People taught they can 'Choose to Lose'
People taught they can Choose to Lose’
Program teaches successful lifestyle change
Richard, a 30 year-old sergeant in a Florida Sheriff’s Department, suffered from several weight-related health problems including high-blood pressure and sleep apnea. Then his department offered officers the opportunity to enroll in a Choose to Lose program at Tallahassee Memorial Hospital.
During the eight-week program that teaches participants about foods that are making them fat, Richard changed his way of eating. Instead of snacking on peanuts from the convenience store, he chose fruit, air-popped popcorn, and pretzels for snacks.
Dropped from a 44 to a 34
Once he developed a new way of eating, limiting fat in his diet, and selecting low fat, high carbohydrate foods, he went from a size 44 pants to a size 34, and his health improved.
Choose to Lose is a community outreach program. While many people who enroll are anxious to lose weight, it is not marketed asa weight loss program. "We focus on health more then we do on weight loss. People need to change their behavior for good and look at something they can do for a lifetime. If you call it a diet or a weight loss program, it sets people up to think about short-term changes, something they would do for a little while and not necessarily a lifestyle change," says Amy McDaniel, CHES, a health education specialist and public education wellness coordinator at the hospital’s Heart Institute.
The program was developed by Ron Goor, PhD, MPH, and Nancy Goor, MFA, a husband and wife team. Goor coordinated the Coronary Primary Prevention Trial at the National Heart, Lung, and Blood Institute (NHLBI) in Bethesda, MD, which proved lowering cholesterol reduces the incidence of heart attack. Following the study, he became the first coordinator of the National Cholesterol Education Program at the institute. Later, he paired with his wife to develop the Choose to Lose program. (For details on how the program works, see p. 60.)
Part of wellness programs
Members of Kaiser Permanente in Akron, OH, are often referred to the Choose to Lose program by their primary care providers or a dietitian on staff. "People are referred because their weight is interfering with their health. We are a health maintenance organization [HMO], so our physicians are looking for ways to improve member’s blood pressure and cholesterol, lowering their risk for heart disease, and to improve their blood sugars," says Kris Voight, RD, MSED, lead nutritionist at Kaiser. Members or non-members can enroll in the program if they need to lose 20 pounds or more.
PacifiCare Health Systems, an HMO, implemented Choose to Lose as part of a company wellness program about two years ago, after forming a committee to review several weight management programs. "Our goal was to find a program that would be simple for employees to implement, focus on low fat, high complex carbohydrate food, and incorporate exercise. Also, we wanted a program we could purchase and easily implement. Choose to Lose best fit our criteria," says Anne Buhlig, MS, employee health improvement manager at PacifiCare Health Systems in Cypress, CA.
The company markets the program to employees via e-mail and fliers. However, following an annual employee health screening that measures such factors as cholesterol and blood pressure, those with health risks are encouraged to attend. One male employee lost so much weight, he no longer looks like the same person pictured on his employee identification badge. Another employee enrolled in the program but could not change her eating habits. Yet, a year later, she enrolled again and was ready to make the lifestyle changes.
Stuck in the same eating pattern
While there are always success stories, many people aren’t able to change their eating habits. "In a class of 30 people, we may get 10 people who are serious about changing. Other people who come learn a little, and they may lose some weight, but they aren’t ready to apply it long term," says McDaniel. (See article on why people can’t make dietary changes, p. 61.)
To make sure more people who enroll in the program are successful, Camilla Whitkanack, MS, RD, a clinical dietitian at Gibson General Hospital in Princeton, IN, tells them exactly what they must do to get results. Her suggestions include:
• Keep thorough food records each day, and track aerobic exercise.
The purpose of the food record is to make sure people are eating enough calories, while limiting fat intake. "One of the biggest mistakes people make is restricting their calorie intake. It may be an effective means of weight loss for the short term, but in the long term, calorie restriction does not work," says Whitkanack. When a person restricts calories, pounds may drop off, but he or she loses muscle and water in addition to fat. Also, a person’s metabolism slows, so when he or she returns to the old eating pattern, the body processes the food more efficiently and the weight comes back, she says.
• Be willing to spend time in the kitchen trying new low-fat recipes and modifying old favorites.
There are several recipes in the Choose to Lose book people receive when they enroll in the class. In addition, Whitkanack gives the class a list of low-fat cookbooks and invites guest speakers for cooking demonstrations.
• Take time to eat.
When people skip meals they are more likely to give in to high-fat temptations, Whitkanack says.
• Don’t deprive yourself.
People count fat calories so they can budget for high-fat items they enjoy. If a person wants a piece of cheesecake they are encouraged to eat it. Should the item put them over the number of fat calories budgeted for the day, they are asked to offset those calories by eating fewer fat calories the next couple of days. This way, people don’t have to give up favorite foods.
• Refrain from weighing yourself at home.
People who do not lose weight quickly enough could get discouraged, explains Whitkanack. "I stress over and over again that permanent weight loss is slow," she says.
• Focus on health benefits; not weight loss.
"I want them to think of improved appearance as a bonus; not the driving force behind their lifestyle change," says Whitkanack.
At PacifiCare, successful past participants are asked to speak to the people in new classes. Also, class graduates are invited to monthly follow-up sessions in an effort to help them stay on the plan, says Buhlig. During the sessions, guest speakers discuss various health-related topics, or some of the Choose to Lose material is reviewed. Employees pay $30.00 to enroll in the program, but the fee is fully refunded if they attend 80% of the class sessions. "When we implemented this policy, attendance improved. People aren’t going to be successful if they don’t attend the classes," says Buhlig.
Fees vary
Health organizations charge various fees for the class to cover the cost of the instructor and materials. While PacifiCare offers the class free as an employee benefit, participants at Tallahassee Memorial who attend Choose to Lose as a community outreach program pay $135.00. "A local HMO allows its members to enroll in our program for a $20.00 copayment. I have found that people who pay the $135.00 have more buy-in," says McDaniel.
Class size also contributes to the effectiveness of the program. Big groups provide more camaraderie and support, says McDaniel. Class sizes at Tallahassee Memorial are usually 25 to 30 people. Yet, Whitkanack finds that keeping class size down makes them more informal, and people are more talkative. She limits the classes to 20 so people have an easier time getting to know one another, and to make it easier to oversee food records. "I have to review each person’s food records, and it takes about 15 minutes to review each record," she explains.
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