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Hospital pushes weight loss without surgery
Program focuses on underlying problems
Gastric-bypass surgery is all the rage these days, but rehabilitation can play a key role in reducing the complications of obesity without resorting to surgery.
At the University of Michigan Health System in Ann Arbor, the Obesity Rehabilitation Clinic treats patients in a multidisciplinary, medically supervised program.
"We do refer some patients for surgery, but obesity is a chronic disease, like hypertension, like diabetes, like heart disease. Just doing a procedure doesn’t take care of the problem," says Liselle Douyon, MD, an endocrinologist who is director of the clinic.
"You have to look at all the things that contribute to the obesity and work on modifying them. Traditionally, psychosocial aspects are ignored, and they cannot be ignored," she adds.
"There are some people who eat for comfort, and the obesity is a manifestation of loneliness or an ongoing traumatic event in their life. They can lose the weight, but the problem that got them to that weight is still there," Douyon explains.
The clinic focuses on four areas of treatment:
At the initial consultation, Douyon covers medical issues including comorbid conditions such as diabetes and high blood pressure. A social worker gives patients a psychosocial assessment to identify stumbling blocks, such as depression, that may need to be treated before the patient enters the program. An exercise physiologist gives patients a stress test to assess fitness needs, and a dietitian works on the patient’s food choices.
Patients commit to a six-month program in which they are expected to attend the clinic once per week to meet either with the whole team or individually with one of the team members. While at the clinic, patients participate in an exercise program and attend a series of lectures on topics ranging from sports bras to medical problems. They also come once a week for a group therapy session.
"We help patients set realistic goals. Some people want to look like Christie Brinkley, and that’s probably not going to happen," Douyon adds. "But maybe they can lose 10% to 15% of their body weight, enough to get off that sleep apnea machine or stop the arthritis in their knees or get rid of their back pain."
Doing things differently
Besides losing the initial weight, the program helps patients prepare for the maintenance phase. "That’s always the problem — keeping off the weight," she explains. "There is no cure for obesity. It’s a lifelong problem so that’s why we really focus on the lifestyle issues and help them find out what contributed to their obesity and what they can do to stop it where it is."
Another aspect of the program is vocational rehabilitation. Staff point patients to resources they need to get integrated back into regular daily life.
"We try to see throughout the program how the obesity affects their life. It’s not just lose weight to look good, it’s lose weight to be healthy," Douyon says.
"Some patients have been so obese they haven’t been able to walk, and now that they can walk, they can get out and look for a job. We don’t look for a job for them, but we point them to resources and get them mentally prepared," she adds.
A lot of the patients in the clinic haven’t been able to exercise at all.
"Being able to walk instead of being in a wheelchair is a drastic difference. Your center of gravity changes, and a whole host of things changes. How people view you, how you view yourself. People are discriminated against and made fun of publicly. There is lots of humiliation, and we try to work with patients regarding that," Douyon explains.
Obesity is a special focus at the University of Michigan because the state has the third highest percentage of obese people in the country behind Mississippi and West Virginia, according to the Centers for Disease Control and Prevention (CDC).
A 2001 CDC report shows that 24.6% of Michigan residents are obese.
"I think everyone is becoming aware of this as really being an issue. The downside is that a lot of people still see it as a cosmetic problem. It should be looked at like having leprosy," Douyon says. "You don’t just have spots on your face; you’ve got a disease that should be treated. When you’re obese, everybody knows you’re obese but no one knows why or how you got there."
The clinic offers an open-ended follow-up program that monitors patients and continues to give them the support they need.
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