CHIP

A California guru of healthy eating hopes to prove Midwesterners can change

By Lorna Collier
Published May 19, 2002 (Chicago Tribune, Health & Family section)

Melanie Fazio has lost 100 pounds -- twice. Both times, she gained the weight back.

Now the 53-year-old Rockford, Ill., woman is convinced she has finally learned how to keep the pounds off for good. Since August, Fazio has dropped 40 pounds -- but not by dieting.

“I finally came to realize that you have to change your lifestyle,” says Fazio, who switched to a near-vegetarian diet, began exercising regularly, and has given up counting calories.

Melanie Fazio is what’s known in Rockford as “a CHIP-per” -- one of about 4,000 local graduates of a lifestyle education program called the Coronary Health Improvement Project, or CHIP. Founded by Hans Diehl, a California epidemiologist, 12 years ago, CHIP preaches the virtues of vegetarian diets and regular exercise as a way to prevent heart disease, cancer and other lifestyle-related illnesses.

Diehl and CHIP’s sponsor in Rockford -- the SwedishAmerican Center for Complementary Medicine -- have lofty aims: they want to make the city the healthiest in the country, plus create in Rockford a reproducible model for community change, a template that can be adopted by cities across the nation.

“The goal is to develop a national training center in Rockford where I and my staff will be training civic leaders, corporate leaders and medical leaders from all over the nation,” says Diehl, founder of the Lifestyle Medicine Institute in Loma Linda, California.

Why Rockford, a primarily blue-collar, pizza-and-beer, “Beef Belt” city of 150,000?

“Rockford is ideal because it is a ‘meat-and-potatoes’ type of town,” says Peter Vedro, CHIP organizational consultant. “If we can be successful here of all places, then we certainly have made a dent in the argument that ‘typical’ Midwest Americans won’t change their diet and behavior.”

Diehl also says he liked the city’s size, its medical school and the support he found in SwedishAmerican Center doctors, who already had installed a Dean Ornish program, a somewhat similar lifestyle improvement plan targeted toward people who have already developed significant disease.

The CHIP program’s nutritional goals are a little less stringent than Ornish’s (15 percent fat versus 10 percent), but share the same vegetarian, whole-grain emphasis. CHIP is less intensive and costly, and is aimed at anyone who wants to improve health.

CHIP participants in Rockford attend an eight-week program, meeting twice weekly to watch Diehl via videotaped sessions led by facilitators. Before and after the program, they receive a medical work-up. Cost is $295 per person, $525 for couples, and typically 20 to 40 people attend.

If any participants are identified in the initial screening as having significant disease, says Vedro, they are referred to the Ornish program. Vedro says Rockford is the only city in the country with both CHIP and Ornish programs under one roof.

When CHIP first came to Rockford in early 1999, sessions were led by the charismatic Diehl in person, four nights per week for a month, attended by several hundred people in an atmosphere one participant described as “electric.” For the past year, CHIP classes have been available on a video basis only, though another live session with Diehl is planned within the next year or two.

CHIP in Rockford is more than just classes, though. Key to the “community transformation model” that CHIP and SwedishAmerican are developing is the integration of various segments of the community.

For example, about 25 restaurants have added CHIP-approved vegetarian dishes to their menus.

“We’ve had an incredible response,” says Melissa Seeling, operations manager at the Rockford-based Beefaroo fast-food chain, which began about a year ago offering veggie burgers, soups and salads in addition to its regular fare.

Besides restaurants, grocery stores have increased their vegetarian stock, while the SwedishAmerican Center started a health-food store of its own, the Midwest Market. The Rockford YMCA provided money for a CHIP program targeting the African-American community, while the Rockford school district is testing a healthy foods program in one of its elementary schools.

In addition, CHIP has branched out into the workplace, with six companies providing training on-site to employees.

Dave Jackson, a 57-year-old machinist at Rockford Products Corp., credits the CHIP program with reversing his angina. Since the program, Jackson has lost 40 pounds, exercises daily, and become a vegetarian.

