M.D. NEWS

Dr. Jack Hauser, the President & CEO of CT Weight & Wellness, was recently the feature/cover story in M.D. News.

This article will answer many of your questions, and will inspire you as well.

Printable .PDF click here

By Katherine L. Kraines

The detrimental health effects of America’s obesity epidemic are proclaimed regularly in the nightly news. Meanwhile, physicians are confronted with clients who are suffering from the immediate and long-term consequences of obesity, such as atherosclerosis, type 2 diabetes, high blood pressure, vascular problems, high cholesterol, heart attack, stroke and depression. Jack Hauser, M.D., a board-certified cardiologist and founding partner of HeartCare Associates, LLC, has dealt extensively with clients whose health was severely damaged from years of being overweight. Feeling like there had to be another way to attack the obesity problem before clients suffered a heart attack or stroke, Dr. Hauser opened CT Weight and Wellness in January at the Stony Creek Medical Building in Branford.

Dr. Hauser and his multidisciplinary team at CT Weight and Wellness have developed a medical weight loss program to attack the problem at its root and to provide evidence-based data about the program’s effectiveness in preventing future disease processes. CT Weight and Wellness is currently serving 1,200 clients, with 500 clients a week being treated at its two offices in Branford and Hamden. The goal is to eventually open a third office in Fairfield.

By immersing himself in understanding obesity, Dr. Hauser hopes to help clients take action before they experience a heart attack, stroke or arrhythmia. “We know that the disease is not the heart attack or stroke, nor is it the blood clot that induced the heart attack,” explains Dr. Hauser. “The disease process began many years earlier, and is typified by imbalances in the body, including the interactions between the vascular system, blood cells, cholesterol, blood pressure and many genetic and environmental factors.”

PHOTO BY WAYNE LOGAN
Erin Buckley, M.A., checks Brad Crerar’s blood pressure, while Dr. Hauser answers his questions. Brad is at his target goal, and has chosen to do their “maintenance program” to keep himself motivated and on track!


Describing the problem, Dr. Hauser states, “As a cardiologist, I am often able to successfully treat a heart attack and chest pain. But the fact remains that performing an angioplasty is like chipping off the tip of the iceberg. This treats the blockage without really dealing with the underlying disease process. And although these clients may initially feel better, they are still usually overweight, don’t feel well, are depressed, have high cholesterol and blood pressure and don’t feel like going back to work. I can give them all kinds of medications, tell them to stop smoking, lose weight and exercise more, but this still doesn’t address the part of the iceberg [underlying disease] that is lurking beneath the surface.”

MULTIDISCIPLINARY APPROACH

The CT Weight and Wellness team uses a multitiered approach, which is both vertically and longitudinally integrated throughout all aspects of the program. The team consists of physicians, nurse practitioners, a physician’s associate, a dietician, registered nurses and certified medical administrators. All members of the team interact to define and refine the program. Dr. Hauser stresses, “We are constantly reevaluating our results and understanding so that we can know what to do differently or better.” Much of the program is the result of Dr. Hauser’s own experience as a certified internist and cardiologist as well as result of the many interactions with his colleagues, including endocrinologists, vascular specialists, internists and primary care physicians.

The different aspects to weight loss are extraordinarily complex, and Dr. Hauser adds, “We believe that with our comprehensive medically supervised approach we can help clients lose weight quickly and in significant amounts and keep it off.” He stresses, “We have clients who have lost 50, 60 or 80 pounds and more and these results rival the gastric bypass surgical data.” Another advantage of the program is that it circumvents the risks of surgery.

BMI

Body Mass Index (BMI) is the basic mathematical relationship between a client’s height and weight that is used to determine whether a client is overweight or obese. “Anyone with a BMI over 25 is considered overweight, and a BMI of 30 is obese,” explains Dr. Hauser. “Based on statistics, about 30 million Americans are overweight. And we wonder why we can’t make a dent in diabetes, vascular disease, stroke, heart disease, arthritis, certain cancers, sleep apnea, atrial fibrillation, gall bladder disease, mood disorders, depression and social and workplace discrimination?”

PHOTO BY WAYNE LOGAN
Dr. Jack Hauser, with Patient Relations Program Director Yvonne Jennings (DNSc, MSN, M.A., R.N.), in the CT Weight and Wellness product room, discussing the nutritional value of their offerings.

THREE PLANS

CT Weight and Wellness allows clients to choose from three medically supervised weight loss plans: the Very Low Calorie Diet (VLCD), the Low Calorie Diet (LCD) and the Individualized Nutrition Plan. The most appropriate plan is determined by the professional medical team in consultation with the client after he or she has been thoroughly evaluated. The program is based on four keys to success: motivation, food chemistry, eating management, and prescription appetite suppressants. Clients commit to a 12-week program, regardless of the plan they choose. Although treatment is not covered by insurance, it will usually cover any necessary blood work or tests.

The VLCD is the most aggressive plan, and is recommended for someone who wishes to lose 30 pounds or more. The diet focuses on a high-protein and very low-carbohydrate intake of 800-1,200 calories per day, with mandatory follow-up every one to two weeks for a minimum of 12 weeks during the initial weight loss phase. The team provides clients on this diet with frequent coaching. “This is done,” states Dr. Hauser, “not only because of the medical implications of a highly restrictive diet, but also because of the astounding benefits derived from the frequent and stable feedback process. Clients both enjoy and need coaching and follow-up for continued success.”

