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 Please allow me to introduce myself. I am a 46 year old woman; divorced for seven years; mother and sole supporter of a challenging and truly beautiful 16 year old daughter. Professionally, I co-directed the Nurse Practitioner Graduate Program at the University of Utah (7/98 – 7/03) and have continued to provide clinical services as a Family Nurse Practitioner both at the University and in a community setting. I have been at the University of Utah since 1987 and currently hold the academic rank of Associate Professor. That may not mean much outside of academic circles but hopefully, it does demonstrate to you that I am ambitious, tenacious, fairly intelligent, and have a strong work ethic.
For the past twenty years, I have had a dream that I have never released, but at the same time, not realized. Approximately 18 months ago, I had a personal epiphany following a close call with death. I now realize even more how precious life truly is and how quickly our conditions may change. As a result, I am motivated to pull together the components to realize my dream of many years… the development of a wellness center specifically designed to promote the total wellness of overweight/obese women in their working years (ages 18 – 65).
Obesity in this country is growing tremendously. In a 1999 press release from the CDC, Dr. Jeffrey Koplan proclaimed obesity as an epidemic that should be regarded as seriously as any infectious disease epidemic. Moderately to morbidly obese individuals are at higher risk to develop a multitude of health problems (e.g. Type II Diabetes Mellitus, Hypertension, Coronary Heart Disease, Strokes, and severely disabling orthopedic problems). Many health care professionals demonstrate obvious bias against obese patients and even those providers who demonstrate compassion are often poorly equipped to assist their obese patients in weight loss efforts and find attempts to do so frustrating.
I believe many of the obese women who choose me as their health care provider, do so because they see me as “safe”, given that I am also a woman of large size. I still closely monitor their weights, blood pressure, lipid levels, etc just as other providers do, but with a true understanding of the multifaceted factors that affect them as “obese” women in our society. I help them understand that even loses of 15 – 20 % of their body fat content may greatly decrease individual risks for diabetes, hypertension, and cardiovascular disease states, while enhancing overall wellness…all benefits that may be seen long before a traditional “goal weight” is achieved..
I believe a successful weight loss program for the women I am targeting must comprehensively address the multiple dimensions of health. My proposed wellness center would incorporate activities specific to each area.
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Emotional pain may lead women into patterns that create and sustain habits, reactions and lifestyles that promote obesity. Some may be victims of abuse and all are victims of living in a society that acknowledges and promotes only one “acceptable” body type that dangerously approximates the “Barbie” doll. Since most women do not have the genetic “right stuff” to fit this image, they often fall into the false belief that they are “fat”, even those who are not actually obese by medical standards. After years of trying every diet fad or nutritional regimen in the press and losing/regaining literally hundreds of pounds; many women think of themselves as failures and require a great deal of emotional support and in some cases, formal psychotherapy. Through dealing with negative self-talk and addressing unrealistic and faulty beliefs, feelings may improve and healthier behaviors may be put into action.
Discussion groups, reading groups, meditation groups, journaling activities, and individual counseling conducted by licensed/credentialed therapists will be made available at the center.
The center will encourage individuals to try new activities they previously may have been reluctant to try due to perceptions about their bodies. Movement based activities such as various dance forms are a wonderful expression of self that obese individuals may never experience due to old/current messages about themselves. Massage may have never been experienced, but after finding it to be “safe” and supportive; clients may discover it helps meet their human need for touch and enhances their personal acceptance of their own bodies. The center will focus upon “removing barriers” that often get in the way of individuals starting exercise programs. Onsite, qualified health care professionals and athletic trainers may alleviate fears and correct misconceptions some individuals may have about safe levels of physical activity and utilizing exercise equipment properly. Comfortable AND fashionable workout apparel in large sizes made available in an onsite “store” at reasonable prices will eliminate the need to go shopping for the right clothing prior to starting one’s program. |
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This component is critical yet difficult to describe. It does not pertain to religiosity, as women from all religious backgrounds would be welcome. The center should have a “safe feel” to it that creates a sense of “connection”, a “oneness”, a “sisterhood”. This element will assist all clients to feel “not alone” in their battle with weight management and self acceptance/self love. Great strength can be gained through feeling support and direction from beyond oneself, regardless of one’s belief system.
A library area is planned for quiet reading/meditation/ sharing resources (Materials specific to our target population and also general information for common life transitions experienced by women). Additionally, the physical space allows for informal, gathering areas for small groups to converse/share, a frequently used problem solving modality for women.
