Weighing In

Donne Marchetto says the difference between weight loss and weight management is much more than a case of semantics.

"Just about anyone can lose 10 pounds," he explained. "But managing weight is a different story. It's about losing weight, keeping it off, and thinking about weight in terms that

Marchetto will help clients learn the ins and outs of weight management, and its importance in controlling and possibly preventing medical problems, as program coordinator of the Center for Medical Nutrition (CMN), a new business that takes a holistic approach to controlling one's weight. Created against the backdrop of the nation's well-chronicled losing battle at the scales (see related story, page 45), CMN takes a team approach to its mission, using physicians, physician assistants, registered dieticians, exercise physiologists, psychologists, educators, and support group leaders.

CMN recognizes obesity and morbid obesity as diseases, said Heidi Szalai, ExP, an exercise physiologist. And by treating obese individuals medically, nutritionally, psychologically, with exercise, behavior modification, and/or surgery, CMI can help reduce and even cure many of the symptoms of the disease, including hypertension, type II diabetes, sleep apnea, respiratory and cardiovascular problems, and others.

Bruce Homstead, M.S., a licensed dietician and nutritionist who is part of the CMN team, said that in the wake of the nation's emerging obesity problem there will no shortage of individuals and businesses looking to get rich quick offering miracle solutions to weight problems.

CMN doesn't offer miracles, because there are none, he said. "Successful weight management is a comprehensive undertaking that requires commitment," he explained. "You can't solve a problem like this overnight."

CMN's partners hope that in time, their concept will be viewed as "the answer" to weight-management problems, said Homstead, who told BusinessWest that doctors will often tell a patient to lose weight but then not have any real suggestions about how to go about that mission.

"We want to be a resource," he said, adding that in addition to referrals from doctors, he expects CMN to be a source of information and educational programs on nutrition and weight management for area businesses and schools.

From a business perspective, the partners in the venture hope that the Agawam facility will soon be one of many CMN sites in the Northeast and perhaps beyond. The business model the company has developed is unique, said Marchetto, and it can work in any large urban setting, and can even be taken on the road.

For now, though, the team members are anxious to sign on clients and show how their comprehensive program can address a problem they say is reaching epidemic proportions.

Food for Thought

When asked to describe just what CMN provides its clients, the team members offered a variety of terms, including structure, control, support, and lifestyle. And those terms hint at what separates the venture from other methods used to lose or control weight.

Marchetto said the reason many people struggle in their attempts to lose weight and keep it off is that for the most part, they try to go it alone. What CMN provides is a support network that can see them through the process and continually remind them that this isn't something that people do for a few weeks or a few months - it is a lifestyle issue.

"People don't need a fitness center; they need a support system," said Homstead, who told BusinessWest that the more structure there is in a weight-management program, the more successful it will be.

While the company can help athletes who want to lose body fat or individuals who simply want to look better by shedding a few pounds, it is essentially for people considered obese or morbidly obese. And there are large numbers of people in both categories. Statistics now show that 60% of Americans are considered obese (25 pounds or more overweight), and that number is projected to reach 90% in 15 years, unless current patterns are reversed. Meanwhile, the number of morbidly obese individuals - those more than 100 pounds overweight is climbing at a dangerous rate.

"It really is an epidemic," said Homstead, "and it needs to be treated that way."

Szalai stressed repeatedly that CMN's programs are not designed to make people look better or fit into last year's bathing suit - although these may be among the results - but instead to make people healthier.

She said that behind the gaudy statistics about how many Americans are overweight lie serious health concerns. Obesity is a disease, she stressed, and one that can have quality-of-life implications.

"We are looking to control medical problems and prevent medical problems," she said. "We want to increase awareness of medical options for obesity, increase selfesteem, and decrease excess weight to increase quality of life."

Marchetto said the process begins with an evaluation of the client, a datagathering exercise designed to chart the individual's health history, factors that contribute to obesity, and track record with diets and other weight-loss methods. This evaluation. or overview, will also identify a person's goals or motivations.

And those goals vary, said Szalai. "Some people just want to took and feel better," she said, "while one woman told us she wanted to live a normal life."

After the evaluation, a program is developed to achieve those goals, she said, adding that such programs can have a number of components, from nutritional advice to exercise programs; educational workshops to information about surgical options, such as the increasingly popular yet still controversial procedure to staple the stomach to reduce eating.

The common denominator in each component is support, said Homstead, adding that clients will be surrounded by people team members as well as others going through the process - who understand and actively deal with weight-management issues.

Such support is important, he said, citing statistics showing how many people drop their health club membership every year or gain back the weight they lost in a fad diet. "It's hard to do this alone."

