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Resources >> Expert Advice
A New Weight Management Paradigm
(NOTE: This article is based on a program description submitted by Dr. Neal Cohen, Clinical Director at Skyland Trail in Atlanta, GA.)
It is widely recognized that substantial weight gain is often one of the most significant side effects of medications used to treat serious mental illness. Fear of -or frustration surrounding-such weight gain is one reason some persons with mental disorders either avoid potentially helpful medications or seek to switch otherwise effective prescriptions.
Comprehensive treatment programs for persons with mental illness must address this important issue if they are to truly help their clients travel the road to reintegration. A number of innovative programs exist for this purpose; one example is highlighted in our Community Spotlight feature on Genesis Club in Worcester, MA.
Another cutting-edge program has been developed at Skyland Trail, a residential and day treatment facility in Atlanta, GA. Skyland Trail recognizes that a significant increase in body weight is often associated with a variety of physical health problems, and that the most immediate and profound consequence of weight gain is frequently a decrease in self-esteem. Staff also understands that once clients put on significant weight, they often encounter serious difficulty in attempting to regain their baseline body weight.
Skyland Trail has determined that in attempting to help the person with excess weight, health care providers and family members often emphasize portion size, calories, fats, and exercise for weight maintenance. Caregivers frequently focus on limiting portion size, eating a balanced diet, and increasing exercise levels. This longstanding method usually portrays the type of food, the portion size, and the individual's activity level as either "good" or "bad."
Under this traditional approach, the individual faced with regulating his or her weight must either restrict food intake and/or exercise more. In short, this approach to weight control places the problem squarely on either the food or the individual with the problem. Too often, this sets the patient up for failure - and a further lowering of self-esteem.
A New Paradigm
Skyland Trail's approach to weight gain utilizes a new paradigm that requires a shift in focus. The focus of this approach, which is under the direction of Robin Cohen, RD, LD, is on what is termed "emotional eating." Efforts are aimed at removing the value judgments that accompany most weight loss methods and that reduce self-esteem for the client.
In place of these value judgments, Skyland Trail staff members help clients become fully aware of their relationship to both food and self. The emphasis is on the role of food in the maintenance of self, as well as on maladaptive thoughts, feelings, and behaviors in relation to one's body.
It should be noted that Skyland Trail's approach doesn't minimize educating clients about good nutrition and the value of exercise. Through a registered dietician and a certified therapeutic recreation therapist, all Skyland Trail clients undergo a complete nutrition and recreation assessment at time of admission. Clients are then assigned to psycho-educational groups in order to learn the basics of making healthy choices regarding food and exercise. They are also instructed on how to identify and prepare health-promoting meals. These steps, however, merely mark the beginning of Skyland Trail's approach.
Measured Thoughts
In addition to the assessments just noted, Skyland Trail measures maladaptive thoughts relating to food and body image. This measurement also assesses the client's style of eating. If it is determined that a client has distorted relationships to either food or self, the client is advised to join the Eating Issues Group. Here, clients are helped to identify the distorted thoughts which have led to feelings and behaviors related to "emotional eating."
Through cognitive restructuring, clients are then guided toward using the identified thoughts, feelings, and behaviors to develop a specific recovery plan which will prevent further weight gain and support a healthy lifestyle. The focus is not on weight or food per se; rather, it is on the client's relationship to food, self, and others.
Staff also believe that educating caregivers to the myths of dieting, the concept of "emotional eating", and the importance of recovery planning is vital to recovery. Skyland Trail thus promotes education that enables caregivers to become part of the team guiding the client's rehabilitation.
Anyone Can Exercise
But there is still more. The Skyland Trail treatment team believes that physical exercise is vital in recovery planning. The clinicians endorse the belief that anyone - regardless of physical health - can engage in recreation. Therefore, in addition to team sports, Skyland Trail also offers options such as a sit-down aerobics group, a yoga group, and several walking groups.
The Skyland Trail Health & Education Center also houses a modern exercise room containing aerobic and weight machines. The room is open to all clients. For clients wishing to use this equipment but who are not familiar with it, group instruction is provided by clients trained in the proper use of the equipment.
Skyland Trail's strong belief that healthy choices are important to recovery is also evidenced in the first annual Skyland Trail G.L.O.W. Run/Walk, which will take place this Fall during National Mental Health Week. This event is intended to promote healthy lifestyles for both mental health consumers and the general public.
The race will begin at twilight on the grounds of Skyland Trail, and each participant will be given a glow stick signifying both the light of wellness and support for the Skyland Trail community. The event will demonstrate the unity of Skyland Trail, as well as the agency's desire to increase community awareness of mental health issues while reducing the stigma associated with mental illness.
In the near future, Reintegration.com will feature a personal "success story" resulting from the innovative weight management program provided through Skyland Trail. We hope you'll watch for it.
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