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More Than Weight Loss: A Steady Diet of Support and Achievement

June 1, 2006
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A pioneering Andover, Ohio, nursing facility has taken a positive approach to bariatric residents for 10 years by Michael Peltier, Assistant Editor
BY MICHAEL PELTIER, ASSISTANT EDITOR More than weight loss: A steady diet of support and achievement
A skilled nursing facility treats bariatric residents with individualized therapy-and the reinforcement of a group "It's not an individual who has a weight issue," says Karyn French, director of social services at Andover Village Retirement Community in Andover, Ohio, "because everybody is here pulling for each other. There's a very good support system among the residents."

To bariatric and other residents, Andover Village offers physical, occupational, and speech therapy; dietary education; psychological and group support services; preop and postop care; and discharge planning. The facility also offers dialysis and respiratory services, and is adjacent to an emergency center. It does not offer, though, bariatric surgery; instead treatment focuses on major lifestyle changes. Residents have come from across the country-and Puerto Rico-to get help. The distance adds to the difficulty of treatment. "The hardest thing about being here is being away from family and friends," says one resident from Louisiana.

The organization has been treating bariatric residents for more than 10 years. It began with just one bariatric resident and has snowballed from there. Roughly one-third of Andover Village's approximately 180 residents are bariatric-weighing as much as 1,000 pounds. "We've got some people who haven't been mobile for years, who haven't been out of a single room in their house," French notes.

Therapy is customized for each resident and includes diet and exercise.
Individualized Treatment
"The biggest challenge for our residents: motivation," French says. "Sometimes the scale is an enemy. When you get on that scale, if it's not reflecting what you want it to reflect, there are tears, there is anger, there is frustration, there is wanting to give up."

Andover Village's physicians request that residents stay a minimum of 90 days. "To come in and think you're going to get it all down pat in two to four weeks-that's not a realistic expectation," French explains. Comorbidities residents may have, including diabetes, cellulitis, lymphadema, and kidney disease, complicate treatment. And residents' health problems aren't all physical. French says the staff deal with "a lot of mental health issues." She adds, "Depression is probably number one. There are some compulsion disorders. Self-esteem is usually in the pits."

Staff also deal with family issues such as ensuring that family members are not trying to bring junk food to the residents. But family members can bring a crucial element to residents: support. Even loved ones from across the country visit residents, and some residents talk on the phone with family and friends every night.

Andover Village stresses interaction between residents and a strong support system. "People who may have been in their homes for three or four years haven't had any social contacts or have been demoralized by family or medical practitioners," French says. Residents might have been mistreated or abused by family members because of their weight. "They get here and say, 'Oh, this is pretty good,'" she notes (although, she adds, that can create problems later on if residents make improvements but lack the motivation to leave the facility). The bariatric residents form friendships that last past their stays at the facility, and they also develop friendships with the older residents in the facility, including those with dementia.

Former residents have stopped by to see old friends and show staff their continued results. "If they're close enough, they'll stop by and visit every once in a while," French says, "which is a really good thing, too, because they're able to say, 'Look how much more I've lost,' or 'Look how my mobility is continuing to improve.'" She stresses that former residents must continue with treatments that have led to success-including those that address mental health. "When people leave, they need to continue that kind of counseling relationship or some kind of outside service," she explains.

Unfortunately, some bariatric residents return to Andover Village because they haven't achieved their goals. And some residents, for financial or other reasons, must leave before reaching their ambitions.

As part of the Health Is Priceless program, thermometers track weight loss.
Education and Diet
"We set goals for people," French says. "What do you want to achieve?" Andover Village offers a basic, balanced diet that follows the food pyramid and good eating habits. "And that's where a lot of our education component comes in, because folks don't know or have forgotten what good eating habits are."

The education component goes hand-in-hand with diet in support groups offered five days a week before lunch and dinner. Educational resources are found in the facility's HIP (Health Is Priceless) Tips newsletter. The HIP program, which began in 2003, includes a newsletter with a schedule, a menu, and information. Residents also receive a notebook with reference information they compile and a journal to record eating habits, measurements, and feelings.