October 2002

Fitsburgh
So you've stepped onto the scale, or just looked in the mirror and know it's time to shed some pounds. Crash diets and fads are not for you. You want to improve your health, not risk it. Where can you look for help?

BY DANA BLACK

So how do we get there from the ninth-fattest city in the United States? At local hospitals, insurance providers and other community groups, help is on the weigh.

If a quick fix is what you seek, we can't help. Nobody can. But for sound, sensible approaches and strategies for long-term health, read on. As anyone who has ever been on a diet can tell you, it's not easy.

"We live in a toxic food environment," says Dr. Madelyn Fernstrom, associate professor and director of the UPMC Health System Weight Management Center. Food is cheap, plentiful and everywhere. But, she notes, "There are no bad foods, just bad portions."

Is obesity caused by genetic predisposition or overconsumption? The problem lies somewhere in between, she says. "Where we go astray is we want to blame everything on genes." People have to take some responsibility for their weight, she says. The first step is to acknowledge that too much food is being taken in, and not enough is being put to use.

Where can you turn for help and sound advice? A good starting point is your doctor, then call your insurance company about what programs and treatments may be covered.

Costs for treatment vary widely, to say the least. Some classes and seminars are free. Surgical procedures can range from $15,000 to more than $25,000. Rates of coverage vary from insurance company to insurance company and policy to policy, and they can change with each patient based on his or her individual health history/condition and its progress. Two patients with the same insurance plan, same amount of weight to lose and same treatment plan could pay radically different amounts if one had no other medical concerns and the other had a complicating condition, such as diabetes, heart disease or joint replacement.

To maximize benefits, both financial and physical, be sure to coordinate and communicate with both your doctor and insurer.

Dr. Jorge Vazquez, director of the Lifetime Weight Management Center at Forbes Regional Hospital/Forbes Lifestyle Center, part of the West Penn Allegheny Health System, suggests that when considering a weight-loss plan, a patient should explore options, considering potential risks/benefits and the potential outcomes.

"Often diet alone is not enough for a patient," says Vazquez. For morbidly obese patients, other options, such as medications or surgery, may be considered.
Pharmaceutical treatment may include Meridia or Phentermine, both appetite-suppressants that alter the neurochemicals in the brain that control eating, resulting in less hunger and a more-full feeling. Patients who take these drugs, in combination with diet and exercise, have experienced a 10 percent to 20 percent weight loss within six months, says Vazquez.

Xenical (which blocks the absorption of fat), explains Vazquez, works in the digestive system, resulting in 30 percent wasted fat in the system, and can result in a 10 percent to 15 percent weight loss in six months. Although he considers this to be a very safe drug, use may result in some embarrassing, but not harmful, side effects.

Whether your goal is 5 pounds or 50, don't be downhearted. "Any progress is positive," says Fernstrom. You don't necessarily need to have a BMI under 25 to be healthy.

"Any change is better than nothing," says Fernstrom, even if it is eating five fruits/vegetables a day or walking 30 more minutes. All small changes help. "There is hope for everyone. It is never too late."

To help you get started on the road to a healthier self:

Hospital-based programs
Canonsburg General Hospital: Part of the West Penn Allegheny Health System. A support group for overweight people on the fourth Tuesday of every month (7-8 p.m. in the hospital's McNary Conference Center) covers such related issues as self-esteem, weight-control options, nutrition, mobility and even makeup/fashion tips. 100 Medica Blvd., Canonsburg, 724/745-5499.

Greene County Memorial Hospital: Through its Wellness Center, the hospital offers nutritional education including dietary analysis, individual counseling and special-needs assessments. Fitness equipment and programs include "Weight Wise" and personal training. 350 Bonar Ave., Waynesburg, 724/627-2500.

Indiana Regional Medical Center: "The ABCs of Weight Loss" is a weight-management program offered to employees and the public focusing on activity, behavior modification and caloric intake. The program and others (like the "Heart Beats" program offered through Select Blue in September) are available. The next class ($30) is tentatively scheduled for November. 835 Hospital Road, Indiana, 724/357-7089.

Jefferson Regional Medical Center: Nutrition Link, an outpatient nutrition-counseling service, offers not only weight-control services, but also helps with nutrition counseling for cancer, diabetes, heart disease, food allergies and other conditions. Counseling and nutrition plans are provided by a registered dietitian. 565 Coal Valley Road, Pleasant Hills, 412/469-7000.

Latrobe Area Hospital: "Learning to Lean," a series of eight one-hour classes ($100), addresses nutrition, behavior modification and exercise; morning and evening year-round. Private consultations with a registered dietitian are part of the program. After completion, members are invited to attend Club Lean, a monthly support group. 121 W. Second Ave., Latrobe, 724/537-1000.

Mercy Hospital: Resources include a pediatric endocrinologist equipped to help children with weight-management issues. Adult endocrinologists also are on staff. The Mercy Heart Institute's Cardiac Rehabilitation Program offers individualized plans for those concerned about cardiac health, proper nutrition, exercise and weight management. The diabetes program offers individual and group sessions on diet, nutrition and weight management for diabetics. A registered dietitian offers individual nutrition counseling and group cooking classes. 1400 Locust St., uptown, 800/232-5660.

