Five questions for James Hill

As Health and Wellness Center wraps Year One, director reveals ‘eureka’ moment in obesity battle

Five questions for Dr. James Hill

James O. Hill, Ph.D., has been at the forefront of understanding and combating obesity for decades. For the past year he’s led that charge from a new headquarters, the Anschutz Health and Wellness Center (AHWC) on the University of Colorado Anschutz Medical Campus.

While still serving as professor of pediatrics and medicine and current director of the Center for Human Nutrition, Hill is executive director of the center, which reached its first birthday on Tuesday.

“Nobody’s ever done anything like this,” he says of the center, which combines the exercise focus of a fitness club or gym with health, wellness and nutrition programs, all while maintaining a research mission. “So we’re out there on the bleeding edge, trying to figure out how we make wellness important, how we pay for it, how we reach out and touch people’s lives.”

The multiple hats he wears make each day interesting, Hill says: He’s a principal investigator on three major research grants, gives lectures on and off campus, mentors faculty and students, helps with fundraising and builds partnerships between the community and the AHWC.

“We see ourselves as knowledge agents: We understand health, wellness and obesity. We think in terms of strategy. We develop research and science-based programs here,” he says. “But ultimately, if we’re going to have an impact, we need to partner with people in the community. So we’re out in the schools – we have projects like 5th Gear Kids with Aurora and Cherry Creek schools – and we have worksite wellness programs. We’re very much interested in partnering with the private sector, so we work with restaurants and grocery stores.

“Through our science-based programs and initiatives, we want to infuse wellness where people live their lives. And to do that, we need to partner with people who are already touching people in the communities where they live.”

1.       When people first visit or use the Anschutz Health and Wellness Center, what’s the reaction?

What I get most of the time is, ‘Wow, I’ve never seen anything like this.’ Many of the components you see here, you can see at other places. But no one has put it together like we have: a grocery laboratory, a traditional metabolic kitchen, a fitness center, a wellness clinic. What we think we’re doing is developing a prototype for wellness centers of the future.

There are places in most neighborhoods to get services like mindfulness, meditation and acupuncture.  There are health clubs, weight-loss programs, cooking classes and dietitians. But no one has effectively combined these services into a comprehensive approach to wellness provided by people who are the best in their fields. We give you a personalized plan incorporating the best wellness services available without worrying whether they’re traditional or nontraditional. If they’re science-based, we consider them.

I believe that in a few years we will see comprehensive wellness centers in the community. They’re not going to have all the research we have here but they may provide the services we offer. Maybe fitness centers will add the other services or maybe these wellness centers will develop independently. Some of the people who work here on campus aren’t necessarily comfortable going into a fitness center and working out on exercise equipment, but might seek out a wellness center to get a comprehensive plan that can include weight management, diet advice, exercise advice and help with sleep and stress.

2.       Has anything about the center’s first year surprised you?

Yes, it was my eureka.

When we started this, I was really focused on this idea of changing our focus from disease management to disease prevention. Great message, right?

I now think that even prevention is not the right message. The right message is to focus on accumulating wellness.

We talk to a lot of people who come to the Anschutz Health and Wellness Center about the importance of getting healthy to prevent the bad stuff, like diabetes, heart disease and cancer. We tell them that a healthy lifestyle can prevent these diseases. Interestingly, people want to be healthy but they  don’t really like to talk about their risks and what might negatively happen to them. It’s a short conversation.

Now we also talk with people about their non-health lifestyle goals and aspirations. They might want to compete in a 10K or bike race or they may just want to be able to take a healthy vacation with their family. Some want to climb a 14er or lose weight to feel better or just to get more energy to get through the day. These conversations that focus on the positives – accumulating wellness – are much longer. We often have trouble getting away. So, being smart people, we said, ‘Aha! We’re thinking about this totally wrong.’ The major reason people want a healthy lifestyle is not to prevent disease – yes, that’s part of it – but to be all they can be. It’s too bad that slogan’s been taken. That’s been my eureka. The reason you get people excited about a healthy lifestyle is not to prevent the bad stuff, it’s to accumulate good.

At the end of the day, why do people want to lose weight or get fit or manage stress? Because it enriches their quality of life. It makes them happy. And that is a huge driver.  Accumulating wellness leads to so many good things, it goes well beyond being healthy.

