Losing weight is study and practice at KU Medical Center weight management clinic
December 12, 2019
By Anne Christiansen-Bullers
Two days before Halloween, James Pryor decided to confront his biggest fear: his health.
Pryor signed up for a weight-loss program at the University of Kansas Center for Physical Activity and Weight Management. He'd witnessed many of his work colleagues dropping pounds, and he decided it was time to make a commitment.
Pryor, a nurse practitioner for the trauma surgery unit at The University of Kansas Health System, diagnosed his own condition. "I'm a 49-year-old, morbidly obese male who needed to make lifestyle changes," he said. "And now I have nothing but praise for this program."
What is the KU Center for Physical Activity and Weight Management?
The center has two purposes. First, it's the site of nationally funded research studies based on weight and physical activity, explained Joseph Donnelly, Ed.D, director of the center and professor of internal medicine at the University of Kansas School of Medicine.
Second, it's a fee-for-service weight-loss clinic, affiliated with the KU Medical Center, that offers medical support in addition to help with nutrition, activity and behavior.
The center is an ongoing part of Donnelly's work that spans four decades of exercise science.
Where is it?
The program's main offices are located in the Kirmayer Fitness Center on the University of Kansas Medical Center campus at 39th Street and Olathe Boulevard. It also conducts research and counsels participants in the Energy Balance Laboratory on the Lawrence campus.
Additional meeting locations are in Shawnee, Kansas, and south Kansas City, Missouri. Another option lets participants call into the center for remote participation.
"We're a pretty well-kept secret," Donnelly said. "I would venture to say that 50 to 60 percent of people on our own campuses don't know what we do."
What research is done at the KU Center for Physical Activity and Weight Management?
Many of these grants build on an equivalency study Donnelly conducted in 2012. The NIH-funded study measured the weight loss of two groups. The first received face-to-face counseling at the center, and the second received counseling over the phone via conference calls. In an equivalency study, Donnelly explained, the goal is to see if similar results can be achieved, but one drawback is that a large number of participants is required.Kimberly Johnson, M.S., program manager for the center, said the center currently has eight National Institutes of Health (NIH) grants to study weight loss in specific populations. "Having eight NIH grants is a big deal at any research center," Johnson said.
Donnelly found that the results could indeed be classified as similar, which opened up a range of studies focusing on remote distribution. One study delivers physical activity to grade-school students, and facilitators work with the students via internet-stream video. Another provides weight-loss help to participants in rural Kansas through video conferencing.
"In video conferencing, they can see one another, they can develop relationships with one another," Donnelly said. "They can see the instructor, the instructor can see them, and essentially create a group dynamic, yet they don't have to drive and meet. These types of things have been developed and now are used in multiple NIH grants."
How is research used in the fee-based clinic?
Annie Eller, RDN, LD, registered dietitian for the center, said she enjoys working at a university-based clinic because of how the latest weight-management research is integrated into care.
"I think a lot of people use ‘what-worked-for-me' evidence, which isn't applicable to the general population," Eller said. "We use evidence-based research to guide our participants."
Having a research component within the clinic means program participants get the benefits of research's most recent results.
"We run the research studies that produce the results, and then we practice the results in real life," Johnson said. The clinic's research arm and the fee-for-service clinic share space in the same offices, using much of the same personnel, she explained. With that much overlap, one function serves the other.
Donnelly said he recruits for studies from the fee-paying participants in the clinic, and if they do qualify, their costs are covered by grant funding. Conversely, study participants can transfer to the fee-for-service side if they want to continue receiving professional guidance on healthy habits after their study is over.
How does the KU Center for Physical Activity and Weight Management help participants lose weight?
Johnson said participants learn three main tenets of weight management: nutrition, physical activity and behavior change.
"We call it the three-legged stool. We don't just target exercise. We don't just target diet. Our program offers the services for an entire healthier lifestyle," she said.
Within those three legs, though, is the opportunity to customize care. As a dietitian, Eller said she appreciates the chance for individualization. "It's not just a one-size-fits-all approach," she said. "Not all programs do that. We get people who come in saying they failed a certain program, when really, the program failed them. It didn't give them a chance to find out why it didn't work and try another tactic."
Who needs the medical support of a physician during the program?
One tactic for weight loss and maintenance is to incorporate medical support into participants' plan of care.
Sarah Stolte, MD, assistant professor of internal medicine, sees participants who may need medical supervision while trying to lose weight and change habits.
"My job for each patient is really to recognize any barriers that they have to weight loss from a medical perspective -- barriers like sleep apnea, metabolism abnormalities, hormone abnormalities and medical barriers that make weight loss really difficult for them," she said. "And then we do what we can medically in order to overcome those barriers."
One solution might be a very low-calorie diet, and such calorie-cutting can be dangerous without a physician's help. Another solution? Changing medications for chronic conditions that might adversely affect weight loss. Still another might be a new prescription to address appetite, Stolte said.
"We are a center with a lot of different educational supports: nutrition and activity, and medical consultation, and all of those people work together to individualize our programs," she said.
Stolte said insurance companies often pay for the cost of medical support during the program.
What proof exists to show that the program actually works?
Donnelly said participants lose 12 to 15 percent of their body weight, on average. At commercial, for-profit weight-loss centers, weight-loss totals are more like 5 to 7 percent, he said.
And the ability to keep the weight off? Donnelly said 70 percent of participants manage to keep off at least 5 percent of their body weight for five years.
"The key to weight management is a behavioral program, and that's what we are," he said. "The average counselor has a master's degree. Some have PhDs. So, the behavioral component that you receive is top-drawer."
The number that matters to Carole Sjolander is 28. That's how many pounds she's lost on the program. Sjolander said she's battled her weight for most of her 81 years. When her age and extra pounds triggered health problems, she signed up for a program.
"It seemed as if everything that was bothering me would be better if I lost weight," Sjolander said. "I had high blood pressure, heart disease and diabetes. My knees were bothering me. And so I thought, ‘I've just got to do it.'"
Sjolander has been able to stop taking some medications, and she attributes the change to her weight loss.
"I'm really pleased at what the program's done for my health, because it's just one issue after another at my age," she said, "but I'm still driving and enjoying an active life."
The icing on the cake for the center was recently winning "Best Weight Loss Clinic" for 2019 in The Pitch's annual Best of Kansas City contest.
What's the best way to get more information?
The KU Center for Physical Activity and Weight Management has three websites. The first, on the University of Kansas Health System, has a participant focus. The second, on the University of Kansas Medical Center, has a mission focus. The third, at the University of Kansas, is a hub for research activities.
Potential KU Center participants can call 913-945-8184 or email to firstname.lastname@example.org for more information.
"Weight issues are, in fact, the disease of the century and are driving most of the major chronic diseases," Donnelly said. "So weight management might be a little bit more important than what it might get credit for. But I think that's changing."