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Recently, an ominous rise in diabetes has paralleled the increase in Americans' waistlines.


Scaling Down, Weighing In
At the Johns Hopkins Weight Management Center there are no gimmicks and no promises of overnight miracles. Just the tailored, well-rounded approach to dieting you've hungered for.

Diana Kopyt, Ph.D., deputy director, and Lawrence Cheskin, M.D., director of the Johns Hopkins Weight Management Center.
And God populated the earth with broccoli and cauliflower and spinach, green and yellow vegetables of all kinds, so Man and Woman would live long and healthy lives.

And Satan created McDonald's. And McDonald's brought forth the 99-cent double-cheeseburger. And Satan said to Man, "You want fries with that?"

And Man said, "Super size them."

(From e-mail humor currently in circulation)

* * * *

Joyce Parks has been a nurse at Johns Hopkins Hospital for two dozen years, yet recently she's found colleagues passing her by wordlessly in the corridors. Parks doesn't fault them. Even she doesn't immediately recognize herself in photos these days. Over the past year, she has shrunk down seven dress sizes, one shoe size, and trimmed 10 inches off her waist. Best of all, after losing 45 percent of her body weight, Parks has shed her medical problems. She has energy enough to actually run up and down stairs, her knees no longer hurt, and she's been liberated from the five medications she was taking every day to control her blood pressure.

"I'm very aware of the risks of being obese," says Parks, a clinical nurse specialist on Meyer 6, where Hopkins' chronic pain and psychogeriatric services are housed.
Parks has struggled with her weight since she was 21 years old. She's tried fad diets and made multiple attempts at Weight Watchers, but has always regained whatever she's lost, and then some. By the time she was 45 years old, she weighed 300 pounds and felt "fearful I wasn't going to make it too much longer." She summoned up the will to call the Johns Hopkins Weight Management Center, the program her doctor had been recommending for years.

The Center has all the Hopkins hallmarks. It is comprehensive-clients fill out an exhaustive questionnaire before the first visit, and early on, get their metabolism, body composition and fitness levels tested. It is multidisciplinary-instead of one cheerleader in the front of a room, a team of physicians, dietitians, psychologists and an exercise physiologist bring their various perspectives and expertise to the patient. It is cerebral-there's a substantial, though separate, research component that studies the problems patients bring with them through the door.

Lawrence Cheskin, a gastroenterologist by trade, developed the program 11 years ago because he saw "a great need" for weight control among his patients.
"It's something that's on many-if not most-people's minds," says Cheskin, "and the need for it has only become more dramatic."

Today in the United States, you are in the minority if you are neither overweight nor obese. Even our children are having trouble controlling their weight. The reason isn't a mystery.

"We live in a culture that says, Eat fast food and be a couch potato," says Cheskin. Yet the societal ideal is to keep your body fit and trim. "It's hard to reconcile those two messages."

Once you've determined to cut calories, having the right motivation is key. "If you do something because you feel bad about yourself," begins Cheskin, "that's a powerful but ugly motivator, and one likely to be resisted by the individual." In other words, if you're dieting out of fear of losing your spouse, it's normal to be resentful.

A more promising motivator is concern over physical health. People who respond to society's "thin" bias by losing weight to improve their health-not because they feel inadequate-have the best chance of success, says Cheskin. "Yes, take advantage of the cultural milieu, but do it for yourself, your health and energy."

In fact, obesity is close to overtaking tobacco as the leading cause of preventable death in the U.S., according to the surgeon general. High blood pressure, heart disease, stroke, even some forms of cancer are obesity-related diseases implicated in 300,000 deaths a year. Recently, an ominous rise in diabetes has paralleled the increase in Americans' waistlines.

Although the concepts of weight reduction are well understood, "it's difficult to put into practice," says the wiry Cheskin, who admits he's never had a weight problem. Joyce Parks did not find the strict fasting phase of the Hopkins program difficult; it's keeping the weight off that worries her.

Since statistically only one in 20 dieters succeeds in maintaining weight loss, Parks has reason for concern. At the Hopkins center, which moved from Bayview Medical Center to Green Spring Station seven months ago, one-third of clients have kept off more than half their weight, and maintenance is talked about early and often in the program.

"We ask people, What will you do to change your lifestyle so you're able to maintain this weight loss?" says psychologist Diana Kopyt, deputy director of the center. "And we help people build skills. Because the more scenarios you can deal with, the better off you'll be."

Kopyt also wants her clients to have the tools to deal with a relapse. "Everyone gains weight back," she states. "You go on vacation, you're in a situation where you're not as careful. The idea is to get back on track. It doesn't have to be the beginning of the end, you're not doomed. We challenge that all-or-nothing thinking. We all make choices that aren't perfect. None of us is perfect. That's a huge step to be able to realize that."

Joyce Parks admits she was a victim of black-and-white thinking. She loves potato chips so much she dared not even look at them. Eventually, her dietitian asked her, Are you going to go through your whole life without eating another potato chip?

They discussed ways she could incorporate chips back into her diet. There was the fat-free option, and talk about what actually constitutes a serving. She might choose part of a bag, or substitute a full bag for something else.

"The point is, you have choices," says Parks. "You ask, How do you make this work for you? It's not, Put it in your mouth and think about it later."

Parks even has the willpower now to bake a cake for her family and not touch it.
"It actually feels better to be like this than that cake tastes."

-Mary Ellen Miller

The Johns Hopkins Weight Management Center can be reached at 410-847-3744, or visit its Web site at Hopkins employees receive a significant discount.

Tips from the experts
  • Pay attention to serving sizes. Sometimes there are 21/2 servings in a bottle of fruit-flavored juice, for example, which means there are not 120 calories but 300 in a bottle.
  • Avoid holding yourself to extreme, perfectionist standards. Recognize that it's OK to have a few occasional deviations from your diet/exercise plan and still do an overall good job.
  • Write down everything you eat as you eat it. Also record your daily physical activity. This strategy, called self-monitoring, has multiple uses. It can help you increase awareness and control, plan meals and snacks, recognize patterns, and measure progress.
  • Keep active. Research shows that exercise is a strong predictor of who will maintain weight loss. It needn't be formal-take the stairs, park farther away, do your own vacuuming.
  • Don't skip meals, lest you train your body to go into "reserve mode," causing you to hold on to whatever food you eat. Better to eat throughout the day to keep up your metabolism.
  • Eat more plant foods and limit the protein. Go for fruits, vegetables, whole grain and beans, which are both healthy and low in calories and fat. Keep the protein (beef, poultry, fish, eggs) to 6 ounces a day, the size of two bars
    of soap.
  • Avoid emotional eating. Are you really hungry? Then make healthy choices and limit the amount you eat. If you have the urge to eat for other reasons-stress, boredom, depression-try to do something else to better address those needs. Take a walk, keep a journal, talk to someone or seek professional help.




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