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FirstHealth of the Carolinas
Taking Control of Your Wellness By Christine Cardellino

There’s good news and there’s bad news in the United Health Foundation’s 2006 edition of America’s Health Rankings.

Although fewer North Carolinians are smoking cigarettes (22.6 percent of the population, down from 31.6 percent in 1990), more of us are struggling to maintain a healthy weight.

According to America’s Health Rankings, North Carolina’s obesity rates have more than doubled since 1990, from 12.9 percent to nearly 30 percent of the population today. In fact, a recent national report ranked North Carolina as the 14th heaviest state in the nation, with 62.7 percent of the population either overweight or obese.

Poor diet and physical inactivity account for an estimated 14 percent of all preventable deaths in North Carolina and are known major causes of obesity and related chronic diseases, reports the North Carolina Department of Health and Human Services.

“We’ve all heard plenty about the health dangers of obesity and other consequences of the ‘typical’ American lifestyle, and many of us are trying to make better choices in our lives,” says Melissa Watford, a health educator with FirstHealth Community Health Services. “There’s so much that we, as individual health care consumers, can do to keep our good health—or to prevent the progression of disease for those who are living with a chronic health condition. Whatever your own health concerns and priorities—fighting a family history of heart disease or diabetes, slimming down, being less sedentary, quitting smoking—we all have to take personal responsibility for our own health. That’s what it means to be a smart and engaged health care consumer.”

Smart Step #1: Get moving!
Physical activity is a proven way to reach and maintain your weight-loss goals and to prevent or manage diabetes, high cholesterol and other chronic health conditions. Through her role with FirstHealth Community Health Services’ Active for Life program, Watford has worked with hundreds of men and women who are taking a proactive approach to their wellness.

Active for Life is a behavioral-change program designed for inactive adults age 50 and older. It teaches people how to make minor, manageable lifestyle shifts that yield major results.

In a recent survey of Active for Life enrollees, less than a quarter of those questioned reported being fairly active. After completingthe program, 81 percent of participants reported they were active on most days of the week.

“Active for Life emphasizes more of a gradual lifestyle change than a formal exercise program, and the content is personalized so each participant can make a meaningful connection to his or her own lifestyle,” says Watford.

For example, because many people believe they do not have time to add physical activity into their day, the program includes a personal time study. “We look for opportunities throughout the day where you can build two minutes of activity into your routine,” Watford says. “Maybe taking a quick walk around your building or walking to get lunch instead of driving. After that, if you can fit in two minutes of activity a day, we look at how you can work up to five minutes and build from there.”

In addition to program materials, participants receive a step counter to help them monitor daily activity levels and fun incentives such as water bottles or stress balls. Active for Life classes meet once a week for 12 weeks throughout Hoke, Montgomery, Moore and Richmond counties.

(More than 900 people have completed FirstHealth’s Active for Life program since it first was offered in 2003 through a grant from the Robert Wood Johnson Foundation. For a schedule of upcoming classes, call (800) 213-3284.)

Smart Step #2: Eat a rainbow
Whether you have a significant amount of weight to lose or just a few extra pounds, attaining a healthy weight requires discipline and dedication. Most nutrition experts recommend watching your portion sizes, being more active, keeping a food journal, eating more fruits and vegetables, and cutting back on fat and empty calories.

“Overweight and obesity are widespread health concerns in North Carolina and across the country,” says Kathy Hefner, MPH, R.D., LDN, a nutritionist with the FirstHealth Center for Health & Fitness- Pinehurst. “People feel they have less time to plan and prepare nutritious meals. They opt instead for the convenience of grab-andgo- type foods. The problem is those convenience items—frozen microwave meals, fast food and takeout—often are higher in calories, sodium, and saturated and trans fats.”

Hefner, who provides individualized nutrition counseling services to FirstHealth patients, encourages people to choose a variety of items from each of the food groups and by eating plenty of fruits and vegetables, especially those in different color categories. The American Dietetic Association recommends two to three servings of fruits and three to five servings of vegetables each day.

“By selecting from the ‘rainbow’ of fruits and vegetables available, you’ll get a wider variety of antioxidants, such as vitamin C, vitamin E, selenium, betacarotene and lycopene,” Hefner says.
“Antioxidants are believed to keep the immune system healthy and to protect the body from diseases such as cancer and heart disease.”

Smart choices from the fruit and vegetable color categories include:

  • Red: tomatoes, strawberries, watermelon, pink grapefruit, cranberries
  • Purple/blue/black: blueberries, grapes, cabbage
  • White/tan/brown: onions, garlic leeks, mushrooms
  • Green: broccoli, spinach, leafy lettuces
  • Yellow/orange: sweet potatoes, squash, oranges, carrots, apricots, cantaloupes, pumpkin

In Hefner’s experience, controlling servings and portions is a familiar challenge facing people who are trying to lose weight or watch their caloric consumption.

