Almost anyone who has visited a doctor’s office has heard the phrase “come see me in six months.” But for people seeking help with obesity, this doctor’s office classic offers shockingly little in the way of guidance.
As recent headlines about weight gain among TV’s “The Biggest Losers” make clear, shedding pounds is a monumental challenge and keeping them off is even harder. Neither is going to be accomplished by a twice-yearly doctor’s visit.
And because many insurance plans either don’t cover weight-loss surgery or pay only part of the costs, this is rarely the answer.
Long-term intervention programs are a more practical and more affordable solution for most obese people, according to experts who spoke last month during the Association of Healthcare Journalists conference in Cleveland.
“I think people have a perception that anyone who is obese can have bariatric surgery to correct that now,” said Cleveland Clinic endocrinologist Bartolome Burguera. “But for most people, that isn’t an option. Only 3 percent of morbidly obese individuals receive bariatric surgery. And the other 97 percent –15 million people – we don’t know what to do with. We as doctors don’t really tell people how to go about losing weight in a practical way.”
A better alternative, according to Burguera’s fellow panelists, are intensive lifestyle intervention programs that are springing up in Georgia and elsewhere.
Participants in these programs check in with their doctors every one or two months in group settings. They discuss progress and stumbling blocks, have nutritional counseling, and can ask questions of their doctors as they arise rather than waiting for that next six-month checkup.
“Group support has been shown to be of incredible help to adults trying to lose weight,” says psychologist Carolyn E. Ievers-Landis, an associate professor of pediatrics at Case Western Reserve University.
“But it can be even more important for the families of children trying to lose weight. Parents and other caregivers have such an impact on the child’s success, and intervention programs help the child learn more about being healthy while teaching the parents how best to support them.”
She has witnessed the impact of ongoing support provided by the “Healthy Kids, Healthy Weight” program at Rainbow Babies and Children’s Hospital in Cleveland, where she studies childhood obesity. The program is supported by the Robert Wood Johnson Foundation.
But Georgia families don’t need to travel to Cleveland to find help for an obese child. The Strong4Life Clinic in Atlanta is one of the state’s largest family based programs aimed at helping children who have been diagnosed as clinically obese. Similar programs for children and adults are available through Emory Bariatric Center’s “Your Weigh” and “Path 2 Health” programs, as well as the Center Helping Obesity In Children End Successfully (C.H.O.I.C.E.S.) in Atlanta.
Based in the Children’s Medical Office Building at Scottish Rite Hospital, Strong4Life serves the families of children as young as 8 months of age and as old as 21. Clinic staff members teach children about healthy eating and physical activity and help them take the lead in bettering their own health. Community outreach, local school visits, and healthcare provider training programs help to ensure that Strong4Life’s educational efforts are far-reaching.
“[During clinic visits] we set two goals at each visit—one for food and one for activity,” says registered nurse and clinic manager Tammi Tanner. “The food goal might be something like only having one glass of juice each day and drinking more water instead; the activity goal might be getting up and moving during the commercial breaks of their favorite show. We want these goals to seem attainable, and letting the kids decide what their goals will be is very helpful for that. They’re a part of the process, they’re not just being told what to do.”
In exceptional cases, families and counselors have decided that bariatric surgery is the best solution for a child. The clinic’s youngest bariatric surgery patient was 13. Behavioral intervention such as nutrition and physical activity training helps 75 percent of patients stop gaining weight and maintain a steady BMI, or body mass index. Roughly half are able to lower their BMIs over time.
“Often, families have been told something along the lines of “your child must lose weight or face serious health problems or death,” says Tanner. “But what are parents supposed to do with that? All this really accomplishes is making kids hate the doctor. At Strong4Life, our goal is to help kids love being healthy.”
By Shelby F. Jarrett