David Howard recalls the moment he decided to take control of his health. It was almost a year ago, sitting on the bed in the emergency room after checking himself in for troubled breathing. He lingered somewhere between consciousness and twilight sleep as the physician spoke to him about his condition.

“I woke up and realized I was having a conversation with the doctor,” he explains during his interview with Good Health Memphis. “I don’t know if I was responding to him but my eyes were open. It was this very surrealistic type of thing and it got me thinking, I’ve got to do something to change this.”

David, 44, is like many Americans. He has struggled with weight all his life. But things took a downward spiral the closer he came to age 40. In 2002, he developed severe asthma for which he was prescribed prednisone, a steroid anti-inflammatory. It helped him breathe easier, but before long he began packing on pounds. Eventually, his health issues caused him to miss work, for which he was written up on several occasions.

“In the back of my mind, I was thinking, maybe I’m just lazy. And I continued to gain weight.”
It wasn’t just a little weight. David  put on about 100 pounds over five years. Then in 2006, he went to his doctor for bothersome chest pains and recalls being unable to breathe when asked to lean back for an echo-cardiogram. The diagnosis: congestive heart failure.

David’s primary care physician referred him to Memphis Heart Clinic (MHC) where he received a full series of tests to determine the capacity of his heart. To his surprise, it turned out there was no blockage. It was just the weight.

This scenario is the inevitable result of obesity. It’s not news to anyone that Americans are too heavy.

Whether it’s the endless bombardment of articles, TV shows and fad books on the subject, or simply taking a look around the grocery store or at the crowd at a basketball game, there is no doubt: our individual weight problems have become a national crisis.

The actual figures are shocking. About 30 percent of the adult population, or 60 million people, are obese.In fact, the Centers for Disease Control and Prevention (CDC), report that from 1980 to 2000, adult obesity rates doubled. Obesity rates have also doubled for children and tripled for adolescents.

Unfortunately the problems aren’t just aesthetic. Excess poundage takes a toll on the body, carrying with it serious health risks including type 2 diabetes, hypertension, osteoarthritis, heart disease, heart failure, stroke, sleep apnea and other breathing problems.

After the diagnosis, recalls David, “The [doctors] told me I was morbidly obese. They said it was time to lose the weight, change my lifestyle and get off the sodium.  I was completely lost.”
He went to the gym but it didn’t last.

“You sit there and try to do exercises and it doesn’t seem like anything is working,” he says. “I had the feeling I would never be able to lose weight again, that I’d just keep spreading out.”

Then David got a better job, although with greater responsibility came more stress. Unfortunately his health issues made it impossible for him to keep the job.

“I just wasn’t able to perform my duties like I should have. I would fall asleep at my desk. I ended up getting so frustrated I had to quit.”

David was unemployed for nearly a year. Fast forward to 2008, two years after a heart failure diagnosis – David is in the ER for troubled breathing, losing consciousness while talking to the doctor – he was heavier than ever and his breathing problems were worse. When a string of tests didn’t reveal the cause, the doctor referred him to a pulmonologist for a sleep study, something suggested to him years before.

The study immediately revealed that David had severe obstructive sleep apnea (OSA), a sleep-related breathing disorder. OSA involves a decrease in airflow that causes interruptions in breathing, triggering the brain to wake up to breathe. OSA affects about 12 million people, more than half of which are overweight or obese, and is more common in men. David’s OSA was so severe he was waking up 30 times throughout the night. He was given a CPAP (Continuous Positive Airway Pressure), a face mask worn when sleeping which provides unobstructed oxygen flow.

The situation was serious enough that David’s pulmonologist feared the CPAP wouldn’t be able to fully treat his sleep apnea. He discussed possibly putting in a tracheotomy to help him breathe. He didn’t need another wake up call. David refused the procedure and vowed to improve his condition by living better.

Turning point

Stephanie Tyler, nurse practitioner at MHC, talked with David about the necessary adjustments he’d be making to his diet and activity level in order to alleviate his breathing problems and strengthen his heart condition. Tyler consulted with nurse and research coordinator, Lisa Burch, to develop a nutrition and fitness program.

David says he jumped at the chance to work with Burch because even though he was eager, he had no clue where to start.

“We believe in a holistic approach, treating the whole patient,” explains Burch. “It begins with the mind. Sometimes people take the literature we give them and we never see them again. [David] has so much willpower and motivation from within. He is willing to take the time and work with it.”

Change is necessary but it’s not usually easy, which is why support and accountability is crucial to make it last. Support can come from a workout buddy, a personal trainer, an online community or even a pet, says Burch.

