Spring 2008

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photo by Ken Burris

Off for good behavior
With no gimmicks, gizmos, or celebrity gurus, UVM's behavior-based weight loss program has helped participants lose an average of twenty-one pounds in six months. Now, it's about to reach millions more dieters nationwide. What's the secret behind VTrim?

As a senior research technician in the Endocrinology, Diabetes and Metabolism Unit at UVM’s Department of Medicine, Rhonda Maple ’87 knows all too well the perils of excess pounds. So when her email pinged with the announcement of a weight-loss program offered on campus, Maple signed up for the next session that began in February 2007.

“I work in a research area where we study the link between obesity and Type 2 diabetes,” she says. “I thought, ‘How much more of a sign do I need?’”

Maple entered the program with only the goal of maintaining her current weight. But by the time the weight-loss program ended in August 2007, she had dropped forty pounds—and has managed to keep it off. And that’s without gorging on grapefruit, slurping up cabbage soup, eating like a cavewoman, or popping strange pills.

How? The answer lies more in the word “why,” according to UVM’s Jean Harvey-Berino, professor and chair of the Department of Nutrition and Food Sciences. For the past sixteen years, she has been developing a weight management program now known as VTrim. Harvey-Berino’s research has shown that after six months, VTrim results in an average weight loss of twenty-one pounds—with, as the program promises, “no diets, no weight goals, no quick fixes, no spandex and no bogus info.”

As VTrim continues to expand beyond the UVM campus to corporations, communities, and computer users online, the only remaining question might be, “When can I sign up?”

Diet Riot
The seeds for VTrim were planted in Kingston, Pennsylvania, where Jean Harvey-Berino grew up eating healthy, natural foods instead of the high-sugar, high-fat products beginning to proliferate on grocery store shelves. “My mother always cooked a balanced meal for us and didn’t bring junk food into the house,” remembers Harvey-Berino. “We also never ate in fast food restaurants and, in fact, ate out very little.”

In 1991, after earning her doctorate in epidemiology from the University of Pittsburgh, Harvey-Berino arrived at UVM, where she continued examining the behavior behind weight gain and loss. “I was always interested in the why—not just what people were eating, but why,” she says.

A decade of study under the Behavioral Weight Management Research Program at UVM ultimately led to the 2004 unveiling of VTrim: a fad-free approach to lifelong health and fitness. “By the time people get to us, typically they’ve been on sixty thousand different diets that didn’t work,” says Harvey-Berino. “This is based on science. It’s not easy, but we have the data to back it up, and people come into it with a sense of relief.”

Behavioral therapy for weight management has undergone dozens of randomized clinical trials since the 1970s, with promising results for sustained weight loss. A study published in 1992 in the International Journal of Obesity and Related Metabolism Disorders, for example, showed that after four years with no active treatment, women who had participated in behavior-based programs were still losing weight—a trend that goes against the norm of regained weight after program cessation.

Beth Casey Gold G’06, a researcher and clinical coordinator who helped develop VTrim, says there was nothing secret or surprising about UVM’s approach and resultant program. “It’s not like the formula for Coke,” says Gold. “Managing your behaviors and your lifestyle around eating and exercise is the gold standard that many researchers use—but it’s not typically available to the general public.”

What was revolutionary, says Gold, was the way the UVM team was able to replicate the successes of in-person therapy online. Two studies found that after Internet plus in-person meetings, participants lost an average of 14.7 pounds. The Internet-only group lost an average of 9.42 pounds.

“That was the golden nugget of what started our ability to expand, commercialize, and become more national,” says Gold.

Reading, Writing, and Arithmetic
Before Jim DeVoe-Tatullo began VTrim in March 2007, he says he gave little thought to eating muffins for breakfast and cheeseburgers and onion rings for lunch, or to guzzling a can of soda in the afternoon. Then DeVoe-Tatullo started counting the calories. “I really liked the mechanics of the program,” he says. “It really boils down to a formula of: less in, more output, and you’re going to have the results. I like the detail and accountability.”

For the community-based VTrim program, about fifteen participants meet once a week with a facilitator, using their current weight and desired outcome to set daily calorie goals, which can be as low as 1,200. “People tell me over and over again, ‘I cannot live on 1,200 calories a day,’” says Harvey-Berino. “But people eat way more than they think they do and move way less than they think they do. Until they start counting, they don’t see how the math works out.”

VTrimmers keep track of calories in and calories out in the lime green “Food and Exercise Journal” which, say many, is the toughest part of the program. “I hated it—despised it!” says Jane Ambrose, professor emeritus of music, who followed VTrim in 2007. “It was not part of enjoying a meal, to sit there and write down what the calorie count is.”

Ambrose eventually memorized the calories in a few of her regular VTrim foods—an egg, an apple, a clementine—and lost twenty-five pounds. Meanwhile, other VTrim participants report how the journal jolted them into better behavior. “Writing everything down was revolutionary,” says Nancy Rabinowitz of Burlington. “It revealed wishful thinking about how many calories are in that piece of cake or pie, or that handful of nuts—it’s almost like a reality therapy of what it takes to lose weight and stay in shape.”

Movers, not Shakers
Aliza Mansolino was inspired to sign up for VTrim after reading an article in the Charlotte, Vermont-based magazine Eating Well, which has a healthy collaboration with UVM. Rachel Johnson, dean of the College of Agriculture and Life Sciences, serves as the magazine’s senior nutrition advisor while UVM alumnus Thomas Witschi ’82 is the chief executive officer of the company. Among Eating Well’s editors is Nicco Micco G’04, who earned her master’s in nutrition at UVM and helped Harvey-Berino research VTrim.

