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'Fat School' In the Hills of North
Carolina, a Controversial Experiment in Weight Loss
May 20, 2008
By Sandra G. Boodman
Click here for original article
 For
many teenagers at Wellspring Academy of the Carolinas, located at
the end of a serpentine dirt road, the remote mountain outpost
students call "fat school" is a last-ditch stop in a losing battle
that has consumed their lives.
The tiny school, which opened last
year in a refurbished summer camp in Brevard, N.C., 400 miles
southwest of Washington, is designed to test one of the most
radical, controversial and expensive ideas about how best to treat
pediatric obesity. At issue is whether plucking youths as young as
11 who are at least 30 pounds overweight out of "obesogenic"
environments and sending them to a highly structured therapeutic
boarding school for rapid weight loss and intensive behavior therapy
actually works.
School of Last Resort In this video
and narrated gallery,
students who attend campuses of a boarding academy for
overweight kids describe their fight to lose weight.
A month's stay at the school, which
has a maximum enrollment of 50, costs $6,250, making a year at
Wellspring more expensive than a year at Harvard. "We know that
moderation has not been successful for these kids," said Wellspring
president Ryan Craig, a graduate of Yale and its law school, who
characterizes measures like improving school lunches as too little,
too late.
A former investment banker who
persuaded Aspen Education, a for-profit behavioral health company,
to spend $6.5 million to test the approach, Craig opened the first
academy in 2004 in a shuttered mental hospital outside Fresno,
Calif. Until March the schools, the first of their kind, were called
Academy of the Sierras. Two more campuses are scheduled to open, one
near Boston and the other near Austin, and a growing number of state
child welfare agencies have expressed interest in placing obese
children at Wellspring.
"Overall, our success rate is
excellent," Craig said. The average weight loss for students who
stay eight months (twice the required minimum) is 81 pounds, he
said, and the first class of 15 students on average maintained their
weight loss 10 months after leaving -- the only results Wellspring
has published. Among them is Terry Henry of Exeter, N.H., who
enrolled in September 2004 at 15 weighing 558 pounds. He left 15
months later weighing 253 pounds and today weighs about 278 pounds,
school officials say.
Henry's success contrasts with the
experience of Jahcobie Cosom, 18, of Dorchester, Mass. Cosom, who
lost 167 pounds at the school and 30 during his first month home,
gained 260 pounds in less than a year, his weight rocketing to 562.
He is scheduled to undergo gastric bypass surgery this summer.
"If their families don't change,
[students] are going to be back to their old ways of doing things"
when they get home, said Anjali Jain, a pediatrician at Children's
National Medical Center who specializes in treating obesity.
One Day at a Time Scenes From a
Recent Visit to Wellspring Academy of the Carolinas
By Sandra G. Boodman
6:55 a.m. CARDIO IN THE MORNING
The sun is just rising as 18
bleary-eyed teenagers straggle out of the dorms and trudge up a
steep hill, shivering in 16-degree mountain air. Their destination
is a dim, cavernous room in a lodge with knotty pine walls that
doubles as a cafeteria and gym. At this boarding school, breakfast
is always preceded by an hour of exercise: a workout, volleyball
game or brisk walk.
A few boys decide they'd rather
sleep. Their absence will be noted on a whiteboard that tracks
progress up -- and down -- the five-level system on which privileges
including phone calls and visits home are based.
Several students make a beeline for
the treadmills and exercise bikes positioned directly in front of a
bank of small TVs; they click on MTV. Television is permitted only
during workouts.
Santee Wells, 15, who lives on an
Indian reservation in Red Wing, Minn., ceaselessly paces the
perimeter of the room, iPod ear buds jammed in his ears,
accumulating steps on the "pedo" that all students are required to
wear from the time they get up until they fall into bed. Wells,
whose jeans hang off his newly thin frame, has been at Wellspring
the longest and is about to leave. He has lost 106 pounds in seven
months and grimaces occasionally.
He will soon discover he has
gallbladder disease, the eighth student to suffer the painful
ailment so far this year; six, Santee included, have undergone
surgery. Rapid weight loss is a risk factor for gallbladder
problems, and Wellspring officials have told parents that the
school's very-low-fat diet -- fewer than 12 grams per day (about one
quarter the amount recommended by Weight Watchers) -- may play a
role.
A few students halfheartedly pedal
stationary bikes, taking swigs from the giant water bottles they are
supposed to tote everywhere. They must also carry a small
dun-colored booklet called an "SMJ" -- self-monitoring journal -- to
record everything they eat as well as their emotional state, which
will become fodder for individual and group therapy.
"The whole point is that just by
monitoring yourself you'll improve," said the school's executive
director, Michael Bishop, a clinical psychologist who, along with
his mostly wiry 20-something staff, follows the same regimen as the
students.