First Burch gave David a notebook complete with nutrition and fitness articles, menu plans and the key element, a fitness journal. David now not only logs his activities and what he eats, but where he eats, what he’s doing and how he feels while eating. This helps him understand any hunger triggers, Burch says.

Federal guidelines suggest 30-60 minutes of moderate physical activity most days of the week. Burch put David on a six-day per week regimen and started slowly.

David met with Burch once a week for walks and weigh-ins, setting a goal to build his endurance in five-minute increments each week. At first, he couldn’t walk three minutes without needing oxygen. As he continued to work on his own and with Burch, his endurance increased and his activities varied. Within four months, David was walking at a normal pace without oxygen and the weight began dropping off. Before long he was tackling the trails at Shelby Farms.

“I will never forget the look on his face after he walked up the steepest hill and I told him to turn around and look at the hill he just climbed,” beams Burch while giving David a pat on the back. “Before he couldn’t walk more than three minutes and he climbed a hill with no difficulty! I’m so proud of him.”

He began in May, and by mid-December, David had lost 105 pounds. He has since been able to wean off his heart failure medication and only uses oxygen now when exercising or sleeping.

In that time he joined a gym and performs a full workout regimen each week including weights and working out on the elliptical machine, which he currently can maintain for an hour and 15 minutes.

“I don’t think I would have been able to do all of this on my own without [Burch’s] help and guidance,” he says.

His accountability to Burch helped him be more accountable to himself. As for David’s willpower, he attributes that to a higher power.

“I think it’s taken me months to realize what it was, that it was God in my life, being involved in my life, and giving me a second chance,” he says.

David also credits the his wife’s support as being integral to his success. She helps him keep up with his journal, logs all his activities on a computer spreadsheet, and when she can, exercises with him.

Changing his outlook

Through this experience David learned the importance of setting goals, and his first big fitness goal had been to complete a 5K for charity. He chose the St. Jude Memphis Marathon  which he enthusiastically completed in December. He’s done so well with his program that he even lost 12 pounds over the holidays, to Burch’s amazement. His total loss to date is 120 pounds. Ultimately, David wants to lose all his extra weight, 239 pounds total. This year’s goal – lose at least 80 pounds – but he expects to lose more than that, he says.

Getting fit has given David a newfound appreciation for being active and he wants to use his own experiences to help others. He is in the process of creating a list of 101 reasons to lose weight and is up to number 22. His number one reason: You get dressed with less effort. Other reasons include breathing easier, more energy, a sharper mind, and being able to fit into an airplane seat.

David has advice to those thinking about starting a fitness routine. “Start out slow to any exercise. If it’s a pound or two, that’s good,” he says. And above all, “Don’t give up.”

Community providing healthier options

With the rates of overweight and obesity at all time highs, this epidemic has been coined as American’s greatest healthcare challenge. Experts agree any effort to turn the tide on obesity has to come from every direction – private and public, in education, business and legislation. While it’s not a task that can be done overnight, strides are being made.

Since 2003 the Healthy Memphis Common Table (HMCT),  a non-profit regional health collaborative for the greater Memphis area, has cultivated an alignment of coalitions between healthcare providers, educators, businesses and non-profits with a range of endeavors that promote a healthier community.

One example of an HMCT sponsored collaboration is the “Healthy Menus” program, which offers Memphians healthier choices when dining out. It was developed by Memphis Heart Clinic as part of their Heart Builders program, an outreach effort involving a variety of services aimed at fighting heart disease. In 2007, MHC teamed up with the Memphis Restaurant Association to kick off “Healthy Menus.”

“A lot of patients say they can’t eat out,” says Tyler. “This is a good way for them to have solutions.”

The voluntary program gives local restaurant owners a chance to work with Memphis Heart Clinic’s nutritionists to identify heart healthy items already on the menu, and suggest new menu options where needed. Currently Garibaldi’s Pizza, Huey’s, Elfo’s and D’bo’s Hot Wings participate in the program, with expansion to more restaurants in the works. Look for a red heart next to these menu items which have smaller portions and are lower in fat, sodium and calories.

For Mike Garibaldi Jr., manager of the Poplar and Yates Garibaldi’s location, many heart healthy items already existed on the menu, he says, which includes most of their sandwiches without mayo, unbuttered bread, Italian spinach, salads with lo-cal dressing and spaghetti with marinara. His motto, “Keep it fresh, give good food,” which means processed foods are kept to a minimum and most items are made from scratch, daily.

“People think pizza isn’t healthy, but it’s okay to have in moderation as part of a healthy lifestyle,” Garibaldi adds. “You can’t eat pizza everyday, but there are enough options here to eat healthy.”

