(click here to visit the Can Do weight loss program site).
 
Anna Bliss didn’t set out to lose 56 pounds; her goal was far more modest. But the South Minneapolis mom signed on to a weight loss program that has been so effective she has stayed with it for more than a year, gradually shedding pounds and dress sizes. Bliss, 40, credits “Can Do” with her success. 

A national epidemic:
According to the Robert Wood Johnson Foundation, 65 percent of Americans over the age of 20 are obese (BMI of > 30) or overweight (BMI of > 25-29.9). Childhood obesity has doubled and the number of teenagers who are overweight has tripled compared to their counterparts in 1980.

Health conditions related to obesity include hypertension, cardiovascular disease, type 2 diabetes, arthritis, depression, digestive disorders, stroke and polycystic ovary disease, according to CDC. The Centers for Disease Control and Prevention links some 400,000 adult deaths per year to poor diet and inactivity.

Individualizing weight loss:
Can Do’s approach to weight loss is holistic, addressing all areas of the patient’s life, including activity level, food choices, work/family issues and beliefs and values, according to Sheila Tippie, R.N., the program’s health educator. Other weight loss interventions are more costly, can be more time consuming and—in the case of bariatric surgery—have more potential for complications, Tippie says.

But while its scope is broad, program weight-loss goals are modest. The National Institutes of Health states that a 10 percent decrease of body weight over six months is a reasonable and desirable goal. According to the American College of Sports Medicine, a weight loss of 5 percent to 10 percent improves overall health immediately. Indeed, some patients could define success simply as maintaining their current weight for six months, according to Tippie.

“Too ambitious a goal can seem overwhelming and quickly discourage patients,” says Jill Johnson, M.D., Burnsville Family Physicians and member, Fairview Physician Associates. “The ‘Can Do’ program encourages gradual adjustments in nutrition choices and exercise levels, which in the long run is more effective.”

Program reports success:
FPA staff has tracked “Can Do” patient outcomes since its implementation in February 2005. According to the data, 48 percent of the patients who completed six months in the program lost an average of 14 pounds, with an average decrease of 2.09 percentage points in BMI.

“FPA physicians are extremely pleased to be able to refer patients to someone who can work with all aspects of that person’s life to help him or her lose weight,” says William Nersesian, M.D., chief medical officer, Fairview Physician Associates. “This program has received overwhelming endorsement from participating clinics.”

At the heart of “Can Do” lies an individualized educational component: intensive coaching by a health educator. “What’s different about this program is that goals are so personalized,” says Tippie. “We present a group information session discussing healthy lifestyles, basic nutrition and physical activity. Then we sit down with each patient to help him or her set reasonable, achievable goals.”

In the time between the general information session and their individual meeting, patients are asked to keep a food- and activity-journal and to record how their lifestyle impacts their choices. “I found I was eating the right foods,” recalls Bliss. “I just was eating too much of them.”

At the individual meeting, patients set personal weight loss goals based on their BMI. Since patients often underestimate their weight, knowing their BMI and the health risks related to a diagnosis of obesity can motivate them to adopt new lifestyles.

The approach has worked for Bliss. “This program is not about getting you back to your weight in college. Rather, it’s about reaching a healthy, realistic, maintainable weight,” she says.

Plenty of support:
Tippie provides support by phone and e-mail, with in-person visits if needed. She also provides such valuable resources as a Web site that lists calorie estimates for homemade meals. Bliss also receives support from Brenda Baker, P.A., Fairview Uptown Clinic, her and her daughter Solveig’s primary care provider. Bliss is able to check in with Baker during Solveig’s visits, as well as her own.

The clinic referred Bliss to “Can Do.” “I have made referred adolescents, couples, and a lot of people in their 40s,” says Baker. “Most people have been happy with the program and followed through.” Baker simply faxes a referral form to Tippie, who lets her know if patients make an appointment.

Building exercise into a life style:
Long-term weight maintenance programs require a life style that includes exercise, say care providers. “Even a small increase in activity can provide benefit,” says Johnson. “Ideally, patients will do some form of cardiovascular exercise, along with activity to improve bone and muscle strength. For older adults, the effect of exercise on overall health is particularly significant.” For Bliss, keeping active includes water aerobics, an exercise bike and weight training at the YWCA. She recently added an evening exercise routine that she describes as a “win-win”: an aerobic workout while she watches her favorite TV shows.

Program can provide model:
FPA is pursuing insurance coverage for lifestyle-change education. “Our ultimate goal is to have obesity treatment through health education reimbursed by third-party payers as part of routine health care in Minnesota,” says Nersesian.

“We see this as a model for other health education and lifestyle interventions, including smoking cessation, decreasing stress at home and work, and improving parenting skills,” Nersesian adds.

FPA launched “Can Do” in 2005 with a grant from UCare Minnesota. Although the grant ended in December 2005, FPA is continuing funding through December 2006.  Tippie hopes to obtain longevity data by following patients’ success over time.

For more information on healthy living click on patient information and then the healthy living section of this Web site or (click here).