Sometimes Santee and his classmates
carry around their "chubbies": color snapshots taken the day they
were admitted. Students pull out these worn photos when they feel
discouraged or depressed as a reminder of their progress.
Santee's is shocking. His chiseled
features and now-visible cheekbones are submerged in pillows of fat.
10 a.m. ON SOLO
Everyone is in second-period class
except Blakely Wilder, who is wrapped in two sleeping bags inside a
green tent in an open-air equipment shed, visible to staff who work
in an adjacent heated office. Her algebra book, a letter from home
and the latest issue of People magazine spill out of Blakely's
backpack. Her feet, she says, are getting numb.
The 14-year-old, who arrived just
after New Year's Day against her will, is on a three-day "solo." One
of the most serious punishments, solos are reserved for violating "nonnegotiables,"
as the rules against sexual contact or physical aggression are
called. Blakely was caught kissing two boys in a single week.
Usually "solos" are packed off to
Camp Hope, a Wellspring summer camp 45 minutes away. There they must
refrain from talking, cook their own deliberately bland food and
reflect on their misdeeds under the supervision of staff. Students
at the California campus are sometimes sent to a wilderness or boot
camp to "refocus."
Because Camp Hope is unavailable,
Blakely spends her solo on campus in isolation. She must sleep in a
chilly room by herself and eat meals away from her classmates, and
she is forbidden to talk to them or attend class. She was also
reduced in rank to the first level, which she fears, correctly, will
torpedo her first trip home to Jeffersonville, Ind., the following
month.
"I made bad choices," Blakely said,
adding that she understood why she was being punished. Her parents
were furious and told her that if this was part of a plan to get
kicked out, it wouldn't work. "I have thought of running away," she
said, but decided against it. Dorm doors and windows are alarmed,
and the school is in the middle of nowhere. She's not the first to
consider bolting; enrollment contracts allow parents to be billed
for "runaway expenses."
Her father, Larry Wilder, said he
supports the disciplinary action. Wilder, a lawyer, described his
youngest child and the only one with a weight problem as sweet, "but
probably as good at manipulating adults as many adults. I think it
helped her understand that nonnegotiable means nonnegotiable."
Some parents object to solos as
unjustified or overly punitive. Others question whether they should
withdraw a child who calls crying about being homesick or miserable,
Bishop said. "A lot of times I have to talk to parents about being
parents. I say, 'If your child had cancer, would this be up for
discussion?' Usually they get on board."
Like many students, Blakely said
her life at home had been difficult: Her parents recently split up,
a grandfather was diagnosed with cancer and classmates called her
"Miss Piggy." Switching schools hadn't helped.
Food has been her enduring source
of comfort. Many days she downed 15 cans of Coke and consumed a tube
of cinnamon rolls. "I didn't have many friends, so I came home and
watched TV and went to bed," she said.
Although there are cliques at
Wellspring and "a lot of drama," Blakely said, it's much easier to
be surrounded by people familiar with the stares, sniggers and other
humiliations routinely visited on obese teenagers. "We were all the
fat kids and know what it's like," she said, adding that she's
adjusting to Wellspring and likes it better than when she arrived.
While shared suffering can inspire
touching acts of kindness, it also breeds bullying, behavior that
Bishop said the staff spends a lot of time combating. "As the weight
comes off, they act out and do [what was done to them] to other
kids."
1 p.m. "SPLENDAHOLICS"
Students surge toward the kitchen
serving window, where one precisely measured serving of lunch -- a
choice of beefalo or garden burger, bun optional -- and a dessert
await, along with a low-fat split pea soup and an unlimited supply
of diet soda. The large camp kitchen with its walk-in freezer is
locked at night to remove temptation and is off-limits during the
day. Students say they like the food and are rarely hungry, even
though they exercise about three hours a day.
All food is dubbed "HOP friendly"
because it meets the low-fat, high-fiber requirements of the Healthy
Obsession Program devised by Chicago psychologist Daniel
Kirschenbaum, Wellspring's clinical director. Three meals are
supplemented by an afternoon and evening snack and total about 1,200
calories of foods called "controlleds," which are rationed; there
are no second helpings.
This Story 'Fat School' One Day at
a Time Experts Dispute Wellspring's Approach When 'Fat School'
Failed Him Reflections on 'Fat School': Kevin Mayburn 16 Reflections
on 'Fat School': Meryl "Spidey" Juster, 15 Reflections on 'Fat
School': Vicky Maltagliati, 16 View All Items in This Story View
Only Top Items in This Story "Uncontrolleds," which are supposed to
teach portion control, may be eaten in any quantity and are
available at all meals. Choices include fresh fruit and salad bar
items as well as fat-free yogurt and cottage cheese. Juice is
banned, but skim milk is available, as is Crystal Light soda, which
many students guzzle at breakfast and throughout the day.
