I visited my chiropractor, Dr. Mike Christopher, in Williamsville last week and told him I was working on a story for today’s WNY Refresh section about people who had set New Year’s resolution-style goals earlier this year and stuck to them.
One of the folks featured in the story package is Wayne Kast, of Amherst, who quit smoking.
I also reported that about 10 others who took smoking cessation classes with Kast already had returned to their cigarettes.
"Dr. Mike," as everyone calls him, then talked about the power of putting a financial incentive behind one’s determination to break a bad habit.
I’ve read several health stories in recent months, and written one, about companies that provide such incentives to help their employees lose weight. Some will even take bonuses out of paychecks for employees who don’t.
Dr. Mike told me about a wager his dad – a three-pack-a-day Pall Mall smoker – made decades ago while working at Bethlehem Steel.
While we’re not advocating this, mind you, it did work.
His dad bet several co-workers at the steel mill $50 each that he could quit smoking for six months. If they caught him with a cigarette, he’d have to pay them $50.
This was roughly three decades ago, mind you, so that was a pretty hefty sum. Still is.
The co-workers, as you might imagine, watched Dr. Mike’s dad like a hawk, for months, particularly on his breaks.
Dr. Mike’s dad stayed smoke-free after making that wager, and got richer to the tune of about $650. A couple of folks didn’t pay up, but it would have been a lot harder for dad to go back on his side of the deal.
My dad was a high school English teacher, a highly educated man. He smoked a couple of packs of cigarettes every day – until he dropped dead of a heart attack at age 45.
I’ve missed him for 30 years, and wish he’d have made, and kept, a similar wager.
"When you make sacrifices to get healthier, that’s a real accomplishment," Dr. Mike told me.
Matt Bove, right, and friend Andrew Donner warm up for the Tough Mudder by flipping tractor tires. The hard driving obstacle race comes to Western New York for the first time this weekend. (John Hickey/Buffalo News)
Matt Bove, 20, of Wheatfield, a senior at SUNY Buffalo State and summer intern at WKBW-TV, and some of his buddies have spent part of the past few weeks pulling cars. Literally.
It’s been part of their preparation for the first Tough Mudder competition to be held in Western New York.
The 10-plus mile obstacle course – a British Special Forces-inspired contest in which contestants run, climb walls, do pull-ups and climb ropes, while slogging through mud – takes place Saturday and Sunday at Tall Pines ATV Park in Andover, Allegany County. (See video from a Tough Mudder by clicking here)
Bove – who is the subject of the "What are you eating?" segment Saturday in WNY Refresh, promised his friend, Ryan Hulub, that he’d run a Tough Mudder someday if Hulub helped him lose weight.
He and another friend, Andrew Donner, talked about the race and his diet in a video interview this week. Meanwhile, here are excerpts from my interview with Bove by phone earlier this week:
You and several friends are running the Tough Mudder. How are you pushing yourselves?
We wanted to do some obscure workouts to try to break the norm a little bit because we knew that would help us because the race is so different than any of us have ever seen before. We’ve been flipping big tractor tires, doing short sprints. Running on pavement is one thing but running on mud and in water (as they will do this weekend) is another thing, so we made sure we got a lot of practice with that.
And we did other strength training, lots of pull-ups and push-ups. (They also had a harness and old car) We strapped it up, we put it in neutral, we had someone steer and then we pulled.
How has your diet changed in recent weeks?
It hasn’t changed too much. I’ve been trying to eat right for a couple of years ...
When I started dieting about three years ago, I was 279 pounds. Now I’m 176. Ryan Hulub and I, we did P90X. We always talked about it when we were working out. He’d say, ‘If you lose 100 pounds, we’re doing the Tough Mudder.’ I had no intention of doing it, but the day finally came when I lost 100 pounds and the Tough Mudder happened to be in Buffalo the following summer, so I’m a man of my word.
He did so much for me and doing this by himself wouldn’t have been as fun. Friends are encouraged to participate. For him, this race won’t be a challenge at all. For me, it’ll be a challenge.
Your eating philosophy?
Limit the sugar, limit the fats. Anything that’s out of a package normally isn’t very good for you. Try to limit eating out as much as possible. Make healthy decisions. You can still eat. You don’t have to starve yourself or anything. Instead of a burger, you get a chicken sandwich. Instead of getting pizza, you get a salad.
The staples of your diet?
