Heavy Concerns Mercy’s New Comprehensive Weight Program Offers Plenty Of Options

The causes of America’s growing weight problem are many and well-documented. Solutions are equally numerous — although people don’t always know which one best suits them.

 

That’s a void that Mercy Medical Center’s new comprehensive weight management program is trying to fill, by giving area residents a one-stop option for assessment of weight problems — both obesity and eating disorders — and a range of in-house treatments that encompass medical, behavioral, and even surgical components.

“A multi-disciplinary weight-loss center is much-needed in the Western Mass. community,” said Dr. Christopher Keroack, medical director of the program. “We’re committed to filling that need.”

With obesity clearly on the rise in America, that’s a need that’s only expected to grow. As Keroack told The Healthcare News, Mercy wants to set the standard in the area in not only treating weight problems, but doing its part to slow the trends that feed them as well.

Weight and See

One of the main appeals of Mercy’s program, Keroack said, is a word in its title: comprehensive. That’s clear from the moment a patient walks in the door.
“When individuals come in with concerns about their weight, they have a medical evaluation, a dietary evaluation, and a psychological evaluation — all based on each patient’s needs,” he said.

From that in-depth triage of sorts, the professionals at the center — who include a program coordinator, a registered dietician, a psychiatric consult nurse, and several physical and occupational therapists — make judgments about which course of care will work best.

For some, it’s mainly behavioral management — alterations in diet, lifestyle changes, or an increase in physical activity. Others might need a medical regimen, possibly introducing pharmaceutical products or making alterations from the medications they already take to treat other conditions, in favor of similar drugs which don’t promote weight gain.

And, for cases of extreme obesity, bariatric surgery is an option. Keroack is in the process of becoming board-certified as a bariatrician, and the surgery — which involves shrinking the stomach down to the size of a walnut — is a consideration for the heaviest patients with the greatest risk factors.

The National Institutes of Health (NIH) sets out guidelines for patients who are best suited for bariatric surgery, but Keroack said one fairly common qualification is a body mass index of 40 or higher. The BMI is a scale that compares height to weight to come up with a number; 25 or higher generally means someone is overweight, while 30 or higher denotes obesity.

On average, surgical candidates are 100 or more pounds above their ideal body weight. Very few people fall into the dangerous 40 range of the BMI, but bariatric surgery is also sometimes recommended for patients with a BMI greater than 35 and medical complications, such as diabetes, hypotension, high cholesterol, thyroid problems, high blood pressure, or cancer.

“On average, all these things cause mortality increases, and these people are in the extreme categories,” Keroack said, noting that patients in Mercy’s program will have access to services at the institution’s Joslin Diabetes Center affiliate. “They start suffering morbidity and mortality from their weight.”

Obesity can even trigger other conditions that are less immediately life-threatening, he added, from sleep apnea and gallstones to osteoarthritis and depression.
Bariatric surgery is still considered a last resort for those who require it, he added. But, with celebrities such as weatherman Al Roker and singer Carnie Wilson losing more than 100 pounds with the procedure — and talking about their successes in the media — it’s gaining acceptance in the mainstream.

Building a Standard

Keroack said he modeled the Springfield program after similar efforts in Boston, particularly at Mass. General Hospital and Mass. Medical Center. “I frequently get advice from the directors out there as I try to make this truly comprehensive,” he said.

But Mercy is trying to distinguish its program in other, subtle ways. For instance, patients learn right away that their privacy and comfort are both valued. While non-surgical patients are seen at 300 Stafford St. on the hospital’s campus, surgical patients are treated at the hospital itself, where six patient rooms on the fifth floor have been remodeled to better accommodate obese patients and their families before and after surgery.

“We’ve substantially widened the door jambs; installed special furniture, beds, and toilets; and made a number of other changes with the bariatric patient in mind,” said Beverly Ventura, vice president of patient care services. “And the six rooms are located out of the way of other patient areas to allow severely overweight patients a measure of privacy.”

In addition, nurses at Mercy have undergone sensitivity training related to dealing with obese patients. That’s key, Keroack said, especially since the hospital expects to handle as many as 200 bariatric procedures a year.

That sensitivity will also be applied to the underweight patients who seek help at the center for eating disorders.

“Unfortunately, these people are going in the opposite direction, so the other aspect of our clinic is counseling and medical management of eating disorders, such as bulimia and anorexia,” Keroack said. He explained that such conditions are often associated with young people, and they aren’t sufficiently addressed in the adult population, although they should be.

“I think most people with eating disorders get treated in their teenage years by pediatricians, but when it continues into adulthood, there are very few resources in Western Mass. to help them,” he said. “We’re trying to form a framework for treating these disorders in adults.”

Food for Thought

Still, Keroack understands that most of the weight-related attention in the medical community these days will be on obese patients. Due partly to an increasing reliance on unhealthy food coupled with a trend toward less physical activity, Americans are simply heavier than ever.

A federal standard called Healthy People 2000 called for a sharp decrease in the percentage of overweight Americans. Simply put, Keroack said, the effort failed, as up to 60{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of Americans are currently overweight or obese, by some reports. A new standard, Healthy People 2010, aims to bring that figure down to 15{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} or 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} within seven years.

Keroack and his staff know that’s a challenge, perhaps even an unrealistic one. But they’re doing what they can locally — through medicine, surgery, and old-fashioned education — to take a bite out of some frightening trends.