By far the most popular item is
Splenda, the no-calorie sweetener students consume in quantities
food service director Chris Holroyd calls "worrying." Students, some
of whom call themselves "Splendaholics," go through more than 500
servings per day. One boy dumps 14 lemon-colored packets into a
small bowl of yogurt.
Other strange food practices
abound. Some kids drench scrambled Egg Beaters with ketchup, douse
baby carrots with mustard or squeeze gobs of no-fat mayonnaise onto
tiny pretzels.
Some obesity experts say that
binging on artificial sweeteners and ketchup may stimulate a desire
for sugar. School officials disagree, characterizing it as harmless
adolescent experimentation; they note that the Food and Drug
Administration has found Splenda to be safe.
Periodically students are given a
chance to test what they have learned through an "off-campus
challenge" at a local restaurant.
One-third "will do great, one-third
will make mistakes and one-third will gorge" on chocolate cake,
Bishop said. "That's fine, too, because these kids have been on such
a low-fat diet they come back and throw up. We want to let people
try and succeed and try and fail" so they can learn from experience
before leaving.
Many students worry about going
home for a visit, or for good, and regaining all the weight they
worked so hard to lose. Some confess that the notion of permanently
forsaking pizza or ice cream the way a recovering alcoholic is
supposed to forever swear off vodka seems overwhelming.
"If you go out and have pizza with
your friends, there's nothing healthy about that," said social
worker Susan Borgman, the school's clinical director. She and the
other staff tell students they can have pizza made with low-fat
sauce and low-fat cheese instead.
2:40 p.m. NUTRITION CLASS
Four girls discuss how they will
cope when they return home.
Sarah Grace Beaty, 15, of
Charleston, S.C., muses about what to do when her family goes to a
favorite festival where fried food is a main attraction.
"Eat before," said her roommate
Tracy Ostrofsky of Houston, who wonders how she will handle
Passover.
This Story 'Fat School' One Day at
a Time Experts Dispute Wellspring's Approach When 'Fat School'
Failed Him Reflections on 'Fat School': Kevin Mayburn 16 Reflections
on 'Fat School': Meryl "Spidey" Juster, 15 Reflections on 'Fat
School': Vicky Maltagliati, 16 View All Items in This Story View
Only Top Items in This Story One girl mentions that her father
routinely eats two Big Macs at a single sitting, while Beaty
observes that cashews are her favorite snack.
"Wait," says teacher Nan Curry, who
is petite and thin. "Cashews are my favorite munchie or used to be
my favorite munchie?"
"Used to be," Beaty replies,
looking chastened.
The best predictor of success,
Wellspring officials say, is leaving with a "clinical blessing":
reaching the third level and staying there for 60 days without a
serious slip. About 50 percent of students at Wellspring's
California campus achieve that, which makes them eligible for a
six-month online aftercare program that costs $500 and is refundable
if completed successfully.
4:30 p.m. IN THERAPY
Kevin Mayburn, 16, his elbows
propped on his knees, hunches forward and nervously fiddles with his
hands as he faces Katie Busch, his "behavioral coach," or "BC,"
Wellspring parlance for therapist. BCs meet with students at least
once a week and regularly call parents to discuss progress and other
issues, such as how to prepare for a visit home. The school also
holds occasional weekend workshops on campus for parents, more than
half of whom have significant weight problems, school officials
said.
Individual and group behavior
therapy, Bishop said, is designed to shore up shaky self-esteem and
"change the self-talk, like 'Diets don't work for me.' "
Kevin arrived Jan. 14 weighing 360
pounds. A high school football player from Livonia, Mich., this is
his first time away from home, and, like others, he is struggling
with separation and homesickness. The previous night, one of his
roommates had to be taken to the emergency room for a medication
problem, and Kevin remains shaken by the experience. "I thought he
had had a stroke," said Kevin, whose mother has suffered
life-threatening medical problems. He is still grieving for his
stepfather, who died a year ago.
He tells Busch he's often tired and
has been clashing with a counselor who accuses him of slacking off.
"I do everything except wake up in
the morning," complained Kevin, one of the no-shows at dawn cardio,
his eyes downcast.
Busch listens sympathetically and
urges him to focus on the good things about losing weight. "Here you
have support from a lot of people who really want the best for you,"
she says. Kevin looks dubious.
10 p.m. LIGHTS OUT
Tracy Ostrofsky sits on the dusty
floor of her dorm room, which is littered with clothes, shoes and
papers. She tosses athletic clothing and gear into a large duffel
bag, hurriedly packing for a weekend caving trip that will depart
early the next morning.
