OUTCOMES

Wellspring has demonstrated the most significant outcomes of any weight loss program, including programs for adults.

Returning to a Healthy Weight at Wellspring

Students at Wellspring Academies (formerly Academy of the Sierras) enrolled for at least two semesters lost an average of 81 lbs., far better results than reported in any prior controlled study. That’s about 3 lbs. per week over a 7-month period. Approximately half of all students returned to a healthy weight before transitioning home.

Maintaining a Healthy Weight at Home

More remarkable is what happened after students transitioned home. While participants in other treatment programs typically regain a significant percentage of weight lost in treatment by the first follow-up, at the 10-month follow-up, Wellspring alumni had maintained all weight lost, on average. Weight loss achieved at the 10-month follow-up was medically very significant for 100% of Wellspring alumni.

Approximately half of Wellspring students had returned to a normal weight before transitioning home.

Some examples of students who have reached normal levels of weight might provide a more complete view of the important changes achieved by Wellspring students:

Fitness

Various measures of fitness also showed tremendous improvements.

Mood/Outlook

A standardized measure of clinically significant emotional states, the Child Depression Inventory or CDI (Kovacs, 1992), provides an assessment of emotional changes during enrollment at Wellspring Academies.

Parents perceived significant improvements in all three of the scales contained by the CDI: Total or Overall Mood, Emotional Problems, and Functional Problems. On average, the perceived improvements in moods brought the students from the slightly elevated (near clinically significant) range to the normal range (close to the 50th percentile).

Of course, the fact that weight loss is being sustained at home is an excellent indicator that students are doing well emotionally at home.

Process: Self-Monitoring, Journaling, Steps and Evaluation of the Diet

Students achieve these dramatic changes in weight, fitness, and moods by participating in intensive cognitive-behavior therapy, an extensive activities program, frequent personal training sessions, a very low-fat, low calorie-density diet, and an integrated academic program.

Examination of measures of the process of change shows that most students participated very actively in these elements of Wellspring and tolerated the challenges quite well.

Self-monitoring - The degree to which students participate effectively is measured, in part, by the consistency of their written recordings (self-monitoring) of their eating and activity levels. Students at Wellspring self-monitor at a very consistent level, far more consistently than typically seen in adolescents or adults in outpatient settings. Previous research has demonstrated that self-monitoring all foods eaten and activities at least 75% of the time predicts long-term weight losses. Almost all of the Wellspring students achieve and maintain this level of consistency throughout their stay in the program.

Journaling - Students also journaled regularly in their self-monitoring booklets. They wrote an average of 126 words per week in their journals. This indicates that they were using the process of journaling regularly, an important coping tool that they can keep using when they leave.

Activity Levels - Students accumulated nearly 15,000 steps per day on their pedometers (i.e., about 7 miles of activity). Walking 10,000 steps per day (a level 33% below that of the average Wellspring student) has been clearly associated with maintenance of weight loss in several studies.

Diet and Hunger - The rapid weight losses observed at Wellspring have raised questions about the parameters of the diet and the degree to which students found the diet tolerable. The diet included controlled foods (entrees; sides; snacks) and ad lib uncontrolled low-density foods (salads, fruit, soups). The controlled foods were designed to be very appealing, totaling 1,200 kcals, with 300 additional kcals expected from the uncontrolled foods (expected totals: 1,500 kcals,<15 g fat, 70 g protein, and >30 g fiber).

All students completed written assessments of the nutritional aspects of their diets based on posted nutritional information and the Doctor’s Calorie, Fat, and Carbohydrate Counter. Complete records over two days from 18 students were obtained. Eight student volunteers were also monitored by staff members who assessed total consumption and analyzed it with standard nutritional software.

Calories and fat assessed via self-report and external report were lower than expected, but almost identical (self = 1,262 kcals, fat = 7.7 g; external = 1,260 kcals, fat = 7.2 g). Protein consumption was in accord with design, but significantly underestimated (self = 49.7 g; external = 73.6 g); fiber was lower than designed, but accurately self-monitored (self =19.6 g vs. external=18.3 g).

Twenty-four students completed ratings of hunger on a 9-point scale at four time periods for two days. The scale was anchored at five points, including: 6.Hungry - I am hungry but I can continue what I am doing; 4. Mildly Hungry - I can ignore my hunger most of the time; 2. Slightly Hungry - I notice my hunger only when I focus my attention on it. In accord with the extant literature, this reduced calorie, very low-fat, and low energy density diet was well tolerated at Wellspring, with hunger ratings for all 33 students averaging near the Slightly Hungry level (2.64); 84% of the students averaged less than the Mildly Hungry level (range = .4 - 3.9).

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