For breakfast, I’m a big oatmeal freak. There’s a lot of oatmeals out there like apple cinnamon and cinnamon sugar, but at that point, they’re dumping sugar in them. They’re not really healthy anymore. So I eat plain oatmeal every morning and a I have a Greek yogurt to get some protein in. For lunch, I try go lean, turkey sandwich on wheat bread with some fruit, maybe some plain popcorn. For dinner, whatever mom’s cooking up, but with the weight loss she’s kind of shaped her cooking around that because everyone’s trying to eat healthy. So a lot of fish, a lot of salmon, a lot of grilled tilapia. There’s always a vegetable. And I pick here and there during the day. I’m a big advocate of dried cereal. I measure out a cup of Cheerios and I’ll snack on that.
It’s nothing too crazy because I have been working out a fair amount and I’ve found that if you do work out you can kind of beat everything as long as you don’t splurge too much. Everything in moderation. But you can give yourself a cheat day. You can make sure you enjoy the foods you eat. No one wants to starve. No one’s going to be happy in that.
Colleen Kilanowski has applied what she’s learned at work, at the UB Childhood Weight Control Program, to her home life in Depew. (Charles Lewis/Buffalo News)
This week’s What are you eating subject in WNY Refresh is Colleen Kilanowski of Depew, a Lancaster High School grad with bachelor’s and master’s degrees from the University at Buffalo who helps run the UB Childhood Weight Control Program.
She and her colleague, Distinguished UB Teaching Pediatrics Professor Leonard H. Epstein, are recruiting for the next six-month stint of the program, which helps parents and their overweight children, aged 8 to 12, adopt healthier lifestyles. To participate, call 829-6697 or email email@example.com.
There is eligibility criteria for the program, but it is not rigorous. Groups meet on Tuesday or Wednesday evenings.
Epstein, a leading international authority on childhood obesity, runs the parent groups and Kilanowski runs the kid groups.
"It teaches behavioral change, focusing on eating and activity, along with parenting," Kilanowski tells me.
Folks from across the region have participated in the ongoing program, which has been around more than a dozen years.
"The program is at the University at Buffalo South Campus," Kilanowski says, "but we’ve had kids and parents come from as far as Dunkirk."
An orientation will take place later this month and again in August.
Kilanowski practices at home what she preaches at work.
Her three children all love seafood, as well as most vegetables and bison, turkey and chicken.
"It depends on the kid," she says. "One daughter likes any kind of pasta, one would eat anything and my son is a big meat eater."
But she does temper their food desires with a balanced diet.
"Whatever is served for dinner is dinner," Kilanowski said, "and they’ve learned that."
The family does occasionally eat something on the questionable side of nutrition.
Mom, for instance, loves cheesecake. She treats herself to it about three times a year.
The family used to have pizza once a week, but less frequently these days.
Dr. Thomas J. Foels started working part-time at Independent Health in 1994 and has worked full-time for the insurer since 1997, the last four as chief medical officer.
He recently spoke with me about the insurance company’s role in improving primary care across Western New York and gearing up for the latest changes to come under the Affordable Care Act, during an interview that was so wide-ranging and interesting, I wanted to include more excerpts online than what I was able to include in today’s "In the Field" segment in WNY Refresh.
Here’s one of the more important things Foels had to say:
One of the things our CEO, Mike Cropp, often talks about when he talks about the Affordable Care Act on a national scale is that the federal legislation set some basic principles and guidelines, but it doesn’t tell you how communities are actually going to translate that into a solution. Every community is going to have a different take on that, so it’s the responsibility of the community, not the federal government, to make this thing work.
Those communities that step up and do it right, and get it right, are going to succeed because of the health of a community and the health care resources in a community. And the affordability of health care in a community is important for the economy in the community.
Some communities are going to get it right, some are going to try and fall short and some communities aren’t even going to try. But here, I think we’re trying, and early indications are we’re getting it right. I’m optimistic.
Here are several others:
What is the insurer’s role in the team approach to care?
I think we’re an important facilitator. In the early days, we took a strong leadership role in forming that collaborative and maintaining its focus. Since last July, we said, ‘Everybody’s doing such a great job in the physician community, we’re going to step back, organize you to assume the leadership roles and we’re going to be facilitators.’
It sounds like previous efforts by Independent Health evolved into The Primary Connection.
