LUCY SCHULTZE

The rising rate of obesity in an age where its risks have never been clearer suggests it’s a more complicated disease than we thought. Should the approach in treating it be equally complicated?

The answer is “yes” for a team of professionals at University of Mississippi Medical Center (UMC).

They’ve come together from across disciplines to expand UMC’s bariatric surgery program into the Comprehensive Weight Management Program (CWMP), an umbrella under which patients ranging from merely overweight to morbidly obese can find the solutions they need — from surgery and medications to diet and behavior change.

“I call this my ‘dream team’ — the coming-together of many disciplines,” said Dr. Annette Low, an internist and director of the program. “We all have the same goal of treating obesity as a serious chronic disease that needs this kind of serious attention.”

Her interest in seeking such solutions grew out of her experience in private practice, where she saw first-hand the way weight issues drive other chronic diseases. Since she joining UMC, her work within the Diabetes and Metabolism Center further underlined those connections.

“We started exploring: ‘How do we pull together a team that will address the obesity condition as a true entity?’” she said.

Low began working with the surgeons in UMC’s bariatric surgery program along with representatives from other disciplines to go over cases and better understand what made some surgery patients successful in weight loss and others not. The team included a key aspect that’s typically missing from other medical weight-loss programs: that of behavior, addressing the complicated psychology behind why we eat what we eat.

The program that has grown out of this team’s collaboration has lifestyle change at its core, and teaches behavior, nutrition, exercise knowledge and more.

“What we’re hoping to accomplish is not just a diet,” Low said. “We want to help our patients learn some useful tools they can use for the rest of their lives to maintain a healthy lifestyle.”

To the bariatric-surgery program, the team added in July 2007 a Behavioral Weight Loss Program under the CWMP umbrella. This program is for those patients with a BMI higher than 25 who either don’t need or don’t want weight-loss surgery. The goal is to lose 5 to 10 percent of body weight at a rate of 1 to 2 pounds per week.

The program begins with a brief medical visit to rule out medical causes and review medical complications related to the patient’s obesity. A brief medical follow-up also comes at the end.

In between, the patient attends 12 weekly classes employing The LEARN® Program by psychologist Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University. At $520 out-of-pocket for patients, the lifestyle-focused program is the same as a patient would use in similar programs at places like Mayo Clinic or Duke University, said UMC psychologist Karen Grothe, PhD, associate director of the program.

“We focus on making lots of small changes that they’re able to maintain over the long term,” Grothe said. “Most people can lose weight; it’s keeping it off that’s the hard thing.”

To help patients maintain their weight after the program ends, they hold on to the manual that comes with it. They are also allowed to come back and attend one class per month indefinitely, to provide greater accountability.

As a next stage, the program is set to add a meal-replacement component through Health Management Resources™ in early 2008. A step up from the basic behavioral program, it also includes weekly classes and is designed for those who need to lose 10 to 20 percent of their body weight.

“It’s more costly, but for some people, the controlled portions and caloric intake are just what they need to take it to the next step,” Grothe said. “We’ll also have an option for people who just want to buy a case of the shakes for breakfast, or want entrées to take to work.”

While the cost will depend on what people are ordering, a patient could do it for around $90 to $100 per week, Grothe said, in addition to filling in with a few fresh fruits and vegetables.

In the second half of 2007, some 10 to 20 people completed the behavioral program — many of them UMC employees and their families, who receive a discount. The program hasn’t yet been widely marketed, but informational sessions offered twice a month have drawn 100 people or more.

“The biggest problem is patient expectations,” Grothe said. “They see the late-night commercials and think they can lose 20 pounds in a week.”

The informational sessions are offered at noon on the second Wednesday of the month, and at 5 p.m. on the fourth Wednesday of the month, both in the UMC Pavilion.

The program takes self-referrals as long as the patient already has a primary-care physician and is meant as a complement to that relationship.

“We’re not assuming care of patients and not trying to monopolize their care,” Low said. “We’re offering them a piece of service they may not able to do on their own.”

For an additional $100 fee, patients can set an appointment for an exercise evaluation, wherein a physical therapist takes time to evaluate their needs and go over types of exercise equipment.

In the coming years, the UMC team is looking forward to being involved in clinical trials as more weight-management drugs emerge.

It has also piloted an Executive Weight Management Program modeled after one at the Mayo Clinic. Under it, at a higher cost, patients see only terminal-degree providers on a one-on-one basis rather that in a group.

Instead of 12 in-person visits, the patient can opt for a minimum of six in-person visits and six more via teleconference. The design is aimed at patients who prefer not to be in a group-based setting, either because of their status in the community or because it’s not feasible with their schedule.

In the long term, the team hopes to develop models for replicating its program in other parts of the state.

In addition to Low and Grothe, the team also includes Dr. Ken Vick (surgery); Emmy Parkes, RD, MS, and Jacinda Roach, PhD (nutrition); nurse practitioner Debra Taylor; registered nurses Carole Ward and Lori Forbes; Katie McClendon, PharmD; Judy O’Jiles, PhD (psychology); and Paige Weathersby, OT/PT.



January 2008