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No More Loafing Around

Justice Health and Forensic Mental Health Network
Project Added:
19 February 2016
Last updated:
4 March 2016

No More Loafing Around


The Elouera Unit promoted healthy weight through education and review of the meal provision program, in collaboration with patients.

More details of the project:



To address rising obesity rates in the Elouera Unit at the Forensic Hospital, by identifying potentials causes that are contributing to weight gain in the patient population.


  • Improves patient health outcomes and morale.
  • Helps patients make informed, healthy food choices.
  • Improves the ability of staff to monitor dietary intake of patients.
  • Educates staff on the relationship between dietary intake and weight.
  • Reduces costs associated with obesity-related health conditions.


Anecdotal evidence suggested that patients in the Forensic Hospital were prone to substantial weight increases throughout their stay, leading to increased risk of diabetes, heart disease and other adverse physical and psychological health outcomes. Of particular concern were patient groups in the lower security units, especially the Elouera Unit, where rapid weight increases in individuals had been observed by practitioners. It was determined that individual factors such as diet and medication were more likely to be the cause of this weight gain, than relative environmental factors such as security restrictions.

In 2014, the Better Health Committee at the Forensic Hospital commissioned the ‘Weight Gain Report’, a study which corroborated anecdotal evidence and assessed the seriousness of any potential weight gain. However, it did not attempt to identify the causes of weight gain in patients at the Forensic Hospital.

In an attempt to improve the health outcomes of the patient population, the ‘No More Loafing Around’ project was developed to identify the causes which were contributing factors to weight gain in Elouera patients. The project was intended to align to the current Justice Health Recovery Model principles, which include:

  • uniqueness of the individual
  • real choices
  • attitudes and rights
  • dignity and respect
  • partnership and communication
  • evaluating recovery.

The principles ensure that patients are part of the decision-making process and are supported during recovery while taking control of their own healthcare needs.


  • Patient feedback surveys and focus groups were undertaken, to identify their concerns with weight gain and what they believed were contributing factors.
  • While medications were seen as the primary concern, patients highlighted bread as being a major contributor to weight gain. All contributing factors noted were:
    • medication 32%
    • bread 21%
    • milk 16%
    • MILO 10%
    • kiosk 16%
    • shopping order 5%.
  • A change was made to the bread order, incorporating brown and multigrain loaves as well as white bread. Elouera staff completed a bread register prior to and following implementation of the project, to measure bread intake for each patient.
  • Elouera staff provided education to patients on healthy bread intake and encouraged them to complete a weekly food diary for personal use, to increase awareness of their dietary intake.
  • Metabolic monitoring was undertaken during the change, to measure health outcomes following the change in dietary intake.
  • The team reduced the amount of milk provided to patients from 14 litres per day to 10 litres per day, to address the third major cause of weight gain in the Elouera population.

Key dates

  • Project start: August 2015.
  • Project finish: June 2016.

Project status

Sustained - the initiative has been implemented and is sustained in standard business.

Implementation site

Elouera Unit, Forensic Hospital, JH&FMHN


Medirest (food, hospitality and support service).


  • Following project implementation, there was a significant reduction in patient bread intake each week.
  • The food diaries have increased patient awareness of dietary intake and enhanced self-management of weight.
  • The average weight of Elouera patients decreased, from 94.63kg in 2014 to 92.18kg in 2015.
  • A full data analysis will be conducted in mid-2016 to determine if the project has improved health outcomes.

Lessons Learnt

  • It was important to engage with key stakeholders early in the project and engage with patients using open and transparent communication.
  • We wanted to use Justice Health Recovery Model principles to guide the project, however the plans we presented were viewed as restrictive and didn’t adhere to the rehabilitation pathway of Elouera.
  • There were initial budgetary concerns around adding healthy bread choices to the menu, but the team managed to deliver healthier bread choices within the budget.

Further Reading

  • Brown B, Van Sciver A, Sullivan D et al. A psychiatric rehabilitation approach to weight loss. Psychiatric Rehabilitation Journal 2006; 29(4): 267-273.
  • Brown C, Goetz J, Hamera E. Weight-loss intervention for people with serious illness: a randomized controlled trial of the RENEW program. Psychiatric Services 2011; 62(7): 800-802.
  • Coakley C, Bolton P, Flaherty L et al. The incidence of metabolic risk factors in an inpatient psychiatric setting. Journal of Psychosocial Nursing 2012; 50(3): 24-30.
  • Daumit GL, Dickerson FB, Wang N et al. A behavioural weight-loss intervention in persons with serious mental illness. The New England Journal of Medicine 2013; 17: 1594-1602.
  • Henderson D, Cagliero E, Grey C et al. Clozapine, diabetis mellitus, weight gain and lipid abnormalities: a five-year naturalistic study. The American Journal of Psychiatry 2000; 157(6): 975-981.
  • Australian Government. Department of Health.
  • Nutrition Australia.


Carl Isherwood
A/ NUM, Elouera Unit, Forensic Hospital
Justice Health & Forensic Mental Health Network
Phone: 02 9700 3396

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