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Finding What Works To Reduce Obesity Among Rural Residents

Bryan Thompson
/
Heartland Health Monitor
Janis Wearing weighs in with Shari Sutton at the Salina Family Health Care.

The recent news that Kansas is now the seventh-fattest state in the nation points toward a future of increased health problems—including cancer. In fact, as smoking rates decline and obesity rates rise, obesity is poised to overtake tobacco as the leading preventable cause of cancer. That’s why the University of Kansas Cancer Center is highlighting a weight control research study as part of its effort to win federal designation as a Comprehensive Cancer Center.

Janis Wearing says she’s been struggling with her weight for most of her life. The Salina woman didn’t have much success with Weight Watchers, TOPS, or even working with a dietician. So when her primary care clinic offered a free, two-year weight loss program as part of a study, she said yes.

“I wanted to take better care of myself," Wearing says. "I was feeling so unhealthy, and you know you get to where you are so overweight, then you get depressed.”

After four months on the program, Wearing has lost 40 pounds.

“Amazing difference! I have more energy," she says. "My bones don’t hurt so bad. My knees don’t hurt so bad.”

Wearing credits the group sessions with about a dozen of her fellow participants. They learn about food choices and exercise, all while motivating each other along the way. They also get a smartphone app called Lose It. Wearing and the others use the app to log everything they eat, a well as their physical activity.

“Say you want to eat something, and you can put that in, and then you notice that it’s a whole bunch of calories," Wearing says. "So then you come back, and you say, ‘No, I’m going to make a better choice.’ So that’s really helped me, too.”

Nurse Shari Sutton meets one-on-one with each of the participants to review their food and activity logs.

“OK, Jan, so how did we do on your week last week,” Sutton asks.

“Well, I averaged 1,030 calories,” Wearing replies.

“Good job! And your calorie goal was 1100 calories?”

“1100, uh-huh.”

If you think 1100 calories a day wouldn’t be that tough, think about this: a Big Mac and large order of fries is MORE than 1100 calories. Sutton says the plan offers specific guidelines.

“Two protein shakes a day, two pre-packaged meals, such as your Lean Cuisine, your Smart Ones, your Healthy Choice, and that’s for the first six months so that you can learn portion control,” Sutton says.

Participants can fix their own meals or eat out as long as they limit meals to 350 calories. Fruits and vegetables, at least five servings a day, are the only between-meal snacks. Sutton says the biggest hurdle for some is the rule that they don’t drink any calories. That means no loaded-up coffee drinks, soda pop, or beer. And she can tell when someone is cheating.

“Yeah, I totally have participants that come in and report, ‘Yes, I totally hit my 1200 calorie goal. I’ve totally hit my five days of at least 30 minutes exercise a day goal,’ however they’re gaining weight,” Sutton says.

But there is no brow-beating.

“We’re not here to say, ‘Oh, you failed.’ Failure is just if you stop trying,” Sutton says.

This weight-loss program is part of a University of Kansas Medical Center study called RE-POWER. The $10 million study will compare three different weight management models at 36 rural primary care clinics in four states. Rural residents have higher rates of obesity and related diseases than their urban counterparts. Their family physician may be their only option to help them lose weight. But many doctors are reluctant to talk to their patients about weight loss. Dr. Robert Kraft is overseeing the RE-POWER study at Salina Family Health Care. He hopes the study will make it easier to have those conversations.

“It’s hard to talk about things that we can’t do something about, so hopefully programs like this will help us develop services that we can then refer patients to,” Kraft says.

The KU Cancer Center is highlighting the RE-POWER study in its bid to be named a Comprehensive Cancer Center by the National Cancer Institute. Dr. Kraft says lifestyle factors are now recognized as major causes of cancer.

“I mean, smoking is very clearly one, but weight is as well," he says. " "There are many cancers that are certainly higher incidence in those who are overweight, and so getting people to lose weight is an important step in trying to prevent cancer.”

So far, 32 out of 40 patients enrolled by Dr. Kraft are actively participating in the program. Some have actually gained weight, but as a group, the Salina patients have lost a total of 500 pounds. The goal is to keep it off for two years.