Five questions for Nia Mitchell
One class – anatomy – almost was the difference between an office nameplate reading Nia Mitchell, M.D., and one reading Nia Mitchell, Ph.D.
But Mitchell finished medical school at Washington University in St. Louis, then completed a residency in internal medicine at the University of Colorado in 2008, followed by a primary care research fellowship at CU, which she completed in 2010. She’s now an assistant professor at the CU School of Medicine with research interests in obesity treatment and prevention for low-income and ethnic minority populations.
As a lifetime member of Weight Watchers, she understands the struggles her patients face and how challenging weight loss can be. She practices medicine at Uptown Primary Care (formerly known as High Street Clinic), a resident and faculty practice affiliated with the university at Presbyterian St. Luke’s Medical Center. She studies the effectiveness of an accessible weight loss program, Take Off Pounds Sensibly (TOPS).
“As a researcher, a lot of my time is spent at my desk, by myself, writing grants or writing papers,” she says. “But when I need motivation, I sit in on one of the TOPS groups that I started with the Center for African-American Health. They have a great time. They were part of my research project, but it continues beyond that. The program is still going and I’m really proud of that.”
1. Why did you choose to study medicine?
When I first went to college, I planned to major in biology and become a doctor. But prior to starting college, I attended a summer program that emphasized engineering. I changed my major to chemical engineering so I could have a backup plan in case I didn’t get into medical school. However, I didn’t even apply to medical school when I graduated. I was afraid of what I called “the dead body class.” I was scared of dead bodies. I decided to become Nia Mitchell, Ph.D. instead of Nia Mitchell, M.D., so I went to the University of Virginia for graduate school. As it turns out, I wasn’t cut out for bench research. I hated being in the lab by myself late at night when the equipment was available, so I got a master’s degree and went to work. I was a practicing engineer for four years. I worked for M&M-Mars, the candy company, and after that, I worked for DuPont. But I felt something was missing and decided to go to medical school.
2. Your current research interests include weight-loss interventions for low-income and minority populations. How did you choose this area of study and how have your life experiences influenced your work?
I was in medical school, between the first and second year, and worked with an amazing primary care physician, Claudia Busiek. So many people’s problems were caused by weight, and if you could just do something about the weight, it would help manage these other medical conditions. So I chose to go into obesity research. I became interested in low-income and minority populations because these populations are more likely to be obese, but they are less likely to have the resources to do anything about it. And, secondly, I am an African-American woman and I’ve also had to deal with weight issues a couple of times in my life – not only with myself but with my family members.
I tell my patients that I, too, had to lose weight. I’m a lifetime member of Weight Watchers. Some people might not be impressed with the amount of weight I had to lose, but I still recognize that it’s hard to do: I’m from Louisiana, so I know how to eat and I love to eat.
When I went to college, I gained the “freshman 15” in six weeks. I didn’t really understand where it came from because I felt I was doing what I always did. But in reality, I went from mom cooking dinner six nights a week, and eating out one day a week, to eating the equivalent of fast food every day for every meal. When I was in high school, I was physically active: I was on the track team and a cheerleader. I was exercising all the time and didn’t realize it, but that pretty much stopped when I went to college. By the time I went to grad school, my slider was about to move – remember those old scales where you had to slide the indicator over every 50 pounds? – and I said, “No, we’re not having that.”
I was motivated to lose weight. I joined the Diet Center and lost 20 pounds. But then my residency came along and I didn’t have the best eating habits. As a resident, you eat what you can, when you can, and exercise is not a priority – at least it couldn’t be for me. Also, during residency, Hurricane Katrina hit New Orleans, and as part of my training, I went back during the month of December – the worst time to be there because there was food everywhere! I gained 8 pounds in one month and I could not fit into my pants anymore. Since I gained the weight in one month, I thought I’d lose it in one month when I got back to Denver, but it didn’t work that way. When I returned, several women in my program lost weight in Weight Watchers, so I joined as well. I lost 15 pounds and fit into my clothes and that started me back on my current track.
My patients often say that 15 pounds isn’t a big deal, but it’s actually harder to lose weight when you have less to lose. I understand that losing weight is hard. And I also tell them that they might be a little bit hungry. So I know it’s hard, but I also know it’s possible.
3. What does your research entail and what have you discovered? For instance, do all minority populations respond in similar ways to the same weight-loss interventions or are there cultural differences?
