Helping people get healthy is Stephanie Spaide’s job. Sometimes, that means being the bearer of bad tidings.
“It’s not what you want to hear,” says Spaide, director of outpatient nutrition services at the Center for Weight Management and Nutrition at Boston Medical Center (BMC). “But if you’ve been struggling with [obesity] for 25, 30 years, the chances of you just losing weight and never having to think about diet or exercise again [are] pretty much zero.”
Getting patients to accept two difficult truths — that losing weight requires effort and discipline, and that so-called shortcuts don’t work in the long run — is at the core of the center, the longest-running clinical weight loss program in Boston.
On average, the center treats about 250 patients each week. About 70 percent of patients are racial or ethnic minorities, groups hard hit by weight- and nutrition-related medical issues.
“Hispanic and black populations do have a higher obesity rate,” says Spaide. “Our [general] population is pretty bad itself, but when you look at the Hispanic population, specifically Hispanic women, and African American individuals, they are at more of a risk.”
While many of those who visit the center come for help with obesity-related problems, the team of dietitians, nutritionists and physicians also treats patients with diabetes, eating disorders, cardiac (heart) problems, hyperlipidemia (an elevation of fats in the bloodstream), pregnancy-related nutritional concerns and more.
Patients seeking the center’s help with a weight- or nutrition-related issue start by getting a referral from their primary care physician, then attending an orientation course. In the orientation sessions, which are held each Monday afternoon, prospective patients are introduced to “the idea that the program offers a lifestyle change, rather than a ‘dieting’ approach to weight loss,” according to a case study describing the center’s offerings.
Following the orientation session, patients schedule their first appointments. A doctor takes a full patient history, administers a physical examination and consults with patients on the selection of diet and exercise plans, and possibly even medication regimens.
Diet selection can be the key to keeping patients involved and on track with their weight management plan. The center offers six separate plans designed to fit a variety of lifestyles, accommodate cultural considerations and achieve specific health goals.
“Some people come and they know they want to go on a liquid diet because they need fast, safe weight loss,” says Spaide. “Some people … just want to be able to eat their normal foods in smaller quantities.”
The most popular choice is the low-fat, high-fiber option, because unlike some diets that have gained notoriety in recent years, it allows patients to eat carbohydrates — “significantly less than what they’ve had in the past,” Spaide notes, “but they still get to have something they know and like.” This diet has proven helpful for patients of Asian, Portuguese, Creole, Haitian Creole, Nigerian and Ugandan descent, for whom rice is a staple food.
Selecting the appropriate diet is one way to aid patients as they make lifestyle changes; another is the center’s wide-ranging 16-week support curriculum.
At weekly group discussion seminars, dietitians speak with patients about some of the detours that make it tough to stay on the right path — “mindless munching” during the work day, sabotaging a disciplined diet plan by late-night snacking, etc. Perhaps more important, according to Spaide, is the opportunity for patients to act as one another’s sounding boards — and sometimes lie detectors.
“Someone will swear that they never pick up candy or munch mindlessly throughout the day, and as a dietitian, it’s hard for us to necessarily step in” and question that, says Spaide. “But you have other group members that will call them on it. They might say, ‘I didn’t think I was doing that,’ but when someone in the group said, “Oh, come on,” that’s when I realized that I did.’”
The focus on group settings extends to the center’s outreach efforts.
“For our community, we realize how important informal groups are,” says Spaide. “For people that go to the same church, that live in the same neighborhood, it’s almost like one comes and then they all come. They rely on one another for information, so if someone has a good experience here, chances are it’ll spread like wildfire.”
That emphasis on community, coupled with the professional guidance of the center’s medical team, can have a significant impact on improving patients’ health. Those who stay in the group for 12 to 16 weeks have average weight loss of 8 percent; the longer they stay, the better the outcome. Other measures of success include lower blood pressure and increased energy, as well as patient-identified indicators like being able to wear old clothes or perform basic household functions without getting winded.
Such improvements may seem minor, but Spaide has learned in her time at the center not to overlook the impact that even little advances can have.
“Small changes really can make a huge difference,” says Spaide. “Say someone is obese and has diabetes. If we can get them to just give up juice, a lot of times that might prevent them from needing diabetes medications.”
As she talks about the importance of persistence for patients seeking help managing their weight and health, Spaide pulls out an old gem from renowned salesman and motivational speaker Zig Ziglar.
“One of my favorite sayings is, ‘People often say that motivation doesn’t last. Well, neither does bathing — that’s why we recommend it daily,’” she says with a laugh. “That’s true for our patients. That’s why they need us as their cheerleaders.”
Readers interested in the program are asked to contact their primary care physicians for a referral to the Center for Weight Management and Nutrition at Boston Medical Center.