Though Mansolino was enthusiastic about how Eating Well described the basic principles of VTrim, she says she found the program challenging. One of the biggest changes for Mansolino was exercising. “I went from pretty much doing nothing to walking several times a week,” she says.

Adding activity to already busy schedules can be challenging for VTrimmers, says Harvey-Berino, a runner, skier, cyclist, and horseback rider. “You start and then something throws you off, like it gets cold and dark,” she says. “You have to constantly reorganize yourself and keep trying different things.”

Though VTrim recommends walking, simply stepping out the door can lead to more. A former college athlete who had lapsed into inactivity, DeVoe-Tatullo says VTrim helped him rediscover the joys of running, biking, swimming, and soccer; he even competed in a few triathlons in 2007. “It was a phenomenal transformation,” he says.

As a jump start for healthy exercise habits, VTrim participants receive a discount on the Women’s Fitness Program at UVM, an intensive, one-week course led by Declan Connolly, associate professor of exercise science and director of the University’s Human Performance Laboratory. Among the other faculty members, who teach weight training, yoga, water therapy, nutrition and more, is Harvey-Berino. Further synchronizing the connections among lifelong learning, fitness and food choices, UVM’s Continuing Education department administers both the women’s fitness program and VTrim.

Healthy Choices
The only tough part of VTrim is that it is tough sometimes. “It took a lot of time each week to shop, to plan, to weigh, to measure, to record—that’s probably the biggest drawback” says Maple. “It’s easy to stop somewhere and get pizza or takeout instead.”

In today’s “obesigenic environment,” sure, it’s hard to stay on track, says Harvey-Berino, who has her own temptations—bread, ice cream, chocolate, and peanut butter—that she simply eats in small quantities. “We live in a time when portion sizes are huge; it’s really inexpensive to get too many calories; we drive everywhere; we market horrible foods to children,” says Harvey-Berino. “We’re not helping ourselves.”

Now, at least, it will be easier for both individuals and groups to follow VTrim. Harvey-Berino and her team are working with nationwide corporations to bring VTrim classes to conference rooms. And last year saw the release of The Eating Well Diet, an introduction to VTrim with more than 150 recipes (see sidebar) that allows readers to participate in the weight-loss program without having to attend a community-based class.

For those who need more accountability, VTrim is also expanding its online courses, which have been extensively studied thanks in part to grants from the National Institutes of Health. Filled with handy tips and weight-loss tools and moderated by a facilitator, the Internet-based program mimics the in-person one—except your classmates might be hundreds of miles away, wearing bathrobes instead of business clothes.

Harvey-Berino says that from comparing past online classes to face-to-face classes, the support seems even stronger in cyberspace. “The people that were online tended to keep in touch with each other better,” she says. “I think that’s because they had access to email and were used to chatting online, so they’d chat more with each other.”

For VTrimmer Nancy Rabinowitz, some of those “chats” have become more internal as she tackles eating healthy on her own and with her husband. She still orders steak frites at Leunig’s on Church Street, but opts for green beans instead of the fries. Rabinowitz spins, walks, and competes in cross-country ski races and if she goes to a wedding, she doesn’t sweat a slice of cake. “The program works; it’s a diet for grown-ups because you get to tailor it to your lifestyle and your taste—you determine what things are important to you in terms of eating,” says Rabinowitz. “It has changed my whole life.”

VTrim has helped many lose weight through in-person and on-line classes. A new publication from Eating Well Magazine spreads the word and offers some tips for the kitchen. Here’s a glimpse:

Sizzled Citrus Shrimp
Healthy Weight | Lower Carbs
Active time: 15 minutes (including peeling shrimp) | Total: 40 minutes
This quick Spanish-inspired saute is a lesson in simplicity. All shrimp really needs to dazzle is lots of garlic and a splash of lemon. Serve as a main dish or as a tapa (appetizer).

Marinade & Shrimp
            3          tablespoons lemon juice
            3          tablespoons dry white wine
            2          teaspoons extra-virgin olive oil
            3          cloves garlic, minced
            1          pound medium shrimp (30-40 per pound),
                        peeled and deveined
Sauce
            1          teaspoon extra-virgin olive oil
            1          bay leaf
            1/4       teaspoon crushed red pepper
            1/4       teaspoon salt, or to taste
            2          tablespoons chopped fresh parsley

1. Combine lemon juice, wine, 2 teaspoons oil and garlic in a medium bowl. Add shrimp and toss to coat. Cover and marinate in the refrigerator for 15 minutes, tossing occasionally. Drain well, reserving marinade.

2. Heat 1 teaspoon oil in a large nonstick skillet over medium-high heat. Add shrimp and cook, turning once, until barely pink, about 30 seconds per side; transfer to a plate. Add bay leaf, crushed red pepper and the reserved marinade to the pan; simmer for 4 minutes. Return the shrimp and any accumulated juices to the pan; heat through. Season with salt, sprinkle with parsley and serve immediately.

Makes 4 servings, about I cup each.

Per serving: 171 calories; 6 g fat (1 g sat, 3 g mono); 172 mg cholesterol; 4 g carbohydrate; 23 g protein;
1 g fiber; 315 mg sodium; 270 mg potassium.
Nutrition bonus: Vitamin A (15% daily value), Vitamin C (15% dv).

Copyright The EatingWell Media Group.
Excerpted with permission from The EatingWell Diet (The Countryman Press, 2007).

More on VTrim: uvm.edu/~vtrim. More on the July 2008 Women’s Fitness Program: uvm.edu/~vtrim/fitness

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