Program targets the complexity of obesity
Program targets the complexity of obesity
Education on healthy eating and barriers to success
To help overweight patients lose the pounds, the New Mexico Veterans Affairs (VA) Health Care System in Albuquerque launched an intensive weight-management program more than two years ago. Physicians refer patients to the program that have a body mass index (BMI) of 27 or greater with comorbidities such as diabetes or a BMI over 30.
However, obesity is not the only criteria for the program. Patients must be highly motivated as well. "Patients are screened for their readiness to change and readiness to take on an intensive weight-management program," says Miriam Simmons, MS, RD, LD, CDE, a clinical dietitian specialist at the New Mexico VA Health Care System.
Willingness to change is essential for success in the program. Patients can be given instructions on how to lose weight, but if they don’t have the skills or capacity to follow through on them, they will fail, says Simmons.
Patients are given one-on-one attention each month for up to two years. So for the time-intensive program to be cost-effective, patients must be willing to fully participate. This includes keeping detailed food and exercise records for the dietitian to review.
To help motivated patients overcome such obstacles as eating disorders or emotional barriers to weight loss, a behavioral psychologist is an important part of the program. One patient who benefited by having access to a psychologist was a woman who found that losing weight brought back all the fear she felt years ago when she had been assaulted. The assault took place at a time when she was young and slender and was a barrier to weight loss, says Simmons.
As part of the program, patients can choose to take a fat blocker called Orlistat that works in the intestinal wall and keeps about 30% of the fat that is digested from being absorbed into the body. Those who choose not to take the drug or can’t be given a prescription due to contraindications are just as successful as the group that takes the medication, says Simmons.
Education is an important part of the program as well. "Once people are in the program, we teach them how to choose lower-fat foods and how to bring their calories down," says Simmons. Patients slowly cut portions down as they increase exercise. Eventually, they learn that they will not be hungry if they stick to a 1,500-calorie menu that consists of healthy foods such as fruits and vegetables. "It’s learning to eat right," she says.
Even though the program has been operating for more than two years, it still is evolving, says Simmons. Currently, the screening process is an oral interview but a questionnaire is being developed that will help identify eating disorders and other issues that require the immediate intervention of the behavioral psychologist.
Once complete, the screening process will determine the pathway through the program that best suits their needs. For example, they may be referred to a psychologist first or work simultaneously with the psychologist and dietitian.
"Eating, like smoking and drinking, is a behavior. If we learn unhealthy eating behaviors, we must relearn how to make them healthy," says Simmons.
Source
For more information in the intensive weight management program, contact:
- Miriam Simmons, MS, RD, LD, CDE, Clinical Dietitian Specialist, New Mexico VA Health Care System, Ambulatory Care Nutrition, 1501 San Pedro Drive S.E., Albuquerque, NM 87108. Telephone: (505) 265-1711, ext. 2662. E-mail: [email protected].
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