SPECIAL REPORT BATTLING OBESITY
The Food Giants Go on a Diet
Federal Funds Fight the Fat
A Hogwarts for Obese Kids
Weighing Bariatric Surgery's Risks
From Fat Nation to Fit Nation
Slideshow: Battling Obesity
As executive director of the Academy of the Sierras in Reedly, Calif., Ryan Craig is developing a niche business with a growing clientele. In September, he started a boarding school for obese children aged 13 to 18. The mission: teaching them to approach weight loss and management as both a behavioral and biological challenge.
The school has 13 students so far, is adding one a week, and expects to have an enrollment of 60 by the middle of next year. That's remarkable, considering that Academy of the Sierras costs $5,500 per month, and health insurance typically only pays a third.
Weight loss is a rapidly expanding business for Craig, who's also president of Healthy Living Academies, which ran its first two weight-loss camps during the summer of 2004 -- Camp Wellspring in upstate New York and Wellspring Adventure Camp in Franklin, N.C. Healthy Living is a division of Aspen Education Group, which runs several other therapeutic boarding schools and camps for teens and young adults with behavioral issues. Aspen has rapidly expanded in the past decade with revenues that topped $100 million in 2003, from $28 million in 1998.
BusinessWeek Online's Pallavi Gogoi recently spoke with Craig about his strategies and goals. Here are edited excerpts from their conversation:
Q: How did you come up with the idea of a boarding school for obese children?
A: We're part of the Aspen Education Group, the largest and oldest organization that runs therapeutic boarding schools. We've traditionally handled teens with overly emotional behavior by combining behavioral health care with education. Five years ago we started looking at obesity as a behavioral issue. Our research showed that diets have become more calorie-dense, portion sizes [have] increased, and that's combined with lifestyles that are more sedentary.
Q: What's your curriculum at the school?
A: There are three components to what we do -- a comprehensive weight-loss program with diet and activity management, behavioral change so the students go home with a lifestyle change, and an academic program with an individualized curriculum that replicates what the child would be taking at school.
Q: Do children have other options aside from boarding school?
A: Families with obese children have been able to choose outpatient activities -- visiting with psychologists or nutritionists on the recommendation of their pediatricians. That tends not to be effective because you're not removing the child from the school environment -- engendering or aggravating the behavior. Diet camps are a second option, where a child is active over the summer, loses weight, but gains it back in the fall. That's not effective.
In past couple of years we've developed our program with leading researchers at Yale, the University of California, and Northwestern University, and research shows that obesity is a multidisciplinary problem. We talked to experts like Daniel Kirschenbaum of Northwestern University's Medical School and Kelly Brownell of Yale and expected to hear 12 different things from 12 different experts, but surprisingly we heard a consistent message -- that it was a problem in the areas of nutrition, physical activity, and behavioral psychology.
So you have to avoid fatty foods, you have to be active, and finally the most important thing you can do is self-monitoring to ensure weight loss. [One key is] keeping a detailed written journal of everything you're eating and all the activities you're doing.
Q: Why is that important?
A: Research shows that 75% or more of the time, you're guaranteed to keep weight off when you're aware of what you're doing. Our medical director, Dr. Kirschenbaum, is a leading researcher and a behavioral psychologist who is changing the thinking in this area by focusing on more than nutrition and exercise. This past summer we ran our first camps with four- and eight-week sessions. We had 30 students for the eight-week program and 100 for the four-week program. The average weight loss was four pounds a week, and we saw signs of behavioral changes in all participants.
Q: What kinds of behavioral changes?
A: There was a high level of consistent self-monitoring and a reduction in the children's depression inventory scores. All of them were 20 pounds overweight or more, some as much as 140 pounds overweight. Now we have a couple of students who are as much as 350 pounds overweight, one aged 15 and the other 17. These are cases where the emotional and psychological issues go out of control.
Q: How do you work on these students?
A: What we do in our program is intensive training on a set of behaviors that scientific researchers tell us you need for successful weight control. We have intense counseling -- many things are hard to do consistently even for the most well-adjusted adult. Think how much more difficult it is for a child.
So we use cognitive behavioral therapy four times a week by helping them overcome the emotional or psychological barriers. It's part of the education-training piece. And we have a therapy piece to help them get control and master the behavior so that they can handle themselves even in most challenging and controlling environment. We give them the tools for self-monitoring and rational thinking.
We have nutrition workshops that include trips to the grocery stores to get them to apply [their new skills] in a real-world situation. Another example is that we go to restaurants, where we train students on what questions you need to ask to maintain the program. So we get students to ask questions with the techniques we taught where you need not be intimidated by a server who doesn't want to answer such questions about whether the food is cooked in oil or if it can be cooked differently.
Q: How have your summer campers done in terms of keeping the weight off?
A: The average weight loss was four pounds a week at the camp. About 33% of the campers are participating in the After-Care program, and they have either maintained or continued their weight loss from the summer. We plan to keep track of them for at least a year and perhaps longer.