September 15, 2002
It doesn't seem like much, 800 calories a day, but Vivian Fonseca says it's not as bad as it sounds. "You lose your appetite in two or three days," he said. "When you break down fat you form ketones that kill your appetite. So you don't miss food and you start feeling better, and you're motivated to keep at it."
Fonseca, a professor of endocrinology whose research focuses on diabetes and obesity, directs the Endocrine Weight Loss Program at Tulane Hospital. The program is intended for obese people whose weight is contributing to health problems like diabetes and heart disease, people for whom commercial weight-loss programs would be ineffective at best and possibly dangerous.
The program is tailored to fit the individual. Some clients might simply attend behavior modification classes and visit a dietician. Others may be referred to surgeon Bernard Jaffe to discuss gastric bypass surgery. But most are going to find themselves getting familiar with the five flavors of the Health One meal-replacement packets developed by Fonseca. Blend the contents of a packet with water and you've got 200 calories worth of potato soup or chocolate shake.
"What we're doing is teaching people to make healthy choices over time," Fonseca explained. "Every week they attend a behavior modification class. But while that is going on, we want to take away choice rather than send people to the grocery story to try to figure out what's what. They've been doing that all their life and they've been gaining weight all their life. So we provide a package diet."
Average weight loss on the program is 35 pounds in the first three months. Participants can stay on a packets-only diet for up to four months before beginning to integrate real food back into their lives.
"Of course, if you just did the package diet, you would regain the weight as soon as you stopped," Fonseca said. "Which is why those classes are very important. The transition is very difficult, but we provide support."
Classes include a formal curriculum and access to a psychologist and a dietician. Participants are encouraged to exercise, but Fonseca understands that many will need to lose weight before they feel comfortable doing so.
"I see people who are on 15 medications, they're very immobile and they feel terrible," he said. "If they lose 40 pounds, they're transformed. If you can get them to feel a little lighter, they'll actually go and exercise."
The packets are low in sodium, and Fonseca has found that the diet often causes a dramatic reduction in blood pressure. That's in addition to the weight loss that can prevent or ameliorate conditions like diabetes. "I like to look at this as being more than weight loss. It's health promotion, or in many cases health restoration."
A month's worth of packets costs $300 and the classes cost $60 a month. "You pay up front for a month of food and a month of classes," Fonseca said. "So you stick with it, and at the end of the month you see results. I think that's very good motivation."
The new program got under way about a year ago, and has enrolled approximately 100 people. Fonseca directed a similar program at the University of Arkansas before arriving at Tulane four years ago. In addition, he is enrolling patients locally for a global study evaluating whether drugs used to treat diabetes and high blood pressure can also prevent the development of the disease.
The study is open to those age 50 and over with certain cardiovascular risk factors (like high blood pressure or high cholesterol) or a diagnosis of cardiovascular disease. For information about the Endocrine Weight Loss Program, call 588-1500. To volunteer for the diabetes study, call 585-4019.
Heather Heilman may be reached at firstname.lastname@example.org.
Tulane University, New Orleans, LA 70118 504-865-5000 email@example.com