“Restaurant portions are much larger than they should be, because people have a perceived need for value,” she says. “Even dishes and utensils are larger, which distorts our perception of proper portion size. Scientific studies have shown that when you have more food on a larger plate, you consume many more calories than you actually need.”

To keep your portions and servings in balance, Hefner recommends that you “use smaller plates and smaller utensils, even to point of measuring the actual portion you consume so you can compare it to the serving size recommended on the food label of what you eat. For example, with sodas, you might think one bottle equals one serving, but if you read the label you will see that the bottle actually contains two or three servings.”

For anyone who is trying to attain or maintain a healthy weight, “there is no ‘quick fix,’ and there are no ‘good’ or ‘bad’ foods,” Hefner says. “A well-balanced diet is just one factor in an overall lifestyle that contributes to your good health,” she says.

Smart Step #3: Get your zzzzzzs
On some occasion in your life—a new baby at home or a crunch time at work, perhaps—you probably have experienced a sleepless night or two. But if you’re one of the 40 million Americans who suffers from sleep apnea, insomnia and other chronic sleep disorders, you’re missing out on more than a good night’s rest.

According to the National Sleep Foundation, sleep deprivation can interfere with your physical and mental well-being— from your alertness and mood to your ability to concentrate on tasks at work and at home. Also, a 16-year study of more than 68,000 American women found that those who slept five or fewer hours per night tended to gain more weight during middle age.

“Sleep problems are quite common,” says Dan Grady, director of Medical/Neuro Services at FirstHealth Moore Regional Hospital. Grady oversees the operations of FirstHealth’s Sleep Disorders Centers in Pinehurst, Rockingham and Troy.

“A couple of factors contribute to the growing incidence,” he says. “As we age, the incidence of sleep-disordered breathing increases. Also, other medical conditions such as obesity, chronic lung disease and stroke contribute to sleep disorders. It also is well known that many people do not get enough sleep for different lifestyle reasons.”

One of the best ways to detect sleep problems is through overnight observation in a sleep center. During a painless procedure called a sleep study, technicians monitor your sleep patterns through sensors, electrodes and other devices attached to the body and connected to a recording device. The machine records brain activity, muscle activity, eye movement, heart rate, breathing and oxygen saturation. A camera helps technicians observe body positioning and movement throughout the study.

“Results of the sleep study provide information to help your physician determine if you have a sleep disorder and then develop an appropriate treatment plan,” Grady says. “Treatment ranges from behavior modification, such as weight loss or relaxation, to medication, special medical devices and, in rare cases, surgery.”

If you have trouble falling asleep or maintaining sleep, awaken earlier than you wish, feel tired upon awakening or suffer from excessive daytime drowsiness, Grady suggests that you talk to your doctor or see a sleep specialist for further evaluation.

“You also can keep a sleep diary to note how long the problem has lasted,” he says. “Don’t put it off, because you can feel much better very quickly.”

For more information on FirstHealth’s Sleep Disorders Centers, please call (800) 213-3284 toll-free.

Smart Step #4: Recharge and balance your life
We all feel varying degrees of stress in our lives at some time or another. Traffic jams, a fight with your teenager or a rush deadline at work can trigger acute, or short-term, stress. Caregiving responsibilities for a sick parent or child, a demanding job, and frequent worries about bills or layoffs can cause chronic, or longterm, stress.

“Stress has been around for a long time, and the ‘fight or flight’ stress response in the human body has been a survival mechanism since caveman days,” says Elizabeth Manley, MSN, R.N., C.S. “What’s different in our modern culture, however, is that we experience the stress response but don’t have any way to expend the energy.”

A therapist with FirstHealth Behavioral Services, Manley conducts the Mindfulnessbased Stress Management Program at Moore Regional Hospital.

During stressful situations, says Manley, "a whole cascade of events happens in our bodies that drive us to outrun our enemies or fight to the finish. The physiological changes that happen during the stress response lead to the release of cortisol in our body. Our bodies need to have a relaxation response to counteract the stress response.”

In people with chronic stress, the body is in a constant state of physiological arousal and unable to produce the relaxation response. This leads to hyperactivity, anxiety, irritability, increased sensitivity to other stressors and other problems.

“Every system in our bodies is impacted by unresolved long-term stress,” says Manley, who strongly believes that stress management is the foundation of an overall healthy lifestyle. “It can affect the immune response, making the body susceptible to infections and possibly some cancers. Chronic stress can lead to burnout and depression. On a daily basis, it can compel us to overindulge in food, alcohol or other addictive behaviors, drain our energy, disrupt our sleep and much more.”

In her Mindfulness-based Stress Management classes, Manley trains people how to “get back in their bodies, be in the present moment, be gently aware of oneself.”

