Genetics, economics, environment, psychology and government policies have all played roles in why, as a nation, the United States has for a generation been getting heavier. No surprise then, that controlling weight needs to be about much more than just 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 it is,'' said Dr. Jamy Ard, co-director of the new adult Weight Management Center at Wake Forest Baptist Medical Center and leader of two non-surgical weight-control programs.
Ard's approach is shared by the leaders of other weight-control programs at Wake Forest Baptist, including those for children and older adults. All of these programs stress education -- not just for the people facing weight issues, but for their families, too -- and long-term commitment to changed habits in addition to healthier diet and exercise practices.
Some people view bariatric surgery as a quick fix for obesity, but at Wake Forest Baptist more is expected of patients than just showing up for the procedure.
Patients are encouraged to lose weight or at least stay "weight neutral" in the month or so before undergoing bariatric surgery, which reduces the size of the stomach or limits its capacity to process food. By adopting new habits during this period, most patients lose a significant amount of weight before the operation, said Dr. Adolfo "Fuzz" Fernandez, co-director of the Weight Management Center and head of its bariatric surgery program. "The goal is making those lifestyle changes,'' said Fernandez, who was a classmate of Ard's at Duke Medical School. "Obesity is a disease. Surgery is the most successful treatment, but without life modification -- portion control, healthy choices and exercise -- even surgery will not be successful in the long term."
In other words, patients who have undergone bariatric surgery can put weight back on if they haven't changed their habits.
"We offer a monthly post-op support group -- group therapy so to speak -- and most of those patients do really well,'' Fernandez said. "We don't see a lot of recidivism."
Susan and Allen Fletcher had bariatric surgery at Wake Forest Baptist after years of following diets that only worked for brief periods. She was 288 pounds at her heaviest and now weighs about half that. She started by losing 50 pounds before having the surgery. Her husband is down to 180 pounds from a high of 450.
The benefits, she said, "have been life-changing."
When she had a work conference in New Orleans and her husband went with her, she said, they immediately discovered the pleasure of being able to fit comfortably in airplane seats. Better yet, she said, during conference down time they were able to explore.
"New Orleans is just the most amazing city," Susan Fletcher said. "Every day after I finished classes we would walk for a couple of hours, just exploring. There's so much on that trip we would have missed if we had not lost the weight."
When it comes to young people with weight problems, Dr. Joseph Skelton believes giving parents tools to raise healthier children is just as critical as working with the children themselves.
"You improve those parenting skills, you can improve the children's weight," said Skelton, director of the Brenner FIT (Families in Training) program at Wake Forest Baptist's Brenner Children's Hospital.
So the Brenner FIT program includes teaching parents and children about the importance of moderation (such as buying and eating a single-size cup of ice cream rather than a pint or half-gallon), showing how low-calorie snacks can be tasty and better for everyone in the household and pointing out the benefits of choosing diet sodas over sugary drinks. Tammy Stegall said she and her husband, Mike, decided they needed help for their overweight 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 said. "I needed some guidance. And I wanted something safe for my child."
Change went slowly for the Stegall family at first. After a few months, said 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 said, because the program preaches "one step at a time.'' He wound up losing 50 pounds, and has kept the weight off.
Weight problems may be different but are no less critical for older adults, according to Barbara Nicklas, Ph.D., who leads weight-management efforts for seniors through the Sticht Center on Aging at Wake Forest Baptist.
"We believe there are specific challenges to older folks that we need to address in our programs, different motivations to start with," she said. "Why would a 70-year-old want to lose weight?"
Among the motivators for seniors, Nicklas said, are improving their physical abilities in grip (to carry groceries, for example), strength (so they can walk or rise from a chair without difficulty) and stamina (walking further, being able to play with grandchildren, etc.).
A 24-week Sticht Center program called My Turn teaches seniors about their habits and how to make positive changes. The classes are held at a YMCA and a retirement community in Winston-Salem.
Calvert Jeffers, 72, said that 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 said. "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 said she initially hoped that her arthritis pain would be reduced through the program, 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," she said.
"There's writing class, the book club and all kinds of things like that," she said. "It may not be that I am free of pain, but I do have more energy."
Wake Forest Baptist's weight-management efforts are aimed at people of all ages because of changes in behavior toward food and nutrition, especially in the past 20 years.
Ard points to the proliferation of fast food and processed foods, larger portion sizes, agricultural policies that support production of unhealthier foods and a decline in active lifestyles as some of the reasons behind the high rates of obesity in the United States -- approximately 36 percent among adults, 40 percent among seniors and 17 percent among young people age 2 to 19.
As obesity rates have soared, so, too, have related health problems such as heart disease and diabetes. Consequently, Ard and his colleagues fear that the next generation may have a lower life expectancy than the current generation.
"But you can't stop the forces of innovation and capitalism and entrepreneurship," Ard said. "As long as people are going to be incentivized to make money with 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 have to be able to adjust, to come up with new strategies to deal with the new environment that we're in and new policies to help us navigate these new challenges, leading to a healthier population overall."
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