BY LUCY SCHULTZE

Like dismantling a bulky barricade sitting in the way of life, effectively treating obesity takes more than one tool in your hand.

That's a lesson applied every day at Central Mississippi Medical Center's (CMMC) Comprehensive Weight Management Center (CWMC). There, the Bariatric Surgery Center founded in 2002 gained a complement three years later with the introduction of the Medical Weight Management program. It's now a model as the state's first hospital based comprehensive program for weight management.

"We knew from the beginning that we were going to offer surgery," said Adam Dungey, RN, program coordinator for the CWMC. "But there was already a vision that we had to offer something for those who are not quite 100 pounds overweight, or who didn't want surgery or whose insurance didn't pay for it."

While the surgery center continues to include aspects like nutritional counseling, psychological evaluation and long-term follow up, the Medical Weight Management umbrella includes meal replacement therapy, weekly counseling and monitoring and a supervised exercise program. The program teams with Novartis for the use of OPTIFAST®.

"What we offer is an 18 week meal replacement program — but it's not just meal replacement," Dungey emphasized. "We don't want them to think it's another diet. Whether it's surgery or nonsurgery, it's all about a lifestyle change. We're just giving them the tools."

In the weight management program, those tools take the form of regular visits with RNs, nurse practitioners and other medical team members. Weight and vital signs are checked weekly, with lab tests performed every other week. Patients receive education in reading labels and choosing health foods, and food diary checks offer accountability.

While all patients who complete the program lose weight, each individual's success is typically tied to their commitment to the program and desire for long-term health.

"Those that stay with us monthly tend to do well — and they also find other ways to lose the weight," Dungey noted. "With those that continually come back to us, we see great results."

Medical monitoring is key to CWMC's formula for safely dropping calorie counts to a very low level during the initial 18 week period.

An integral exercise program is also vital. When CMMC's employee gym opens to patients in the afternoon and evening, an exercise physiologist or intern is on hand to act as a personal trainer for weight management patients, offering encouragement and making adjustments to their fitness regimens.

Because the program requires such close and regular interaction between patients and the CWMC team, hospital employees and other Jackson area residents were the first to take part. More than 40 patients have participated in the nonsurgical program over the past year, including commuters from Natchez, Meridian and Philadelphia.

"We just have to make sure they go to a fitness center in their area, and that they have a psychologist in their area," Dungey said.

Although CWMC provides a letter of medical necessity to each insurance company for patients' treatment, payers' policies for bariatric surgery and other obesity management treatments varies widely, Dungey said.

For patients whose surgery is not covered, CWMC has made a point of including comprehensive treatment in its cash prices so that patients paying out of pocket know their costs up front and aren't surprised by a la carte additions. For example, the program's $16,500 fee for its recently introduced LAP-BAND® procedure includes preoperative psychological, nutritional and pulmonary visits, as well as a 90 day follow up with the surgeon, coverage in case of complications and education with an exercise physiologist. A support group with fellow patients is included as well.

The CWMC's surgery component has completed more than 300 procedures since its inception in 2002; some 200 patients were on the waiting list in late 2006.

Challenges on the horizon include working with a coalition of other surgeons in Mississippi as well as with teachers and other state employees to push for insurance coverage for obesity management surgery and services.


January 2007