Digesting the Subject Matter

One of the central themes of any weightmanagement program is the subject of food, and CMN will address that matter in a number of ways, said Marchetto. For starters, there will be educational programs about nutrition and which foods are appropriate, he said, and there will also be counseling sessions designed to show people how they can still eat some of their favorite foods and manage their weight at the same time.

"We know that people cheat ... we just don't want to call it cheating," he explained. "We want people to have an understanding of how to incorporate their snacks into their lifestyle. They don't have to deprive them capacity. That capacity, for some companies, was cut in half last fall. That further bumped up prices and, in some cases, forced insurers to cut back on policywriting and reduce coverages previously offered.

"Throughout 2001, carriers were trying to get double-digit rate increases for a number of reasons, including poor performance in the stock market and a slowing economy," Phillips said. "Sept. 11 just accelerated that.

"Whether or not they had written insurance for those directly affected by 9/11, all companies buy from the same reinsurers, and that market for catastrophic losses went up substantially," he continued. "Now, with the continued deterioration of the stock market, there has been a lot of upward pressure on rates."

Taking Responsibility

Personal lines of insurance, including automobile and home coverage, are expected to rise in cost only slightly. But employers must continue to deal with the more steady rise in health insurance, a direct result of the soaring cost of health care delivery, which is rising in America at a much steeper rate than general inflation.

It's in property and casualty insurance that the hardest hits are being felt, with rates rising anywhere from 20% to more than double, Hanmer said. And, as Phillips pointed out, these are areas of coverage that, unlike health insurance, are more of an overhead item and not easily transferable to employees.

"As far as the average client is concerned, some of them are suffering rate increases in excess of 25%, and I've heard stories of more than 100% or 200% increases," Long said. "Also, availability of coverage has changed dramatically. A lot of industries aren't getting as broad coverage as a year ago."

Contractors, truckers, and light manufacturers are among the industries that have been hardest hit by the changes, but the effects are being felt across the board, he added. Hamner said that mid- to large-sized companies are feeling the strain much more than small businesses.

There are a few things businesses can do to counter the higher rates and reduced coverages, he added. One obvious strategy is greater risk retention - an increase in deductibles or the introduction of deductibles where there had been none before.

"Companies have the opportunity to perhaps take higher deductibles and also bolster their own internal risk-management and loss-prevention plans," Long agreed.

Also, some companies, such as large construction and real estate firms, have the ability to transfer risk to subcontractors and tenants through contracts and leases.

Hanmer also said businesses are being forced to review their insurance program design in detail, perhaps for the first time in a long time, to determine where they might have been overinsuring. "Before," he said, "it had all been so cheap, and the attitude was, 'why -not?'"

Strategic planning can also reap rewards, Hamner said. For instance, tight lossprevention controls and internal safety awareness programs can go a long way toward lowering costs and minimizing increases, he said, as companies with an excellent loss history are seeing lower increases.

Insurers are also looking more favorably on companies that have a strong disasterrecovery plan in place, he said, as they look on such an initiative as a team effort to minimize loss in the event of a claim.

In effect, Hanmer explained, businesses now have to compete not only for good rates, but simply for needed coverage, and any internal steps they can take to manage their own costs and disaster planning are only going to move them more quickly to the top of the pile when insurers make decisions about whom to take on.

"Insurance companies are now looking very hard at the prospective clients' loss ratio and what exposures they have, so from the clients' perspective, they need to do as much as they can to prevent losses as well as provide a safer work environment," Long said.

"Reducing losses makes them attractive to insurance companies - and they have to compete, where three years ago, insurance companies were competing for them."

Optimistic Outlook

None of the other industry changes should overshadow the impact of Sept. 11, insurers say. Hurricane Andrew, previously the largest insurance event in American history with losses totaling $16 billion, was dwarfed by the $40 billion price tag associated with the terrorist strikes.

Combined with the struggling investment markets and the needed insurance market hardening, 9/11 was just one more factor in handing the insurance industry one of its more challenging years.

But there are some positive signs that rates could begin to come down again after the new year, Phillips said. Of course, because some insurance companies have gone bankrupt over the past few years, there are fewer choices and, hence, more leverage in the hands of insurers to dictate terms to the marketplace, he noted. But an eventual softening is inevitable in this cyclical field.

Hamner said the industry has lobbied the U.S. Congress to create a federally funded pool to help insurers protect against major insurance events in the future. But, in any case, he said, whether the current cycle lasts two years or five years, rates will eventually come down.

"The financial stability of the whole industry is not dire," Phillips said, "but it is, being questioned."

It might be another year or more before the answers are clear.