Prior to CHIP, Jackson and his wife -- also a CHIP graduate -- were typical American diners. “We’d have a big roast or lots of pork chops, with a little bit of vegetables with it,” says Jackson. “I would eat meat three times a day. I was addicted to it.”

Jackson was surprised to find that he was able to drop meat from his diet with ease. The benefits from the changes: Jackson says he has more energy and no more chest pain.

Jackson is one of about 120 Rockford Products employees to go through CHIP in the last 18 months, says spokesman Richard Mowris. The company is studying whether the program has saved money, but has no firm results yet.

“We know it’s had some significant impact on a number of people,” says Mowris, pointing to diabetics and heart patients who have stopped medications. However, says Mowris, about a third of the participants no longer follow the program.

Whether people can stick with CHIP long-term is the big question. Long-range research in Rockford is “just getting going,” says Dr. Roger Greenlaw, gastroenterologist and medical director for the SwedishAmerican Center. However, one study looking at Rockford workplace participants showed promising results, at least in the short term.

Researcher Steven Aldana at Brigham Young University found that workers lost an average of 9 pounds and 17 cholesterol points in eight weeks. Improvements in weight, cholesterol, triglyceride, and blood-pressure reductions were the best he had ever seen reported in any worksite program, says Aldana, who also found that CHIP results were the same for both video and “live session” participants.

Aldana tested some of the workers after six months and found that most improvements remained -- except for cholesterol levels, which rose almost to beginning levels. Aldana says this could be due to participants stopping cholesterol medications or to people sliding back into poor diet and exercise habits.

About 30,000 people in 76 cities in the U.S. and Canada have taken the CHIP program, which is heavily supported by Seventh Day Adventist groups. It was offered in Kalamazoo, Mich., several years ago, where medical director Dr. Alicia Williams, a Kalamazoo cardiologist, said it had “a great impact on the community.” Diehl says a follow-up study of the Kalamazoo program by a Western Michigan University intern showed that 93 percent of the people one year after program graduation still had weight loss and on average had lost another 16 pounds.

One way SwedishAmerican is trying to keep Rockford’s CHIP-pers on track is through an alumni association. About 370 CHIP grads are enrolled in the group, which costs $60 annually, meets monthly and holds events such as “CHIP-nics” and “CHIP-lucks.” Thirty-five Rockford grads recently went on an 11-day “wellness cruise” to the southern Caribbean, which featured CHIP-approved food in lieu of typically rich cruise fare.

Dr. Thomas Pearson, dean of community and preventive medicine at the University of Rochester in New York, who also chairs the Centers for Disease Control’s “National Action Plan for Cardiovascular Disease,” says community education programs like CHIP are “generally good,” and agrees that in order for people to change, their environments also need to change.

However, Pearson has reservations about diets that call for less than 25 to 35 percent fat, which he says can raise triglyceride levels.

Greenlaw disagrees, noting that sometimes CHIP participants have a “transient rise in triglycerides,” but that this “usually settles down in time.” Sometimes, dietary adjustments are made. “I have found CHIP and Ornish ideal for 85 percent of people,” says Greenlaw. “In 15 percent, something doesn’t suit them, and we have to adjust the fat or carbohydrates or protein a little bit to make it more suited to their metabolism.”

CHIP can be modified by people to fit their needs, says Vedro, who gets frustrated by the perception that CHIP is only about taking meat away. Rather, he says, the program attempts to give people information about optimal diets, and lets them choose what they feel is necessary for them.

The next step for CHIP in Rockford is to create more CHIP-pers.

“What we want is to go from 4,000 to 7,000,” says Greenlaw. “When we have 7,000 to 10,000 graduates, we’ll be affecting 5 percent or more of the adult population of the community. All it takes to change the whole community is 5 percent in step.”

Once that is achieved, Greenlaw sees SwedishAmerican and Diehl partnering to offer the Rockford “template” to other hospital systems and communities around the country.

“We are just now starting to turn our attention from our local work to our regional work,” says Greenlaw. “But we don’t want to get distracted too much -- we have a lot of work to do just to keep the Rockford project developing to the next level.”

© Copyright Lorna Collier, 2002