Hospital program takes holistic approach
Lifestyle issues lead to weight problems
Instead of focusing only on weight loss, hospital programs should help employees in a more "holistic" way, approaching weight management as a lifestyle issue, says Susan B. Frampton, PhD, director of the Be Well! Center for Health Management at Beth Israel Hospital in Boston.
Some 30 to 40 employees sign up for the center's 10-week Eat Well nutrition and weight management program each quarter. Eat Well I is an introductory course, while part II is a maintenance program. Individual "drop-in" sessions with a registered dietitian give participants support between weekly meetings.
"It's important not to do just a weight-loss program," Frampton says. "We look at it as a lifestyle issue. What is it about your lifestyle that has gotten you to the point where you have a problem with weight? It could be that the most important thing for some people to do in a program like Eat Well is increase their activity level. They may be eating fine but not exercising enough. You have to look at it from a holistic point of view."
The program is entirely voluntary. No supervisor would ever tell an overweight worker to sign up, nor would an employee health practitioner suggest it unless a worker asked for help with weight loss.
Those who do enroll receive an individual assessment by a department nurse, who takes blood pressure and resting heart rate, performs a body-fat analysis, and draws blood for a cholesterol test. She also helps employees establish reasonable program goals.
"One thing that has not contributed to people's success in weight-loss programs is when they go into it with unrealistic goals, such as thinking they will lose 40 or 50 pounds in a 10-week class. That wouldn't be healthy, so we help people arrive at some realistic goals," Frampton says.
Forget the elevator
Goals might include decreasing the percentage of fat in the diet, exercising more, eating more servings of fruits and vegetables each day, or losing one pound a week for the 10 weeks in the program.
Participants plan and track their goals each week. The one-hour classes are led by registered dietitians and focus on better nutrition habits, using information based on the food guide pyramid. The program costs $8 per week, and employees can continue in Eat Well II indefinitely.
Employees are encouraged to increase activity levels, whether by using the hospital's on-site gym or just by choosing to climb the stairs to their work site instead of taking the elevator. Those who join the gym can receive specially designed exercise programs from the exercise physiologist.
The group format enables participants to share their emotional frustrations and difficulties, but the program is designed for behavior modification, not therapy, Frampton says.
Program participants range from workers who want to lose only five to 10 pounds to those whose goal is a 70- or 80-pound weight loss, says Frampton. Others might just want to improve their nutritional habits but have no weight to lose.
Reasons for offering the program vary as well. "There's a relationship between obesity and increased morbidity and mortality in the literature," Frampton notes. "Also, there's a demand for it. Employees look for support when they're trying to improve their eating habits and manage their weight."
She cites a 1993 study in which researchers found that 28% of Americans died from causes directly related to poor diet or inactivity.1
"We're not so much dying of contagious diseases -- we're dying from things we're doing to ourselves," she says.
Clinical changes predicted for participants
Later this spring Frampton plans to analyze data tracked from comparing a group of 25 employees who participated in the Eat Well program's first year with a group of another 25 who had just the initial assessment and the post-assessment but did not go through the program.
Although the data are not yet available, Frampton says initial impressions suggest positive changes in weight and blood pressure.
"We're going to see some clinical changes," she predicts, "particularly in those individuals who have continued on with the program."
In addition, satisfaction survey results show that many participants have been able to meet the goals they set.
Programs such as Eat Well are "important services" for hospitals to offer, Frampton adds. "More and more information is coming out saying obesity is a symptom of other things, such as a sedentary lifestyle. Many of the people who work in our hospital have sedentary jobs. They're sitting at computers or desks all day, and they're not active. If you're not active long enough and you don't modify your eating habits, you're going to gain weight."
(Editor's note: For more information on the Eat Well program, contact Susan B. Frampton, PhD, director, Be Well! Center for Health Management, Beth Israel Hospital, 330 Brookline Ave., Boston, MA 02215.)
Reference
1. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993; 270:2,207-2,212. *
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