Business incentive for healthy employees

Extra weight isn’t just bad for one’s health; it has a price, and it’s hitting the economy hard. The National Institutes of Health (NIH) estimate the annual cost of obesity in the United States is approximately $123 billion.

As explained by the CDC, obesity has roughly the same association of chronic health conditions as 20 years of aging. Statistics compiled from ObesityinAmerica.org, reveal that obesity and obesity-related conditions result in at least $62.7 million in doctor’s visits and $39.3 million in lost workdays each year.

This has not gone unnoticed by businesses, or health insurance companies. In fact, a Humana report released in December broke down in dollar amounts how much an extra pound adds to a person’s healthcare costs. Humana estimated an annual increase of $19.39 for every overweight pound.

There are more than 122 million overweight and obese Americans between the ages of 20 and 65. On average, their additional healthcare costs are $534 per year for an overweight person and $1,614 for an obese person. A 25-year-old who is obese and remains obese until age 65 will average $179,000 more in healthcare costs over those 40 years.

With numbers like that, insurance companies and business groups are strengthening strategies to promote and reward good health. The good news from Humana’s report – even a small change can make big difference. Just a reduction of 276 calories a day for overweight people would start moving millions of Americans from the overweight category to healthy, the report notes.

People don’t have to reconstruct their lives to become healthier. Small, simple, incremental steps – like choosing grilled instead of fried, giving up one soft drink per day or walking an extra 1,000 steps each day – does the trick.

At Nucor Steel Memphis, Inc., employees are given opportunities to improve and maintain their health at work. Each year as part of national corporate policy, Nucor Steel holds annual health screenings which help employees learn about their blood pressure, blood sugar and cholesterol. In addition, the company’s “NuYou” program offers employees the chance to receive free health insurance by participating in annual health questionnaires from which the company assesses the general health of employees. It also gives them an opportunity to utilize telephone support services if they want to quit smoking or lose weight.

Staff nurse practitioner, Ginger Warmath, says the majority of employees participate in the program. Warmath is full-time staff and available on-site to assist employees with health issues, which provides an alternative to taking off work to see a doctor.

Currently the steel mill is still under construction, but as is part of company-wide policy, explained Warmath, the facility will have a gym on-site once construction is complete. In the mean time, employees developed their own version of “The Biggest Loser,” fitness competition, at work. Warmath says the employees actually came to her to start it and she helped devise a 12-week protocol.

“A little healthy competition is always good,” Warmath points out. “A group of people can hold each other accountable.”

Participants utilize the web site, FitDay.com, a health service site where people can track goals, choose healthy foods and customize workout routines. Employees are utilize those tools to get fit and submit with weekly weigh-ins. The people with the first, second, and third highest percentages of weight lost after 12 weeks, not the highest number of pounds, win the money. Forty employees signed up for the competition, which kicked off the second week of January.

Group competitions like this, along with Nucor’s screening programs, foster a healthy workplace environment; the basic building blocks to happy, healthier, more productive employees.
“When employees are healthy, they’re at work,” notes Warmath, adding, “The incidence of depression is less when employees are healthy.”

Gaining momentum

The prevalence of obesity and disease are massive problems to take on, but Memphians have a reason to be positive. Last month the University of Tennessee Health Science Center (UTHSC) offered some good news about the health habits of Mid-Southerners. While rates of obesity and diabetes continue to climb, more Mid-Southerners are making healthy lifestyle changes needed to reverse the epidemic. These findings are the result Healthy Memphis Common Table addressing the diabetes and obesity epidemic.

Obesity and diabetes rates in Shelby County remain higher than the national averages.  However, the rate at which obesity increases appears to be rising at a slower pace than both the state and national obesity rates.
More than 700 citizens in the Memphis area were surveyed to determine their health habits – thabits that contribute to either wellness or to poor health outcomes, including obesity and diabetes. The telephone survey revealed that more adults are exercising at least one day a week, eating more fruits and vegetables and cutting back on fatty foods.

“Overweight and obesity remain the plague of our generation,” laments Jim Bailey, M.D., principal investigator for the Healthy Memphis Data Center and professor of medicine at UTHSC. “In Memphis it continues to cause terrible suffering in terms of early heart attack, sore joints, diabetes and so on. The report says that people in Memphis are doing the things that create change. It’s a very small start.”

Change is not easy, maintains Bailey, and it starts with everyday choices. The efforts of non-profits like Healthy Memphis Common Table, businesses like Nucor Steel, and healthcare providers like Memphis Heart Clinic indicate the city just might be turning a corner.

For David Howard, what began with three minutes of walking a day has evolved into a paradigm shift in his life. His next goals are to become a personal trainer for people like him and complete a triathlon. He has turned the corner, and his journey is just beginning.

- by Holli W. Haynie