The LCD allows for more calories than the VLCD, while using the same high-protein focus. This plan is also medically supervised, and is easy for clients to follow because they don’t feel very hungry and have high energy.

The third plan is the Individualized Nutrition Plan, which is supervised by the team’s Registered Dietician. This program entails the creation of an individualized nutritional plan for gradual weight loss and is based on the client’s metabolic needs and personal goals.

Dr. Hauser says, “With the use of pharmacotherapy, behavior modification, frequent follow-up and nutritional restriction and re-education, we can do a lot to help clients make significant strides in losing and keeping off weight by using science and simplicity.”

PHARMACOTHERAPY

When addressing weight loss, it is important to understand the complexities of biochemistry. In the VCLD and LCD plans, Dr. Hauser states, “We like to very judiciously use appetite suppressant medications. We understand that these medications can suppress the cravings and intermittent hunger that kills many diet programs. They also have thermogenic properties, meaning the medications can induce a 15 percent increase in resting metabolic rate. Thus, we are able to increase energy expenditure and decrease energy input [calories], while keeping clients from experiencing unnecessary suffering. This also facilitates integrating behavioral modification as it relates to the client’s response to food cues, eating patterns and the environment.”

NUTRITIONAL RESTRICTION

When it comes to restricting the number of calories consumed in any of the plans, the focus is on the quality and distribution of nutrients. According to Dr. Hauser, “In the average American diet most of the calories are derived from carbohydrates and protein. We try to invert that ratio by deriving 50-60 percent of total energy from high-quality protein, and then dividing the rest of the calories between carbohydrates and fat. This is where our nutritionist steps in with her understanding of the impact of these nutrients on internal biochemistry.”

The goal is to have clients consume frequent meals based on protein. Dr. Hauser explains that by doing this, “We are resetting the metabolic set point at which insulin is liberated and consumed, and thus how glucose is metabolized. We want to shift the equation to the preferential mobilization and breakdown of stored fat for energy, which begins with a protein-based regimen.”

BEHAVIOR MODIFICATION

The use of behavior modification becomes a focus when clients have transitioned from weight loss to maintenance. Once clients achieve a weight that is within 10 pounds of a mutually established weight goal, they no longer require a restrictive hypo-caloric plan. At this point, pharmacotherapy becomes less important, and the goal shifts to helping clients understand and interpret environmental food cues in order to maintain their weight loss. “Through the use of behavior modification, we work with clients by helping them to modify their responses to food and eating in their daily behaviors,” explains Dr. Hauser. “This is best accomplished by both individual and group counseling.”

PHOTO BY WAYNE LOGAN
Dr. Jack Hauser with some of his “team” at CT Weight and Wellness. Left to right (standing): Jennifer Ansaldo, Erin Buckley, (sitting) Laura Christensen, Nancy Lorenze, Dr. Hauser, Kati Midgley and Elissa Crerar.

CHILDREN AND OBESITY

One of Dr. Hauser’s greatest concerns is the rapid increase of obesity in children. “We are seeing type 2 diabetes in younger and younger children. It is not uncommon for a 9-year-old to be overweight or obese. If not for obesity, type 2 diabetes would most likely not exist in this population,” he explains. “But once diabetes or pre-diabetes exists, a catastrophic chain of events begins that bridges the problem of obesity to cardiovascular morbidity and mortality. This will be the first generation in about a century with a shorter expected life span than the previous generation. There are three times as many children who are overweight or obese as there were 20 years ago.”

A few older children have been through the program, and Dr. Hauser is currently developing a comprehensive program based on the recognition, management and treatment of obesity in children as young as 5 years old. He wants to establish relationships with pediatricians and endocrinologists to supplement the program with the intent of getting it off the ground later this fall.

An important aspect of the children’s program includes the child being accompanied by at least one parent, but it is preferable that the whole family attend nutritional counseling. “The data supports significant improvements in results when the whole family comes as opposed to just the child,” explains Dr. Hauser. “Thus, by using family support and nutritional counseling we can provide a lot of feedback and re-education.”

Because Dr. Hauser’s program is medically focused, team members can use the biochemical and clinical components that are critical to success. “For example,” he notes, “if a child has ADHD, or if he or she has special needs, such as asthma or food allergies, we can recognize and treat these issues as part of a cohesive plan.”

FACILITATING TREATMENT AND EDUCATION

The effectiveness of the CT Weight and Wellness program lies in the results experienced by some of its clients (see client snapshots). In summary, Dr. Hauser states, “We are not looking to compete with the medical profession, but we are looking to provide support and help. Our goal is to create a foundation of prevention, so that we can facilitate the treatment and education that the medical community feels so strongly about.”
 

PHOTO BY WAYNE LOGAN

Registered Dietician Jacqueline McCullough, M.S., R.D., CD-N, and Dr. Jack Hauser with 11-year-old Elsworth (Els) Evarts, IV, who has lost more than 15 pounds on their program and is very excited about his new life! He said he can now run without getting tired, his legs don’t hurt now and his self-esteem is soaring! This was the first time he actually got to hold 15 pounds of faux fat, and could feel what he had accomplished.