The Last Resort
Students at the Academy of the Sierras look like teens everywhere, with multiple piercings, tattoos, pimples. Except they’re bigger--220, 300, 570 pounds. They move more slowly. Some take medicine for Type 2 diabetes, and some take antidepressants.
The academy, located in Reedley, about 25 miles southeast of Fresno, is the nation’s first boarding school for obese kids--and a new but as yet unproven concept in long-term treatment of childhood obesity. Every morning, students participate in the first of two mandatory daily physical activities, including walking, biking, basketball, soccer, tennis, roller hockey or aerobics. Then they hit the showers and head to the cafeteria for breakfast. They clutch tiny journals and copies of “The Doctor’s Pocket Calorie, Fat & Carbohydrate Counter,” their bible. They’re supposed to jot down their meals’ calories and fat grams, a behavioral approach called “self-monitoring.” They all wear pedometers and aim for at least 10,000 steps a day.
During meals students are allowed “controlled” foods, such as an entree or dessert, which is measured out, and “uncontrolled” foods, such as berries, melons and fat-free soups. They can have as much of the latter as they like; they just have to write down every morsel in their journals. The numbers of calories, protein and fat grams in each controlled menu item are scribbled on a blackboard at one end of the cafeteria; the goal is 7 to 12 grams of fat per day and no more than 1,200 calories from the controlled food group. And unlike most diet programs, the academy intervenes as little as possible, which is why students are allowed to indulge their appetites for artificial sweeteners, caffeine and salt.
“We’re trying to get them to obsess in a positive way, so they feel bad if they don’t exercise or eat healthy,” says Dr. Dan Kirschenbaum, the clinical director of Healthy Living Academies, a division of the organization that oversees operations at the school, and a professor of psychiatry and behavioral sciences at Northwestern University Medical School in Chicago. He insists that skeptics who find the notion of positive or healthy obsessiveness oxymoronic also fail to understand the nature of morbid overeating: “You have to be mildly obsessed to lose weight.”
Nearly one in three Americans between the ages of 6 and 19 is overweight or at risk of being overweight, according to a study published last year in the Journal of the American Medical Assn. The Insula Rehabilitation Centre in Germany operates a residential weight-loss school for kids 13 and older, but the Academy of the Sierras is a completely new model in the U.S.: a boarding school where students can live for a year or longer, study, exercise and get therapy with other kids in the same situation.
“I just felt this was almost my last resort,” says 13-year-old Kevin Marema. In his young life, Kevin has worked out with a personal trainer, sweated through Pilates training with his mom, met with nutritionists and chalked up three summers at camps guaranteed to slim down fat kids. He would lose a few pounds--up to 20--then quickly regain them. Kevin has been at the academy since its inception in September 2004; so far, he has gone from 243 pounds to 153. He smiles easily now. He looks like a little boy.
Ryan Craig, the school’s 35-year-old executive director, spent three years as a vice president at Warburg Pincus, the international private equity firm in Manhattan, researching educational and training investments for the company. At Warburg Pincus, Craig had been impressed by Aspen Education Group, a Cerritos-based company that operates long-term residential programs for kids with behavioral and substance abuse problems. While he was researching Aspen, the federal Centers for Disease Control and Prevention began sounding the alarm about a childhood obesity “epidemic.”
In January 2003, Craig quit his job at Warburg Pincus, and moved to Santa Monica to work with Aspen and be closer to his wife, Yahlin Chang, a television writer. During the next year, he assembled a group of high-level players in the obesity field--such as Dr. Melinda Sothern, director of the Laboratory for the Prevention of Childhood Obesity at the Pennington Biomedical Research Center at Louisiana State University, and Dr. Dennis Styne, a professor of pediatric medicine at UC Davis--to sit on an advisory board for the school. He also found 68 acres in the San Joaquin Valley. It is farm country, the perfect place for a group of outcasts to congregate. The first 12 students arrived last September; 18 more came in January. They pay $5,500 per month for tuition, room and board, most of which is not covered by insurance. So far, they’ve lost more than 2,400 pounds combined.
“It’s good to be around people who understand where you’re coming from and who have similar problems as you,” says 17-year-old Mal Mahedy, who has dropped 130 pounds since September.
Four times a week students meet with a “behavioral coach,” either individually or in groups. In those coaching sessions, students review their self-monitoring journals, rating their accuracy and consistency. Then in pairs they evaluate each other’s behavior as well as that of their peers. This can get intense. A student might rate himself an 80 (out of 100), and his partner might disagree and confront him. Seventeen-year-old Natasha Ulch remembers storming out of a group because, she says, “I felt like I was being pushed up against a wall. People were calling me on stuff like eating too much uncontrolled food and not waking up in the mornings, and I didn’t want to hear it.”
Losing weight is one thing, but losing the issues that can lead to weight gain is quite another. No matter how much they’ve learned to modify their behavior, family crises, peer pressure and endless supplies of junk food still exist in the world to which the students eventually return.
Eight students went home on June 5; another 20 arrived the following day. The odds aren’t in the students’ favor. Only about 33% of the patients at the Insula Rehabilitation Centre maintained at least some of their weight loss two years after leaving the clinic.
“Right now the Academy of the Sierras is using the best of science to start [its] program, but there’s no idea what will happen in the future,” says Dr. Thomas Wadden, director of the Weight and Eating Disorders Program at the University of Pennsylvania School of Medicine. “Will the behavior these kids have learned stick when they go home? They have the tools, but which is stronger: their training, skills and education, or a multibillion-dollar market that says, ‘Eat this’? In the long term, it seems the environment wins.”