Monsour Medical Center: Three staff physicians offer separate regimes of weight loss/nutrition/food supplements. Route 30, Lincoln Way East, Jeannette, 724/527-1511. The Wellness Weight Loss Center, directed by Dr. W. John Monsour, integrates dietary counseling, lifestyle modification and an exercise regime with educational seminars on physiology and metabolism; 724/836-1701. The Dr. Bob Medical Weight Loss Program operates eight centers throughout the area; 888/221-7358. Dr. Geoff Medical Weight Loss combines prescription medication, nutritional counseling and food supplements. 28 Fairwood Drive, Irwin, 724/863-8822; and Crawford Building, 12000 Frankstown Road, Penn Hills, 412/798-3451.

Monongahela Valley Hospital: "Lifestyles of the Fit and Healthy," a nine-session series, focuses on lifestyle and behavior, nutrition, exercise and stress management, using the expertise of registered dietitians, physical therapists and psychologists. The program is supported by grants from the Pennsylvania Department of Health and Roche Pharmaceuticals. The next session ($25) begins Oct. 1 with prescreening, individual consultations and program overview. Postscreening is conducted at six and 12 months following completion of the program. Country Club Road, Monongahela, 724/258-1318.

Westmoreland Health System: The Well-Being Center for Mind/Body Health offers the "Weigh to Be" program, with nutrition education, physical activity ad behavioral modification. Phase 1, an intensive eight-week program, combines individual nutrition consultation with eight weekly group sessions. Phase 2 includes continued renewal and support and incorporates monthly group sessions with regular weigh-ins. 532 W. Pittsburgh St., Greensburg, 724/830-8568.

UPMC Health System: Its Weight Management Center treats obesity itself as a chronic disease. The multidisciplinary team addresses biological, metabolic and neurochemical issues, employing the expertise of gastroenterology, pulmonary medicine, preventive cardiology, plastic surgery, endocrinology, clinical nutrition, exercise physiology, sports medicine, complementary medicine and psychiatry. Treatment options include lifestyle adjustment, adding pharmaceutical treatments, or in the case of severe obesity, surgical solutions including gastroplasty (commonly known as stomach stapling) and gastric bypass. Lifestyle is always a foundation of treatment at the center, explains Fernstrom, but the center offers a "tool box" approach, and sometimes medications, or pharmaceutical therapy, to help by providing "tools" for weight loss. However, patients must realize that nothing medication-wise can eliminate lifestyle concerns. "Tools" like medication or surgery will make the lifestyle more manageable, but not easy. Even after surgery the lifestyle is even more difficult, Fernstrom cautions. Losing 100 pounds is quite a different task than losing 10 or 15 pounds, so treatments are individualized and depend upon an individual's risk factors, existing illnesses and what he or she is willing to do. Clinical-research studies also offer the opportunity to participate in new treatment strategies for weight control. In May, UPMC's Health Enhancement Program launched its Lifestyle Weight Management Program, a 12-week series of classes on nutrition, cooking and exercise. 200 Lothrop St., Oakland, 800/5538762.

West Penn Allegheny Health System: The Forbes Regional Hospital Life Styles Center's Lifetime Weight Management Program, an individually customized physician-directed program, provides medical nutrition therapy, education, exercise, behavior modification and psychological support. Services are offered "a la carte," including a behavioral weight-loss program (LEARN, for Lifestyle, Exercise, Attitudes, Relationship, Nutrition), which helps patients develop lifestyles and skills to manage their weight, nutrition counseling, individualized nutrition and exercise plans, an on-site exercise facility, yoga and tai chi programs and personal training. Treatment options include a very low calorie (less than 800 per day) diet, which is most commonly provided in liquid form 12 to 16 weeks. This program includes behavior modification and an exercise program. The liquid diet can be very useful, if used appropriately, says Vazquez, most often for patients who have extreme obesity combined with another health problem, perhaps to reduce the risk of complications with surgery, or to get weight down before surgery. Referrals also are made to Allegheny General Hospital for gastric bypass or other weight-reduction surgeries, if appropriate. Forbes Life Style Center, 2580 Haymaker Road, Suite 403, Monroeville, 412/858-3030.

Insuring health
Highmark: Customers have free access to seven HealthPlace locations, which provide exercise classes, yoga, tai chi, nutrition education, one-on-one counseling and more. 800/650-8442.

Cigna Healthcare: The "Healthy Rewards" program gets members discounts at approved fitness clubs, and "Working Wonders" gives members who exercise regularly fitness-related prizes like sports equipment and sweat clothes. 800/870-3470.

In the community
Mall Walkers: Monroeville Mall and Forbes Regional Hospital have partnered for the Monroeville Mall Walkers Club, which encourages residents to take advantage of walking in a safe and comfortable environment: walking three laps around the upper or lower level of the mall equals one full mile. Walkers can do their thing Monday-Saturday from 7:30 a.m. until 9:30 p.m. weekdays, and Sundays from 10:30 a.m. to 6 p.m. (Note that pedestrian traffic is lightest before 10 a.m.) Members receive a mileage card to record miles walked. Miles can be exchanged for a variety of incentives, from water bottles to mall gift certificates. On the first Thursday of each month, 8-9 a.m., the hospital hosts a health and fitness station in Kaufmann's Court providing health information and screenings. Monroeville Mall, Business Route 22, Monroeville, 412/373-0374.

Carnegie Library of Pittsburgh: The library offers a free "Fitness and Nutrition Resource Guide" at all branches that provides lists of books, Web resources, databases and state and national organizations. Carnegie Library of Pittsburgh, 412/622-3114.

Pennsylvania Department of Health: The state is funding nutrition and exercise offerings in Southwestern Pennsylvania as part of two programs: the "Cardiovascular Risk Reduction Efforts" and "Health for Life." 1-877-PA-HEALTH.

Dana Black is the former lifestyles editor of this magazine.