A Resolution on Weight?
Genetics, environment, psychology, government policy all play a role in why, as a nation, the United States has for a generation been getting heavier. No surprise then, that managing your weight is about much more than diet and exercise.
"My job is to build a specialty program that deals with medical weight management, providing a long-term care model to treat obesity as the disease that it is,'' says Jamy Ard, MD, who arrived at Wake Forest Baptist in September to become co-director of the new adult Weight Management Center. The center is one of just a few places nationwide to put medical weight loss and surgery programs together.
Ard joined his classmate from Duke Medical School, Adolfo "Fuzz" Fernandez, MD, as co-director of the Weight Center, where Fernandez directs bariatric surgery and Ard leads two new non-surgical weight management programs.
Their approach with adult patients is similar to those taken by Joseph Skelton, MD, MS, whose work with adolescents in the now 5-year-old Brenner FIT (Families In Training) program, and Barbara Nicklas, PhD, who leads weight management efforts targeted at older adults through the J. Paul Sticht Center on Aging and Rehabilitation. The colleagues frequently discuss the issues common to weight management.
All of the programs in place at Wake Forest Baptist stress education-not just for the people facing weight issues, but for their families, too. The physicians running the programs say they typically look for long-term commitment to changed habits rather than quick diet and exercise fixes.
The Gastric Bypass Option
Bariatric surgery is often perceived as a quick fix approach for obesity, but at Wake Forest Baptist, patients are educated that more is expected of them than just undergoing the surgery.
Patients are asked to stay weight neutral or lose weight in the month or more before bariatric surgery, which tends to reduce the size of the stomach or limits the stomach's capability to process food. Most patients, Fernandez says, lose a significant amount of weight before surgery as they learn better habits.
"The goal is making those lifestyle changes,'' he says. "Obesity is a disease. Surgery is the most successful treatment but without life modification, i.e. portion control, healthy choices and exercise, even surgery will not be successful long term."
In other words, patients who have been through bariatric surgery can put weight back on if they have not changed their habits.
"We offer a monthly support group, group therapy so to speak, and most of the patients within those groups do really well,'' Fernandez says. "We don't see a lot of recidivism.''
Susan Fletcher, 42, of Yadkinville had bariatric surgery along with her husband, Allen, after years of diets that only worked for brief periods. Susan Fletcher was 288 pound at her heaviest and is now about half that. She started by losing 50 pounds before the surgery. Her husband has lost 270 pounds, down to 180 from a high of 450.
The benefits, she says, "have been life changing."
When she had a work conference in New Orleans and her husband went with her, they immediately discovered the pleasure of being able to fit comfortably in an airplane seat. Better yet, during conference down time, they explored.
"New Orleans is just the most amazing city,'' Fletcher says. "We went on a walking tour of one of the cemeteries. Every day I finished classes we would walk a couple of hours, just exploring. There's so much from that trip we would have missed if we had not lost the weight.''
Obesity and Youth
Skelton says that for overweight children, giving parents different tools is just as critical as working with the children themselves.
"You improve those parenting skills, you can improve the children's weight,'' he says.
So Brenner FIT helps teach parents and children about:
- Moderation, such as buying and eating a single-size cup of ice cream rather than pints or half-gallons.
- Preaching the wisdom of diet sodas over regular.
- Showing how low-calorie snacks can be tasty and better for everyone in the household.
Brenner FIT is reaching more than obese children and families. It has created a partnership called the Kohl's Family Collaborative to bring parenting and nutritional resources to families and providers in education and health fields throughout the region.
"The majority of kids who have a problem with weight before puberty will continue to have problems after puberty,'' Skelton says. Society cannot, as it did in previous generations, count on children "growing out'' of obesity, he says.
"Kids are going to sports leagues, church, music lessons, tutoring. All good things, but the more time you spend on the go the less time you have (as a family) sitting down together to share a meal,'' Skelton says. Inevitably, that leads to eating foods with less fiber and more fat.
"So many of us know what to do to be healthy. But that doesn't mean we do it,'' he says. "What we do in Brenner FIT is help people learn how to do it.''
Tammy Stegall says she and her husband, Mike, decided they needed help for their son, Michael, when he was 13 and had started to bully his younger brother, a sign that he himself was being bullied at school.
"There are so many misconceptions about what is best, what you eat and what you don't eat,'' she says. "I needed some guidance. And I wanted something safe for my child.''
Change went slowly for the Stegall family at first. After months, says Michael Stegall, now 15, "I looked in the mirror and said 'that's not who I wanted to be.' And so I thought 'Let's try to make a change.'"
Brenner FIT was a good match, he says, because the program preaches "one step at a time.'' He wound up losing 50 pounds and has kept it off.
Weight Issues and Seniors
The problems may be different, but they are no less critical for senior citizens, Nicklas says.
"We believe there are specific challenges to older folks that we need to address in our program, different motivations to start with,'' she says. "Why would a 70-year-old want to lose weight?''
The motivation that has to drive them, Nicklas says, is improving their physical activity and ability in grip (for example, carrying groceries), strength (so they can walk or rise from a chair without as much of a struggle) and stamina (walking further, being able to play with grandchildren).
The 24-week My Turn program offered through the Sticht Center teaches seniors about their habits and how to make changes. Classes, open to anyone, are currently held at either the Robinhood YMCA or Salemtowne Retirement Community, both in Winston-Salem.
Calvert Jeffers, 72, of Winston-Salem, says although he was not grossly overweight, vanity became an issue.
"My granddaughter kept teasing me about my belly. I said 'OK, I'm going to get that under control,'" he says. "These things become a matter of how one goes about just simple day-to-day activities. I continue to exercise, things I've always been doing, but I do it with a little more purpose in mind and a little more discipline as a result of My Turn.''
Judy Freeman, who at 75 requires a walker, has lost 50 pounds midway through her second series of My Turn classes. She says she initially hoped that her arthritis pain would be reduced, something that hasn't happened.
But paying more attention to healthier habits is helping her to get "involved with things that are not necessarily physical,'' says Freeman, who lives at Salemtowne.
"Writing class, the book club and all kinds of things like that,'' she says. "It may not be that I am free of pain, but I do have more energy.''
Awareness About Weight and Environment
Wake Forest Baptist's weight management efforts are aimed at all ages because of how society has changed with regard to food, in the past 20 years especially.
Ard says he fears the changes the last 50 years have brought:
- A proliferation of fast food and processed foods.
- A decline in active lifestyles.
- Increasing portion sizes and the resulting health problems.
- Agricultural policies that support production of unhealthier foods.
As obesity rates have soared, so, too, have related health problems such as heart disease and diabetes. With his colleagues, he expresses the fear that the next generation may have a lower life expectancy.
"But with that being said, you can't stop the forces of innovation and capitalism and entrepreneurship,'' Ard says. "As long as people are going to be incentivized to make money for new technologies and labor-saving devices and new food products, you're going to have these things and they're going to keep coming faster and faster.
"So our job is not to say 'Hey, we can't have any sugar-containing beverages because we think those are bad.' Food is around to be enjoyed.
"We've got to be able to adjust, to come up with new strategies to deal with the new environment that we're in. New policies to help us navigate these new challenges so that leads to a healthier population overall.''