As Obesity Rates Climb In Rural Kansas, So Do Cancer Concerns

Sep 27, 2016

Salina, Kansas, resident Janis Wearing, right, weighs in as nurse Shari Sutton records the data. Wearing is taking part in a University of Kansas Medical Center weight management study called RE-POWER.

The recent news that Kansas is now the seventh-fattest state in the nation points toward a future of increased health problems, including cancer. In fact, as smoking rates decline and obesity rates rise, obesity is poised to overtake tobacco as the leading preventable cause of cancer.

That’s why the University of Kansas Cancer Center is highlighting a weight management study as part of its effort to gain federal designation as a Comprehensive Cancer Center.

Download story on University of Kansas Cancer Center's quest for "comprehensive" designation here

An ‘amazing difference’

Janis Wearing says she’s been struggling with her weight for most of her life. The Salina woman didn’t have much success with Weight Watchers, TOPS or even working with a dietitian. So when her primary care clinic offered a free two-year weight loss program as part of the KU study, she said yes.

“I wanted to take better care of myself,” she said. “I was feeling so unhealthy, and you know you get to where you are so overweight, then you get depressed.”

After four months on the program, Wearing has lost 40 pounds.

“Amazing difference!” she said. “I have more energy. My bones don’t hurt so bad. My knees don’t hurt so bad.”

She credits the group sessions, where she and about a dozen other participants learn about food choices and exercise. They also use a smartphone app called Lose It to log their physical activity and diet.

“Say you want to eat something, and you can put that in, and then you notice that it’s a whole bunch of calories,” Wearing said. “So then you come back and you say, ‘No, I’m going to make a better choice.’ So that’s really helped me, too.”

Nurse Shari Sutton meets one-on-one with participants to review their food and activity logs.

During a recent meeting, Wearing told Sutton that she averaged 1,030 calories per day the previous week. Her goal was 1,100 calories a day, so she did quite well.

If 1,100 calories a day sounds easy, consider this: A Big Mac and a large order of fries is more than 1,100 calories. Sutton explains that the diet provides specific guidelines to help participants stay below the goal for caloric intake.

“Two protein shakes a day, two pre-packaged meals such as your Lean Cuisine, your Smart Ones, your Healthy Choice — and that’s for the first six months so that you can learn portion control,” Sutton said.

She realizes that nobody really wants to eat two pre-packaged meals a day, every day. Participants are allowed to fix their own meals — or eat out — as long as they limit each meal to 350 calories.

The plan calls for all between-meal snacks to be fruits or vegetables — at least five servings a day. But the biggest hurdle for some people is the rule that they shouldn’t get any of their calories from beverages.

Sutton said that means no soft drinks, alcohol or cream-and-sugar-laden coffee drinks. She said it’s obvious when someone is straying from their diet.

“Yeah, I totally have participants that come in and report, ‘Yes, I totally hit my 1,200 calorie goal. I’ve totally hit my five days of at least 30 minutes exercise a day goal.’ However, they’re gaining weight,” she said.

But regardless of how much a person may cheat on the diet, there is no brow-beating.

“We’re not here to say, ‘Oh, you failed.’ Failure is just if you stop trying,” Sutton said.

Rural study compares three models

The program is part of a KU Medical Center study called RE-POWER. The five-year, $10 million study will compare three weight management models at 36 rural primary care clinics in four states.

Statistically, rural residents have higher rates of obesity and related diseases than their urban counterparts. Their only source of professional help with weight loss may be their family physician. But many doctors are reluctant to talk to their patients about weight loss.

Dr. Robert Kraft is overseeing the RE-POWER study at Salina Family Health Care. He hopes the study will identify ways to make it easier for doctors and their patients to have those conversations.

“It’s hard to talk about things that we can’t do something about, so hopefully programs like this will help us develop services that we can then refer patients to,” he said.

Kraft said lifestyle factors are now recognized as major causes of cancer and are one reason why the KU Cancer Center is highlighting RE-POWER in its latest certification effort.

“Smoking is very clearly one (contributing factor), but weight is as well,” he said. “There are many cancers that are certainly higher incidence in those who are overweight, and so getting people to lose weight is an important step in trying to prevent cancer.”

So far, 32 of 40 patients enrolled in the RE-POWER study at Kraft’s office are actively participating in the program. Some have actually gained weight, but as a group the Salina patients have lost a total of 500 pounds.

The study will evaluate the three weight-loss strategies by how well participants manage to lose weight and keep it off for two years.

Bryan Thompson is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.