An important part of the spiritual component will be developing a “service” program that allows members to “sponsor” women who do not have the financial (or emotional) resources to give the gift of membership to themselves. |
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Physical health components of the center will include offering specific primary health care services, nutrition services, massage therapy, and access to comprehensive workout areas (gym with aerobic and strength building equipment and a studio for low impact aerobics, other dance and movement modalities, tai chi, yoga, pilates). Many individuals are reluctant to try new, unfamiliar physical activities. Resistance may be compounded for the obese person. The center will encourage clients to try a wide range of activities within a safe, respectful and supportive environment.
Individuals could either be referred by their primary care provider (after assessing physical state of health and safety parameters or risk management necessary) or may choose to have an initial assessment at the center performed by a Family/Adult Nurse Practitioner. This may include, at the woman’s choice, a pelvic exam and PAP smear. (Many obese women avoid getting these as they have felt humiliated by health care providers in the past. Also for women who are victims of sexual abuse this exam is very traumatic and must be approached very slowly, gently, and delicately; characteristics often not present with the typical pelvic exam in many health care settings.) Local surgeons that perform bypass surgery to address morbid obesity will be invited to refer their post-op patients to the center to enhance their emotional, spiritual and physical changes as they rehabilitate.
Specialty care and imaging services will be offered for those at higher cardiovascular risk in collaboration with a nearby cardiology center.
Exercise programs will be designed to fit within the physiologic parameters safe for the cardiovascular and musculoskeletal systems of the individual.
INSIDE the center: studio with padded floor for dance and movement activities, weight room/gym for circuit weight training/stretching and cardiovascular endurance machines (e. g. stationary bikes, elliptical machines, treadmills).
OUTSIDE: “Center” sponsored walks, hikes, biking in our beautiful surroundings in the Salt Lake Valley. Plan to contract with local pools for swimming, water aerobics and “noodle” workouts. May also sponsor group trips to health spas and recreational areas (e.g. river trips, winter sports trips) Individualized nutrition counseling will be available to develop personal nutrition plans. Years of dieting have affected the metabolic activities of such individuals. An adequate nutritional plan must meet the specific physical requirements, particular tastes, and lifestyle of the client.
Classroom based instruction and one-on-one counseling with a registered dietician will be available onsite. Cooking classes and demonstrations will be made available through the center. |
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In summary, I envision a wellness center that caters specifically to obese, working age women and is designed to address their health needs within a supportive, respectful, non-threatening environment. I believe the name I chose for the center twenty years ago, “The EXTRAORDINARY Woman”, captures the essence of my dream. A dream capable of helping multitudes of women, not only in the Salt Lake City area, but potentially serving as a model program that could be duplicated in other cities. It also is a dream that creates for me personally, a refocused and healthier career avenue better utilizing my knowledge, skills, and experiences to promote total wellness for clients.
I would like to consider the center as a “model” program to address obesity in a comprehensive manner and reduce the risk factors for serious morbidity in this population. The model could even be promoted as franchises across the country if the founders desired, as long as any such programs that followed met a strict criteria for quality control. I plan to present the concept to the major local HMOs and insurance carriers to consider direct reimbursement to the center for services provided for their obese female members. At the very least, I would ask the HMOs and insurance carriers to recommend the “Center” to such members for health promotion and offer financial incentives for health promotion and achieved risk reduction.
My experience and faculty affiliation with the University of Utah, a Level I - Research Institution, would allow the potential for grant funding, through Health and Human Services at the federal level and also private foundations. Once the center is established such grants could fund studies to evaluate the approach utilized by the center, long term behavioral changes achieved and the potential health benefits received by participants.
The prospective building (formerly a large furniture store) sits on two and a half acres (includes parking lots and some undeveloped space). It is located fairly central in the north/south layout of the Salt Lake City metropolitan area. The property is on a major commuter route through the business center of a well established middle to upper- middle class community. It also just happens to be across the street from my home! (Yes, it does seem at times that God is hitting me over the head to get this center started!) The main level of the spacious building will be ideal for provider offices, small group counseling areas, the library and sharing areas; with emphasis taken to utilize the large amount of natural light from display size windows and several skylights. The basement level will provide a cool environment for workout rooms and shower/dressing facilities. Each level is 13,000 square feet.
I am currently exploring funding avenues for such a center, approaching a local bank for a SBA loan just under two million dollars. (The property/building alone has a current market value over one million dollars.) I will need financial backers in order to qualify for the SBA loan. “Limited partnerships” will be offered to those investing their financial reputations behind the start-up of the business. Projections show that the business proceeds could make the loan payments, pay salaries and other operating expenses, and still make a “healthy” profit.
Please consider joining me in the exciting opportunity. Thank you for taking the time to allow me to share my dream with you. |
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