This Story 'Fat School' One Day at
a Time Experts Dispute Wellspring's Approach When 'Fat School'
Failed Him Reflections on 'Fat School': Kevin Mayburn 16 Reflections
on 'Fat School': Meryl "Spidey" Juster, 15 Reflections on 'Fat
School': Vicky Maltagliati, 16 View All Items in This Story View
Only Top Items in This Story Much of what she is taking arrived that
day in a package sent by her mother, opened, as are all packages, in
the presence of a staff member who inspected it for contraband food
or gum.
Talk soon shifts to a favorite
topic at Wellspring: imagining what people will say when
slimmed-down students return home.
In Ostrofsky's case, the reaction
may be less dramatic than most. A skilled lacrosse player, she
arrived barely 30 pounds overweight and looks little more than
chubby. At 16, she is a veteran of summer fat camps, diets and
personal trainers. She keenly feels the contrast with her older
sisters, identical twins and high school co-valedictorians who have
always been thin. Tracy could never keep the weight she lost off for
long.
The daughter of a Houston Internet
entrepreneur, she arrived in February, after boys in her high school
computer class pulled up a photograph of her at a cotillion dance,
looking stunning, but not skinny, in a turquoise dress.
"I thought I looked amazing, but
people were laughing at me," said Tracy, who burst into tears in
class. "It was a turning point. I had to get out of there."
Like many of her classmates, Tracy
kept her destination secret, saying only that her parents were
sending her to boarding school out of state. "They'll find out where
I was when I get back," she said.
'Fat School' In the Hills of
North Carolina, a Controversial Experiment in Weight Loss
Tuesday, May 20, 2008; Page HE05
Wellspring's California school,
opened in 2004 with 15 students, currently has about 95 and includes
a college program. Enrollment at the North Carolina campus is capped
at 50, and usually about two dozen students as young as 11 are in
residence. Many are from the South.
Teenagers take classes in academics
as well as nutrition and eat a strictly regulated diet that hovers
around 1,200 calories per day and contains fewer than 12 grams of
fat. They must accumulate a daily minimum of 10,000 steps on a
pedometer (the equivalent of walking about five miles) and
participate in intensive behavior therapy.
Privileges such as telephone use
and trips home are contingent on moving up a five-level system based
largely on effort, weight loss and compliance. Cellphones, DVD
players and computer use except under supervision for schoolwork
(forget Facebook) are banned.
Misbehaving students can be
temporarily shipped to a disciplinary program run by Wellspring's
parent company, which operates a burgeoning network of boot camps
and treatment programs for troubled youths.
The primary goal, said Wellspring
clinical director Daniel Kirschenbaum, a professor of psychiatry at
Northwestern University, is to create a "healthy obsession" with
weight that will endure long after a student leaves. Kirschenbaum,
who devised the boarding school program, said students are taught
that in order to become an "LTWC" (long-term weight controller),
they must maintain the lifelong discipline of an elite athlete.
"This is like training for the
Olympics," said Kirschenbaum, who said he has maintained a 30-pound
weight loss for more than 35 years.
But other obesity experts question
the wisdom and sustainability of Wellspring's rigid,
total-immersion, extremely low-fat approach, as well as its claims
of unparalleled success.
"I've known Dan Kirschenbaum for 25
years, and I think he's done a good job of taking the best of
science and marrying it with the best of practice," said Thomas
Wadden, director of the Center for Weight and Eating Disorders at
the University of Pennsylvania.
Wadden applauded the school's use
of cognitive behavior therapy and self-monitoring, which have been
found to be effective in maintaining weight loss. But Wellspring's
results have not been subjected to rigorous scientific scrutiny, so
there is no way to tell whether the program works, Wadden said.
"It's an interesting idea, but the answer is going to be in the
data."
Pediatric endocrinologist David
Ludwig, director of the obesity program at Children's Hospital in
Boston, said he fears that a stint at Wellspring might leave some
students in worse shape.
"For some people, rapid weight loss
is motivating and inspiring," said Ludwig, an associate professor at
Harvard Medical School.
For others, dramatic weight loss
can be "a traumatic experience," particularly if food has been used
to self-medicate or as a kind of body armor to cope with sexual
abuse or other trauma.
While some people thrive in
authoritarian environments, he added, others find them oppressive
and rebel.
Ludwig said he is particularly
worried about the effect on vulnerable teenagers who regain weight
after their families have sacrificed so much financially to send
them to Wellspring.
"The sense of failure that can set
in afterward" could inflict long-term damage, he said.
Kirschenbaum disagrees. In his
view, Wellspring may plant the seed of future success in the same
way many smokers make multiple attempts to quit before doing so.
"What this program does," he says,
"is show them the yellow brick road."
-- Sandra G. Boodman
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