3.       What goals do you have in mind for the center as it begins its second year in operation?

We are conducting a lot of research and we have established many effective, science-based wellness programs in our first year. In our second year, we want to do more to let people know what we have and how we can help them accumulate wellness. We just want people to come and see what we have to offer. We have three target audiences: our employees, patients and the community. Our success is meeting the needs of all three of those groups.

We’re trying more to help people understand that being well is not something to do on the side – it can impact what’s most important in your life. We help people get in touch with what they most want to accomplish in life and show them how being well can make it easier to achieve their goals. This might be being the best parent possible, or becoming the CEO of your company, or changing the world.  Whatever your major purpose in life, being well can usually help you achieve it.

If you look at CEOs, most of them are pretty lean and fit compared to anybody else. The reason is, that helps them do their job better. That’s why they get up at 4 or 5 in the morning and go work out. Because they’re so ambitious to succeed and they’ve figured out this helps them.

4.       How and where does that begin, that effort of engaging more people to change how they live?

It starts with our campus and our employees. We have a fabulous medical school here on campus and we think it should be the healthiest place in town – actually the universe. But our employees probably mirror the average Americans out there in terms of health and wellness. We think a medical school should be a place that’s enriched with employees who value wellness and serve as models for others. So we’re going to work with our employees to help them enhance their own wellness. We have the best fitness center in town available to our employees at a valued price. We have the healthiest restaurant on campus and we have great tips for eating healthy, getting more active and managing sleep and stress. We have a one-of-a-kind comprehensive wellness clinic where you can assess your wellness, get an individualized wellness plan and enjoy massage and acupuncture treatments, behavior change consultations and body composition testing, all in one place.

If our employees who work with patients value their own wellness, they will communicate this to their patients. If they are actively working on their own wellness, it will be easier for them to convince their patients of the value of healthy lifestyles. I feel so good when I see department chairs, center directors, deans and even the provost working out regularly at our center. If some of the busiest people on campus can find time for their own wellness, we can’t use being too busy as an excuse.

Over the next year, we are very excited to be able to work with our clinicians to develop wellness programs for our patients. Patients come to our clinics with many different health issues and we want to offer them the opportunity to work on what is right with them while they are dealing with various health issues. We are starting by offering a program called Exercise is Medicine – For Life to our diabetic patients, but we will soon develop wellness programs for cancer and fertility patients. We feel you can have cancer and still be well. Simultaneously, this provides us with a great opportunity to research whether the focus on wellness can help with management of the disease.

5.       There have been many findings in obesity research over the past year, including some from CU such as identifying a “fat gene” in mice that could lead to breakthroughs in human obesity. What trends do you see in obesity research and what can we expect in the months and years to come?

We have one of the best obesity research groups in the world. That new gene and the role it may play is exciting science. But genetics is only one piece of the puzzle. We have to understand other aspects of basic human biology, metabolism and behavior. The more we understand, the better we will be able to develop effective interventions to prevent and treat obesity. For example, we offer several different weight loss programs at the Anschutz Health and Wellness Center. Most places that offer obesity treatment have a single plan and advertise it as effective for everyone. We know that isn’t the case, so we have different programs to meet the needs of different people. We are also using our research to develop obesity prevention programs and even to affect societal change.

Obesity developed from so many little things that changed over time – on the food side, on the physical activity side. The problem is, we want to fix it with one big thing. So, ‘Let’s get rid of soda pop or fast food or cars or fill in the blank!’ I don’t believe this approach of focusing on single factors will move the needle in fighting obesity because there are so many other factors in play. We pioneered the small changes approach to lifestyle change where we focus on getting people to make small changes in what they eat and how they move. Once people start making some small changes, they tend to make more and more small changes and pretty soon we can move the needle. We are more likely going to be successful in reducing obesity in our society by concentrating on making small changes in many areas than in making one or two big changes.

Finally, we need to take advantage of being in one of the healthiest – and the leanest for adults – states.  We believe that Colorado is in the sweet spot in terms of leading the way toward reducing obesity and promoting wellness. Of all the states, we probably have the most residual culture of health. In the ’60s, ’70s and ’80s, people moved here for quality of life. They didn’t say, ‘I want to move to Colorado and prevent obesity or diabetes.’ They said, ‘I want to move to Colorado because it's the place I can live the lifestyle that makes me happy.’ I believe we can re-create that culture and we want to be part of doing just that.