Yes. One of the things that’s an increasing responsibility of primary care physicians is behavioral health issues. Some feel very comfortable with those, some feel less comfortable. Some are a little confused about medications, how to you approach problems. So we identified a team of behavioral health providers who would co-locate in some of the offices and so now the physicians would have a resource down the hall.
We’ve begun to experiment with programs around geriatric care, so for the most frail elders, can we have a dedicated team of geriatricians who would help the primaries?
We’ve created a blur between traditionally what is the health plan role and the provider role. The health plans have a lot of care coordinators that do a lot of telephonic outreach. We have the ability to identify people with very complex problems and we serve as navigator for many of them. We call them up, arrange for transportation, make sure they get to all their specialty visits, help coach them on how to converse with their physicians, help clarify what their benefits are. We we’re housed at the health plan and not at the physician’s office, so we said, ‘Let’s put them at the doctor’s office.’ So a lot of the empty cubicles out here on a Monday are normally filled with care managers (on other days), but today they’re out of the offices. Now, the nursing staff at those offices will identify patients who are falling through the cracks and work with our care managers.
The system's very fragmented. We’ve got to have the whole jigsaw puzzle put together.
How many more nurses, doctors and health care professionals do you have working at Independent Health now than you would have 20 years ago?
The number hasn’t changed, but we’ve gotten more efficient with what we do. We have about 20 staff members who have devoted their full or part-time to The Primary Connection. ... They’re more positioned toward the front line of health care delivery...
How are things going since this new team and data-driven approach to care was launched last summer?
The primaries are telling specialists, ‘This is our model. We’re looking for collaborators.’
We understand, for instance, not every cardiology group in town is going to embrace this, but we don’t need to refer to every cardiology group in town. If there are a couple of groups who are willing to step forward, to align themselves with some things we think are very important principles, that’s what we’re looking at.
For example, our specialty work group would say to the cardiologist, ‘We have a patient that needs to be seen. First of all, we expect to be able to pick up the phone and get one of you cardiologists on the phone immediately, because we’re only calling you because we have something that requires some degree of urgency. And if we have a problematic patient that could be evaluated in your office instead of the emergency room, we expect your office to make itself available for this diagnostic test. Now, we’re not going to send you somebody involved in a massive (heart attack) to your office, but if we’ve got somebody with some unstable angina and rather than send them to a hospital – who knows when someone will see them, when they’ll get a diagnosis or whether I’ll ever be called back – I expect you’ll be available in the next hour, you’ll be available and you will call me and we’ll discuss what happens with the patient from this point on.’
This is already starting to happen.
We’re also saying to the cardiologist, ‘We expect you to be completely transparent about the quality and data and affordability. Share with us your generic rates, share with us how many procedures and tests you're doing, share your quality outcomes. Of the heart failure patients you have, how many wind up being readmitted to the hospital within 30 days? That’s a bad quality indicator if you’ve got a high rate of that happening. If you’re not able to measure that, if the health plan doesn’t have that measurement, we expect you to start measuring.’
So docs have to be willing to sign onto this greater scrutiny and being part of a team.
What changes do you anticipate January 1, when most Americans will be required to have health insurance?
Access is potentially an issue. There will be a lot of individuals who will have medical needs that have gone unaddressed for long periods of time. Now that they’re insured, they’ll be seeking out care to have those needs met.
Primary care is going to be an important component of that, so we’re working very hard to make sure the primary care offices have the capacity to take on new patients. What’s a big concern nationally is that primary care won’t have the capacity nationally and these patients will deflect to emergency rooms and urgent care centers. They do their bit, but they’re not equipped to address chronic conditions. They’re designed to address minor, acute, straightforward, we-can-solve-it-today sort of problems. A lot of people coming into the system will have much more complex problems, so where are they going to go with that?
Based on state figures, there is a shortage of primary care doctors in Western New York.
The answer there is yes, but if you look the through the traditional lens that everything is physician-delivered, you’d say, ‘Too few, we’re in big trouble.’ But if you say, ‘A primary care physician is the leader of a team that includes mid-levels (nurse practitioners) and nurses practicing at the top of their license,’ I’m not going to say we have an abundance of resources ... but I’m thinking the glass is half-full.
We’re looking at the (University at Buffalo) medical school and moving back four years to undergrad schools ... where primary care physicians can have these students in their office to mentor them and to say, ‘Your traditional thoughts of what primary care can be are probably old and outdated. We’re going to show you why this career would excite you and where we think it’s going, and you might want to get on this train now. We’re also reaching out to other para-professional schools for nurse practitioners and nurses, saying these are new roles.
