Does Obesity Rehab for Kids Work?

Elizabeth Fedorchalk was tired of being fat. She had been trying to lose weight since elementary school, but diets never made a difference. She wasn’t husky. She wasn’t big-boned. By age 16, the 5-ft. 5-in., 291-lb. high school junior from Holts Summit, Mo., was undeniably obese. And each year, it was only getting worse.

Fedorchalk’s diet was abysmal. She skipped breakfast, ate lunch at school — usually chicken strips and fries — and frequently had dinner at McDonald’s: a burger and more fries. She drank nondiet soda and snacked on potato chips and Little Debbie cakes. She never exercised because, between school and extracurricular activities, she claimed she didn’t have time. “It got to where I didn’t like sports anymore,” Fedorchalk says. “I’d get out of breath and get upset because mentally I wanted to do so much, but physically I couldn’t.” She gained 45 lb. in 2009 alone.

(See 10 dieting myths debunked.)

She had high cholesterol, and her weight put her at risk for hypertension, heart disease, sleep apnea and Type 2 diabetes. By any measure, Fedorchalk was in poor health. But look around. She is hardly alone.

In the past 30 years, obesity rates among U.S. children have more than tripled. A flurry of antiobesity legislation has taken aim at environmental factors that have contributed to the epidemic, and Michelle Obama’s sweeping new Let’s Move campaign to end childhood obesity will most likely inspire further changes in the coming years. But while healthier school lunches and public-service announcements may help future generations stay fit, they won’t make someone like Fedorchalk thin. Our national dialogue focuses on obesity prevention, but what do we do for kids who have already gained the weight?

(Watch a video with Jillian Michaels: “How to Lose Hundreds of Pounds.”)

As Fedorchalk’s weight climbed, her parents feared for her well-being. “We couldn’t communicate with her or get her to change her habits,” says her mother Michele. Family members decided there was nothing they could do for her at home; she needed professional help. In September, they sent her to Wellspring Academy, a residential weight-loss facility in Reedley, Calif. For families like the Fedorchalks, Wellspring offers a commodity often in short supply: hope. But turning that hope into a long-term remedy for teen obesity isn’t easy.

(See and listen to an audio slideshow about Wellspring Academy.)

Weight-Loss Boarding School
When marathon runner and educator Ryan Craig opened Wellspring Academy in 2004, it was the only residential obesity-treatment center of its kind. (Others existed mostly in clinical settings.) A former board member of the Aspen Education Group — one organization behind those wilderness programs for troubled teens — Craig learned about the staggering U.S. obesity rates and saw an enormous untapped market for a weight-loss school.

Wellspring Academy houses about 75 students in grades 8 through 12, all at various stages of weight loss. Students can enroll at any time and must stay at least four months. They live together in dorms, just like at traditional boarding schools.

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Aside from regular academic classes and sessions with staff therapists, kids participate in simple exercise routines like walking 10,000 steps (5 miles) each day. The school’s weight-loss program was designed by Northwestern University Medical Center professor Daniel Kirschenbaum, who used to run a number of clinical obesity programs in Chicago-area hospitals. Students are served three perfectly proportioned meals a day and are asked to note everything they eat in a journal. Calorie and fat counts are displayed on a whiteboard in Wellspring’s cafeteria, making it easy for kids to copy them down. The diet, which allows for unlimited access to fruits and vegetables, works out to about 1,300 calories per day and results in 1 to 5 lb. of weight loss a week, depending on the student. Wellspring claims its students lose an average of 25% of their starting weight and 70% maintain or continue their weight loss a year after leaving the academy.

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Every meal at Wellspring is basically a fat-free re-creation of something unhealthy. In their nutrition and cooking classes, kids learn to make mozzarella sticks with fat-free cheese and PB&J sandwiches with imitation peanut butter. They’re nowhere near as tasty as the original versions, but the kids seem to like them, and at least they don’t feel deprived. “A lot of parents ask me why we don’t serve organic health foods,” says Craig, “to which I say, Is your kid really going to eat that?”

(See the 10 worst fast food meals.)

No Easy Answers
A program as progressive as wellspring’s is bound to have some kinks. Like most other weight-loss programs, Wellspring is not covered by any health insurance plan. Many families find themselves taking out loans to pay the $6,250-per-month tuition. “A lot of parents use their kids’ college money,” says Craig. Its prohibitively high cost makes the place inaccessible to many Americans who could benefit, especially since the highest obesity rates are found in low-income areas. But Wellspring kids are far from wealthy. Fedorchalk’s mother and father, who work at a nursing home and Walmart, respectively, struggle to pay the bill. Freddy Fahl, 16, attends the school courtesy of a several-thousand-dollar student loan taken out by his mother Debi DeShon.