“This is the concept of ‘mindfulness,’” she says. “Through the practice of daily mindfulness meditation, you learn self-discovery, how to manage stress and how to create a better quality of life for yourself. In that state of self-awareness, you learn how you deal with emotions and circumstances and whether or not they have a positive or negative effect in your life. What one learns in mindfulness is about acceptance and letting go, about patience, and meeting each moment with a sense of adventure.”

During the eight weekly sessions of Mindfulnessbased Stress Management, participants learn four different types of meditation and receive two meditation tapes to use at home. Each two-and-a-half-hour group class covers a different concept or theme. The program includes an all-day Saturday session, and each participant meets privately with Manley before and after the program.

“From being more active to eating a well-balanced diet, everything you do to be healthy also is positive in terms of stress reduction,” Manley says. “If you approach your health from a holistic perspective that includes the physical, mental, social and spiritual needs, you will get good results.”

The next Mindfulness-based Stress Management class will begin on Sept. 10. The deadline for registration is Aug. 20. Please call (800) 213-3284 for more information.


If you are interested in learning more about becoming an involved health care consumer, try these books, which are available at the Health Sciences Library at FirstHealth Moore Regional Hospital.

  • “Educating Hospital Patients and their Families,” by the Joint Commission on Accreditation of Healthcare Organizations
  • “The Savvy Patient: How to Be an Active Participant in Your Health Care,” by David R. Stutz and Bernard Feder
  • “The Intelligent Patient’s Guide to the Doctor-Patient Relationship,” by Barbara M. Korsch and Caroline Harding

You may also be interested in the following:

  • “YOU: The Smart Patient,” by Michael F. Roizen, M.D., and Mehmet C. Oz, M.D.
  • “Smart Health Choices: How to Make Informed Health Decisions,” by Judy Irwig, Les Irwig and Melissa Sweet
  • “American Medical Association Guide to Talking to Your Doctor”
  • “The Essential Patient Handbook: Getting the Health Care; You Need—From Doctors Who Know,” by Alan B. Ettinger, M.D., and Deborah M. Weisbrot, M.D.
  • “Patients as Partners: How to Involve Patients and Families in Their Own Care,” by Joint Commission on Accreditation of Healthcare Organizations
  • “Making Informed Medical Decisions: Where to Look and How to Use What You Find,” by Nancy Oster, Lucy Thomas


If you’re ready to take that very important first step toward a fitter, firmer new you, the specially trained professionals at the FirstHealth Centers for Health & Fitness are eager and ready to help.

“We believe fitness has a role in everyone’s life,” says John Caliri, director of the Centers for Health & Fitness. “A healthy, active lifestyle is key in disease prevention and management, and we have literally thousands of people who have improved their lives through regular activity and better nutrition. When one moves into a more active and healthy lifestyle, it is not a question of if it will help you—it is a fact.”

The six FirstHealth Centers for Health & Fitness—serving individuals and families in Southern Pines, Pinehurst, Troy, Richmond County, Raeford and Pembroke—are medically based facilities, meaning you’ll have “direct access to the knowledge and experience of a clinically trained staff of professionals who can help you achieve your health or fitness goals,” says Caliri.

“These professionals are trained in caring for a person’s health both before and after there is a medical issue,” he says. “These professionals also can help the highest-caliber athletes train and get the most from their physical ability as possible. We strive to find a place for everyone and to open our arms to those who are a bit reluctant and perhaps a bit shy about starting off.”

At FirstHealth’s Southern Pines center, Manager Cinnamon LeBlanc-Young believes the holistic philosophy of care makes the medically based FirstHealth approach unique.

“FirstHealth’s mission is to care for people, and we care for the whole person,” she says. “Our staff gets to know members by name and enjoys building relationships with them. You don’t always find that level of personalized service at typical gyms in the community.”

LeBlanc-Young recalls a former participant in one of the cancer wellness programs she teaches. “He and his wife lived on a farm,” she says. “After cancer, he had difficulty walking the perimeters of fencing around his house. When I saw him a month ago, he said that since he’s been exercising, his tumor-marker numbers have dropped 1,000 points, and he’s feeling stronger. I’ve also watched one woman, a nurse, lose about 90 pounds. She’s been doing the nutrition piece and exercising on a regular basis. Her body is changing and taking shape.”

Members of the Centers for Health & Fitness staff include nationally certified personal trainers, a master’s-prepared licensed dietitian who works with members one on one and also teaches classes, and licensed massage therapists.

“If you are new to exercise or looking for a refresher, our Total Health membership is an excellent option,” says Caliri. “In this membership type, you are guided through your lifestyle management by our team of professionals, meeting regularly with our exercise physiologists and dietitian. This membership also is ideal for people with medical issues; our team will stay in contact with your doctor to help you make progress.

We also offer group exercise classes and programs on everything from eating healthy, to beginning exercise, competing in triathlons, and pretty much anything you could imagine that deals with health and fitness in any conception of the word.”

For more information on memberships at any of the FirstHealth Centers for Health & Fitness, please call (800) 213-3284.