You’ll be on the insurance exchange come January. How will that work?
Individuals and small business will have the opportunity to obtain their insurance through exchanges on January 1 if all goes well. For people with lower incomes, there are income subsidies. So they’ll go onto the web and the web should communicate with all the various government agencies to make sure (an applicant is) a U.S. citizen and their income can be verified by the IRS, and it will pull up what their federal subsidy will be.
And then they’ll go shopping. They’ll have an array of insurance products on four levels – the products with the broadest benefits will tend to have the highest cost compared to those with more modest benefits – and New York State will manage the exchange.
Some small businesses may choose to do what they’ve always done and contract directly with the health plan on all their employees or they’ll say, ‘I’m going to let my employees go out and shop. I’ll subsidize them, but I’ll let them go out and make individual choices.’
This is a big change for the insurance industry, of course, because we’ve tended to have our relationships with employers representing groups of individuals. The exchange is really an individual market.
Ann Gross, 37, of Amherst, a physical therapist and nationally certified personal trainer, opened Crunch gym two weeks ago in the Sheridan Plaza, at Sheridan Drive and Sweet Home Road in Amherst.
I spoke with her this week for a "What are you eating?" segment that will run Saturday in WNY Refresh.
Before I tell you a little bit about the new gym, I wanted to share her favorite healthy breakfast recipe.
"It’s a healthy French toast," she says. "I make it with five egg whites, and I do a tablespoon of vanilla, about a teaspoon of cinnamon, a dash of almond milk, one pack of the sweetener Stevia, and then I scramble it up and into it I will put two pieces of Udi’s gluten-free whole grain bread. Then I’ll use my non-stick cooking pan with a little Pam and I will make my French toast.
"You feel like it’s a cheat meal but it’s not. It’s actually amazing."
Gross has a "balanced eating" philosophy and tends to eat five meals a day. She says it’s alright to cheat a little – she will take one or two chocolate chip cookies, no more, when baking with daughters Ava, 7, and Nadia, 5 – but portion control is key, with meals of no more than about 300 calories.
"I eat a lot of egg wheats, I’m a huge believer in eating oatmeal in the morning, so I can fuel my workouts and fuel my day," she said. "I’m not someone who believes in eating no carbohydrates. Carbohydrates are a main source of fuel and energy for the body and for the brain. To get that energy is so important. I’ll do a lot of whey protein shakes for a supplement after a workout.
"Mid-day, I usually like to eat a lean choice of protein, lean turkey with vegetables. I really like seasonal vegetables, so I’ll do a lot of Brussels sprouts or asparagus or broccoli. And my lean meat will be chicken, turkey or mid-day fish. I’ll also do a carbohydrate at that meal. I’ll insert a cup of brown rice or corn tortillas, trying to avoid as much flour as possible.
"And later in the day, I’ll eat a really measured source of protein, 4 ounces of meat, and I believe in eating some healthy fat at a meal, doing some almonds, but again, a portion of almonds. Even doing some potato, some sweet potato or Russet potato, but again, it’s a portion of it, 3 ounces.
"Later in the day, around 6, 6:30 with my family, I like to curb my carbs. I do a lean meat over a huge salad with healthy monounsaturated fat, like avocado. ... I eat organic meat. I think that it’s a clean, healthy source of meat, avoiding antibiotics that are often put into meats and all the hormones...
"I don’t really drink alcohol that much. I’d rather fuel my body with good foods, but in general I don’t eat sweets on a daily basis, or white bread. One thing I would never eat is white bread."
Back to the gym.
Gross has the lone Crunch fitness franchise in the region.
The fun-friendly, non-judgmental gym chain is based in Manhattan. It first spread to big cities in Florida and out on the West Coast, and now is expanding into mid-sized markets, Gross said.
She has revamped 18,000 square feet in a former Crawford Furniture store.
The franchise location offers a no-contract, $9.95-a-month membership that includes weight and aerobic equipment, as well as cardio and strength training classes. Premium memberships that include unlimited tanning, hydro-massages and guest privileges, run $19.95 a month, and can be cancelled anytime.
Scott Scanlon is an award-winning reporter and editor who has covered various topics in his quarter-century as a journalist in South Florida, Syracuse and Buffalo. He is aiming to pass along what he is learning these days about health, fitness, nutrition and family life.