(See TIME’s special report on paying for college.)

Fahl arrived at Wellspring in September. He was up to 351 lb., having gained 40 lb. a year for three years straight. “His weight was completely out of control,” says DeShon. Last year, Fahl was even denied health insurance because of his weight. “He was 16, and I thought, O.K., I have two more years with him. Am I willing to send my child into the world at 400 lb.?”

When he stayed on the diet, Fahl lost an average of 4 lb. per week. But he found himself cheating whenever he could. While visiting his brother off campus one weekend, he went to Taco Bell and ate “almost everything” on the menu. At another outing to a restaurant, he ordered pie. Over Christmas break, he managed to lose weight, but only because his mother kept him on the program. When he returned to campus in January, he mysteriously started gaining. His therapist wonders whether he didn’t smuggle in some candy.

(See pictures of what makes you eat more food.)

Fahl’s weaknesses mirror one of Wellspring’s: its success hinges on the parents. Craig hosts family workshops and urges parents to rid their homes of unhealthy foods. Yet despite the thousands of dollars they spend on tuition, only some Wellspring parents are willing to change their behavior. In medical studies, family-based behavioral treatments have proved almost twice as effective as those that involve only the child. “You can’t have a successful program if the parent is telling the kid not to eat chips while he’s sitting there eating ice cream,” says Leonard Epstein, a clinical psychologist and professor at the University at Buffalo.

After they leave Wellspring, students remain in contact with their therapists for six months to help them readjust to the real world. They have been spoon-fed diet-friendly meals for so long that they are often unsure how to act at birthday parties and pizza nights.

Which points to another problem: the fat-free diet. It’s difficult to maintain and, over the long term, nutritionally unsound; humans need fat to survive. “People don’t lose any more weight on a low-fat diet than they do on a high-fat one,” says David Ludwig, director of the obesity program at Children’s Hospital Boston.

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“This is the only area of our program that is controversial,” Craig acknowledges. But he adds that kids need something they can understand, and they understand fat.

The school’s self-reported 70% success rate is based on voluntary follow-up assessments with former students, most of whom agree to participate. A rate that high is almost unheard-of in the diet world. Only 7% of dieters finish Jenny Craig’s one-year program, while Weight Watchers counts people who stay even a few pounds under their starting weight as a triumph. But these programs lack the comprehensive approach of Wellspring. Research indicates that therapy-based obesity treatment can be three times as effective as traditional diet-and-exercise models. But how many people can run off to rehab for six months? “The outcome is probably better [at Wellspring] than if the program were applied to the general public. The people who can go to that school are a small sliver of the population,” says Kerri Boutelle, associate professor of pediatric psychiatry at University of California at San Diego.

(See “The Year in Health 2009: From A to Z.”)

After Wellspring
Fedorchalk and Fahl have been at Wellspring for nearly six months and have lost 72 and 82 lb., respectively. Fedorchalk dropped eight dress sizes — from a size 22 to a 14 — and although she’s still considered obese at 219 lb., for the first time in her life she can shop at what she calls “skinny people” stores. She counts fat grams obsessively and adheres to her diet whenever she’s at a restaurant. On a recent visit to an Olive Garden, it took her 20 minutes to find something on the menu she could eat. She is also exercising regularly. “Whenever I’d try to do a sport at home, there’d always be really skinny people who were always really good at it, and I’d feel kind of awkward,” she says. “Here I can give 100% without looking stupid.” In November, she and Fahl walked a half marathon.

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Fahl was scheduled to leave Wellspring on Jan. 15, but he was still struggling with the program, and DeShon didn’t think he was ready to come home. Two days before his departure, she told him he had to stay. “I did my part,” Fahl complained. “Why can’t I lose the rest of the weight at home?”

That’s a lot easier said than done, of course. “It’s way harder than they ever tell you it will be,” says Ganzy McCorvey, 19, who lost 104 lb. at Wellspring in 2007, only to gain half of it back. “I felt really guilty making my mom eat the same things as me. And then there were my friends, who always wanted to go to Wendy’s.” Other former Wellspring students experienced similar roller-coaster cycles of losses and gains.

Wellspring is no miracle cure. Even the most advanced kids at the academy are far from thin. But they are healthier, and they have been empowered with the uncommon gift of hope. Nobody is destined to be fat forever, says Fedorchalk. “Even if you do mess up, even if you do fall, what matters is you get back up again. You can always start anew at the next meal.”

See pictures of the college dorm’s evolution.