkers were obtained on site, at the time of each cycle of the CHIP program dating back to 2015. The average age of CHIP participants was 57.9. All subjects were Caucasian (N = 73). The gender profile was predominately female (79%). Participants of CHIP were volunteers who sought improvement of health status. The requirements of participation in CHIP are minimal; the participants must be at least 18 years old, have diagnosis of a chronic illness, and pay a fee to partake.
Results
The mean blood glucose prior to initiation of the program was 123.78 mg/dL (N = 73). After 18 sessions of CHIP over a 12-week time frame the group mean was decreased by 11.53 mg/dL. The post-intervention mean was lowered to 112.25 mg/dL (N = 73). The mean systolic blood pressure prior to initiation of CHIP was 128.97 mmHg (N = 73). Following 12 weeks of intervention, the systolic blood pressure values were discovered to be reduced. A scant decline of 1.42 mmHg landed the post-intervention systolic blood pressure reading at 127.55 mmHg (N = 73). Prior to the initiation of CHIP, members were found to have a mean weight of 213.838 pounds (N = 73). After 12 weeks of classes the 73-participant group experienced weight loss. CHIP triggered a reduction in weight by 7.945 pounds per individual. The p-value for paired t-test between pre and post blood glucose groups were 0.008, indicating statistical significance. The p-value for weight was 0.000, signifying a statistical significance between pre- and post-intervention data sets. The p-value for pre and post blood pressure t-test was 0.403.
Community Impact
CHIP was so successful in the city of Rockford, Illinois that dozens of restaurants started offering special plant-based menu options.
Theoretical Basis of CHIP
The CHIP intervention incorporates elements from several behavior change theories including the Health Belief Model, the Social Cognitive Theory, and the Transtheoretical Model. Underpinning the intervention, however, is the Theory of Planned Behavior. The Theory of Planned Behavior asserts that behavior is driven by intention, which is formed from attitudes, social norms, and perceived control. CHIP has a strong educative component to change the participants’ attitudes toward healthy living, and health literacy around nutrition and health behaviors has been shown to significantly improve as a result of the program. CHIP occurs in a group setting to foster new social norms and accountability.
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CHIP in Iowa
CHIP has more than a 30-year history in Iowa and represents vital local action to promote and protect the health of Iowans. At least every five years, local public health assures a community-wide process takes place to identify the most important factors affecting health in the community and to plan strategies to build on strengths and work on gaps.
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