Obesity Program Stresses Lifestyle Changes

October 1, 1997

Judith Zwolak

Sugarbusters...Phen/ Fen...Pritikin--the members of the first group of participants in the new Tulane Obesity Program have tried all of the popular diets, pills and fads. And most of them have lost weight--for a while.

"We see people who have been in all kinds of programs and participated in all sorts of diets. They have been there, done that," says Deborah Marcontell, assistant professor of psychiatry, clinical psychologist and clinical director of the obesity program. "They lose the weight for a while, but they gain it right back."

Part of the medical center's Eating Disorders Clinic, which is under the direction of Susan Willard, associate professor of psychiatry, the obesity program eschews the "quick-fix" diet mentality and embraces a more long-term, holistic approach to weight loss and weight maintenance. "We try to emphasize that obesity is a chronic disease," says Marcontell. "Some people will always need to maintain their awareness that they have a tendency to be overweight. They will always have to be mindful of what they eat and incorporate exercise as well as other lifestyle changes into their lives."

Marcontell and Willard began developing the program last year in response to patients encountered at the clinic. Although the clinic is primarily known for treating individuals suffering from anorexia nervosa, a disease marked by a relentless pursuit of thinness, and bulimia nervosa, a condition in which binge-eating is followed by self-induced vomiting, therapists had seen compulsive over-eaters in the clinic since its inception in 1982.

They decided to develop a group program based on the clinic's established, multidisciplinary approach to treating eating disorders. "On an individual basis, we have been doing this kind of program all along," Marcontell says. "It's the group format that's new." 

The 12-week program begins with psychological, nutritional, medical and physical therapy evaluations. Not all people who want to lose weight are automatically eligible for the program, says Marcontell.

"I perform the initial evaluation and determine whether the program will be beneficial for a particular individual and whether I think they are an appropriate candidate," she says. Someone with severe emotional or psychological problems would not be a candidate for the program, Marcontell says, but would be referred to more appropriate services.

Janet Johnson, assistant professor of psychiatry, is the program's psychiatric consultant. Also, Blanche Gray and Lise Diamond-Devine are therapists available for individual psychotherapy. Following acceptance into the program, a physician evaluates the health status of the participant and gives the prescription necessary for a physical therapy evaluation.

The participant's own physician can perform the evaluation or the program's physician, Terry Cummings, assistant professor of medicine, may see the individual. During the physical therapy evaluation, physical therapist Stacy Cosse notes any special needs or limitations to be considered when designing an individual's exercise program.

Included in the nutritional evaluation is a computation of body mass index, using a statistical formula equal to a person's weight in kilograms divided by height (in meters) squared, to indicate how overweight someone is. Other indicators include skin-fold measurements, waist circumference and waist-to-hip size ratios.

"An individual is considered obese when their body mass index is 27 or greater," she says. "An index of 27 tends to be the point at which someone has an increased risk of medical complications."

Throughout the evaluations, the exercise and nutritional components are individualized for the participants. In the 12-week program that follows, participants meet in group sessions including psychosocial therapy, nutritional counseling, lifestyle changes and physical therapy.

"We believe that we have designed a program that people can stick with long term--one that fits their lifestyles, includes their food preferences and works for them," Marcontell says. "If they're eating food they don't like or doing exercises they hate, then they are just not going to complete the program. I know I wouldn't!"

Nutritionist Corey Walsh, a registered dietitian, offers nutritional evaluations and guidance. Walsh currently teaches the program's weekly nutritional class, which covers such topics as portion control, fast-food eating and recipe modification. Jan Johnson, the clinic's senior nutritionist, provides consultation.

In the program's lifestyle change classes, held twice a month and led by Alison Lester, instructor of psychiatry and neurology, participants learn how to identify what triggers them to overeat, such as stress or negative feelings about themselves. Marcontell leads the weekly psychosocial support-group session, where program members develop coping skills to help them incorporate what they've learned in the rest of the program.

"In the lifestyle-change class, we teach behavior modification techniques and participants learn how to correct negative thinking patterns that lead to overeating," Marcontell says. "In the support group, we talk more about the feelings and the barriers that prevent individuals from implementing what they learned in the lifestyle change and nutrition classes. Group members can also give each other support."

An individualized exercise component, which incorporates two physical therapy sessions a week, rounds out the program. With all parts of the program in place, Marcontell says that a realistic, healthy weight loss average is about two pounds per week. The cost of the obesity program, excluding evaluation fees, is approximately $1,200 for 12 weeks.

"That's reasonable for a program as comprehensive as ours." Marcontell says. In fact, the costs may add up to less than the total money spent on some weight loss programs that require participants to purchase their program's specially packaged food, she adds.

Currently, a group of eight people are participating in the 12-week program. Two are participating in monthly aftercare meetings. The Tulane Eating Disorders Clinic moved all of its clinical operations last month from Tulane Hospital and Clinic to the DePaul-Tulane Behavioral Health Center at 1040 Calhoun St., next to Audubon Park. For more information about the Tulane Obesity Program, call 587-7480.
