By Celia Milne
TORONTO | A letter to Dr. Neda Amani from one of her Iranian patients reads like a diet ad: “I never imagined that losing weight was so easy and fun. By enrolling in this program I not only feel more energetic but also I no longer suffer from the leg pain that I have had for months,” wrote Parisa, age 25.
But Dr. Amani’s program, designed to teach patients to eat well and exercise, is far from a commercial weight-loss program. If anything, Dr. Amani calls it “charity work.” But because the program—which she calls The Real You—makes such a difference to patients’ lives, it feeds her natural sense of optimism. “Whenever people come into my office, I don’t see them as overweight, I see them as fit, healthy and confident—the best self they can be.”
Dr. Amani is a young family physician. In 2000, she established her practice in Toronto, and now splits her time between there and Ottawa, where her husband was transferred. She was born in Iran and was seven years old when she came to Canada. Because she speaks Farsi, she is filling a niche: About 70% of her practice consists of Iranian women.
The medical literature indicates ethnic women living in Canada are a high-risk group for obesity and inactivity, and Dr. Amani’s experience reflects this. Many of her patients have trouble adjusting to their new climate. “A lot of these ethnic women here are completely inactive. Because of the weather, they are shutting themselves into their home. I ask them how active they were in Iran, and they tell me they used to be a swimmer or they played in volleyball tournaments. Here, they don’t know where to go. Often, their finances are poor.”
Day after day, Dr. Amani was dealing with patients who complained about the same things: neck pain, depression, tension, fatigue, low sex drive, breast pain. Many patients had high blood pressure, high triglycerides, high blood sugar or insulin resistance. “I got tired of Band-Aiding problems,” she said. “I was really frustrated.”
In 2002, she started the The Real You™ program. Patients meet with Dr. Amani for an initial assessment, and then see a trainer for 10 one-hour sessions. They learn the basics of cardio exercise, weight training and stretching. For nutrition, Dr. Amani teaches them how to eat healthfully without dieting. Some of her suggestions are: drinking eight glasses of water a day, cutting red meat to once a week, eating five or six times a day, with protein each time, using brown rice instead of white, cooking fish in the oven, eating lower-fat cheese and consuming complex carbohydrates instead of simple carbs.
About 200 patients have enrolled in The Real You™ program; of those, about 90% are women, and there is a wide age span, from 16 to 85. About 80% are Iranian. Approximately 80 patients have now finished the program. “Patients on the program are losing one to two lbs. a week, or one to two sizes a month,” said Dr. Amani.
Besides weight loss and gaining confidence, women who have been through the program are suffering from fewer ailments. Dr. Amani has used the program to successfully treat arthritis, diabetes, hypertension, depression, insomnia, musculoskeletal pain and PMS.
“It made me see the power, the huge impact we can have as family doctors.”
The only down side of the program is figuring out how to pay for it. Unlike a similar program set up in Alberta that was inspired by Dr. Amani, in Ontario patients have to pay for it themselves. When Dr. Amani first started the program, she charged $40 to patients, and billed OHIP for a minor assessment. OHIP wrote her a letter saying she’d have to charge privately. She now charges patients $100 and doesn’t bill OHIP, but she wishes Ontario would pay for illness prevention. “If I want to counsel to prevent inactivity and poor eating, there’s no code. There should be a code.”
“I could do just cosmetics and make $1,000 an hour. But this is a real way we can make difference in people’s lives. It’s the future. People trust physicians.”
The financial story is quite different at the Lifestyle Program set up by Dr. Calvin Stewart and his son, Dr. David Stewart, in Lethbridge, Alta. The father-son team work together in a group of six family physicians at the Family Medical Centre. They started the Lifestyle Program in April 2004, and it is modelled after Dr. Amani’s program. But in Alberta, patients don’t have to pay for the doctor’s time. “We bill this as an office visit,” said Dr. David Stewart in a phone interview. The way he sees it, “We’re saving the health-care system a fair chunk of change. I saw a lady this morning who is approaching 100 lbs in weight loss. That’s saving the health-care system money down the line.”
Dr. Stewart has tracked outcomes for the Lifestyles Program up until July 2005, including data on 420 patients. Half of them stuck to the program, making three or more visits. Of those, the average weight loss was 4.5 kg (10 lbs) at three months, 6.8 kg (15 lbs) at six months, and 9 kg (20 lbs) at one year. He estimates about 600 patients have now participated. “This is a particular population we’ve helped to shrink,” said Dr. Stewart. “It’s fun to make a difference where you weren’t making a difference before.” And, he adds, “Dr. Amani gave us the idea. She deserves credit for what we’ve done here.”
The secrets to success for The Real You™ and the Lifestyle Program are education and accountability. Before starting the program, said Dr. Stewart, “We were asking patients to exercise more and eat less, but we weren’t having success.” Now, patients have to come in and step on a scale, and they have to keep a food diary. “If they are wondering whether to have a doughnut or an apple at 10 o’clock at night, they don’t want to write down ‘doughnut,’ so they’ll have an apple.”