Learning to Treat Obesity as a Chronic Disease
Physical education teacher Valerie Prim with students at Forbush Elementary School in Yadkin County.
Because Valerie Prim grew
up in a large Italian family, food has always been an important part of her
“Everything about food
was big,” Prim said. “You never thought about what you ate.”
But a few years ago, when
Prim was dealing with a job-structure change and a case of empty nest syndrome,
food became a bigger part of her life – and not for the better. The longtime
swimmer, aquatics instructor and physical education teacher fell into a deep
depression and turned to eating as a coping mechanism.
The fast-food restaurants
of Yadkinville, North Carolina, where Prim lives, beckoned all too often, and
her weight rose from under 150 pounds to over 220. She also developed high
blood pressure, was close to being pre-diabetic and was unable to participate
in physical activities with her students because of pain in her knees and other
Stories like Prim’s are
A Centers for Disease
Control and Prevention study released in June found that 38
percent of American adults are obese in terms of body mass index, a measure of
body fat calculated from weight and height. Three years ago, the American
Medical Association declared obesity a disease.
The AMA’s action was
important to Dr. Jamy Ard, co-director of the Weight Management Center at Wake
Forest Baptist Medical Center in Winston-Salem, which offers both medical
weight-control programs and weight-loss (bariatric) surgery.
have been taught directly or implicitly that obesity is more of a character
flaw … that it’s related to being lazy and inactive,” Ard said. “Now, we have
the AMA designation of obesity as a disease, which has been influenced by
progress in the science of obesity. As a result, we’re changing people’s
attitudes, and the next step is to improve access to more medical treatment for
Ard noted that commercial
weight-loss programs gained traction long before obesity was understood to be a
chronic disease. But most of those programs have centered on diet rather than
lifestyle changes, he said, whereas medical weight loss focuses “on the ideal
weight for you to do the things you want to do and be healthy.”
For people with serious
weight problems who are not interested in or candidates for bariatric surgery,
Wake Forest Baptist’s center has two physician-supervised weight-loss programs
that go beyond diet and exercise to tackle obesity from multiple angles.
In January 2013 Prim
entered the Weight Management Center’s Optifast program, a comprehensive
52-week course that includes meal-replacement and nutrition plans, behavior
modification to promote lifestyle changes, counseling to address underlying
issues that contribute to weight problems, medical attention to weight-related
conditions such as high blood pressure and personal exercise training with a
fitness specialist, plus follow-up sessions, support and guidance.
Through the Optifast
program, Prim lost about 70 pounds. More importantly, she has kept off nearly
all of that weight.
“This was a lifestyle
change,” said Prim, 58. “This was not just about losing weight. It was about
getting healthy again, having energy, feeling good. It didn’t matter what my
body looked like; I wanted to be able to teach these kids.”
Annette Frain, a dietitian
with the Weight Management Center, said attitude goes a long way toward success
for medical weight-loss patients.
“If someone is looking to
me for a ‘diet,’ I’m the first to turn them away,” she said. “Fundamentally,
they have to change their relationship with food.”
Wake Forest Baptist’s
patients learn how they often eat in response to the stresses in life and are
taught ways to change their behaviors over time. “It sets our program apart
from others,’’ Frain said.
Measuring the lasting
effects of medical weight-loss programs is difficult, Ard said. Although
studies have shown that the majority of bariatric surgery patients maintain at
least a loss of 50 percent of their excess weight over time, the field of
medical weight loss is so new that long-term data on success rates is not yet
“What I tell people is
that they need to stay connected, come to their maintenance visits and continue
to go to group classes to be successful in maintaining weight loss,” Ard said.
“We’re also trying to develop more electronic engagement, ways to capture data
via a wearable device.”
The Weight Management
Center’s medical weight-loss programs suggest that people eat up to five times
a day – three meals and two snacks – but with limited calories. And the
calories they do consume must include protein. Prim, for example, often snacks
on Greek yogurt, which is low in fat and high in protein.
She began collecting her
empty yogurt cups for teaching purposes, and her fellow educators and
administrators in the Yadkin County school system began sharing their empty
cups with her.
Today, Prim uses those
hundreds of empty yogurt cups in athletic activities with her students, as
towers to race, hop or skip around, for example. She hopes her healthier
lifestyle sets a positive example for her students and colleagues.
“This is my motto: ‘I
used to be a has-been athlete because that’s how I felt. Now I’m a triathlete,
never to be a has-been again.’”