As a fellow, I was looking for a weight-loss program that I could bring into my clinic where we treat an underserved population. The problem is that many are uninsured or have Medicaid, so they don’t have a lot of extra money to spend on weight loss. One of the programs I found is Take Off Pounds Sensibly (TOPS). I contacted TOPS to find out what kind of evidence there was behind the program. They basically sent me propaganda; they didn’t have the scientific evidence that the program worked, so I asked if they would allow me to research the program. My initial analysis showed that people who join TOPS can lose 5 percent or more, which is clinically significant because the loss can lead to improvement in diabetes or high blood pressure or sleep apnea or osteoarthritis.
In addition, TOPS costs only $90, which is much better than other programs that cost anywhere from $500 to $5,000 a year. One of the reasons TOPS is less expensive than other programs is because it is a peer-led organization. TOPS provides the administrative and educational materials.
Since then, I’ve done another study looking at seven years’ worth of data, and I had a community engagement pilot grant with the Center for African-American Health through the CCTSI (Colorado Clinical and Translational Sciences Institute), where we started the Senior Wellness Initiative and TOPS Collaboration for Health (SWITCH) project. This project started TOPS chapters at sites of the Senior Wellness Initiative, a program of the Center for African-American Health, with the goal to help seniors maintain their independence through classes on nutrition and diabetes management, for instance. We started three TOPS chapters around the city to help seniors manage their weight.
One of the things that I’m most proud of is that one of the chapters is still in existence today. The study ended in August 2012, but the chapter kept going. Participants can afford it and they really enjoy themselves. The community and camaraderie that they’ve developed keep them engaged in weight management and in life.
In the future, I plan to do a randomized control trial with TOPS, and my hope is to prove that the program is efficacious, which is the gold standard for research.
Most of the participants in weight-loss intervention studies are women, and research has shown that African-American women tend to respond less well than Caucasian women even if they are in the same program. There are a lot of calls to change the programs, but the problem may be that the programs haven’t been tried sufficiently in minority populations or perhaps the participants would respond better if they felt they could relate to the leaders.
We put a lot of emphasis on racial cultural differences, but I think there are a lot more regional cultural similarities. I’m an African-American woman from the South, and the way I ate growing up is similar to the way everyone in the South eats — regardless of race.
4. The American Medical Association has labeled obesity as a disease, but not everyone agrees with that assessment, including insurance companies. Does this have an impact on your practice?
What’s really important about obesity being labeled a disease is the hope that the treatment for it can be reimbursed – that insurance will help pay for people to join weight-loss programs. That insurance is going to pay for weight-loss medication. That insurance is going to pay for weight-loss surgery. Weight loss is easy; it’s maintaining the weight loss that is difficult. People have to stay on top of it; it has to be treated all the time, just like high blood pressure. You don’t take away someone’s antihypertensive when their blood pressure gets to goal, but we reduce or stop weight-loss treatment when people reach their goal weight.
It’s one of the reasons I like the TOPS program. With a lot of programs, in the weight-loss phase, you are expected to participate weekly. Once you lose the weight, in the maintenance phase, you participate less frequently, usually monthly. The next thing you know, you see the weight creep back up because the people aren’t fully engaged. With TOPS, the expectation is that people will participate weekly in the weight-loss and maintenance phases. When they reach their goal weight, they become KOPS members who are working to Keep Off Pounds Sensibly and still go to weekly meetings.
5. What do you do in your free time? I understand that you are a mentor for Whiz Kids. What is the program and what is your role?
I am currently training for a half-marathon. I feel if I tell enough people about it, I’ll actually do it. It’s easier to back out if it’s only in your head. I ran a marathon when I was in medical school, but since I’ve been in Colorado, I haven’t been running much, so I thought I’d try a half-marathon. I also started road biking when I moved here. Before I moved to Colorado, I wondered why anybody would want to be on a bike all day, but now that’s changed and I’ve done a couple of supported rides – a 50-mile and a 100-mile ride – that were good challenges for me. I like to play tennis. And I currently am finishing my first DIY project, staining a vanity. I think that if I can earn four degrees, I should be able to do this. It’s not that simple, but it’s been fun.
Whiz Kids is a program offered through my church. We tutor kids in elementary and middle school weekly. There’s a half-hour of club time, where they get a group Bible lesson or sing religious songs, then we spend 20 minutes reading, 20 minutes on math and 20 minutes playing a game. I really enjoy it and it’s great for me to see my mentee reading better than she was last year. My hope for her is that she will come to enjoy reading and look forward to it, because if I didn’t enjoy reading as a kid, I wouldn’t be where I am today.