Health conditions like obesity, high blood pressure and high cholesterol are part of the metabolic syndrome that leads to diabetes, heart and kidney disease, blindness, peripheral neuropathy, vascular conditions/loss of limb and-some say-even dementia.

Metabolic syndrome is reaching epidemic proportions in the U.S., and it is lifestyle driven. It is the consequence of choices people make every day about self-control: how much and what to eat and drink, whether to ride their bikes or watch TV, whether to smoke or use drugs, how to choose over-the-counter medications, how to handle tension at work and at home, what to spend money on and how much, and what pastimes to pursue with which friends.

Many of their choices are not health promoting. Changing them is about habit re-training, a foundation of occupational therapy in its formative years.

Even people who are now healthy are aging. How will they choose to stay active as they age, and escape the effects of pain? How will young people learn to avoid the pitfalls and build healthy habits from the start?

As licensed and recognized professionals who help people "live life to the fullest," occupational therapy practitioners should be able to help set the standard for the wellness market. The question is, will they?

At the University of Southern California, it"s already happening with an innovative faculty practice that uses a new model, USC Lifestyle Redesign©. The occupational therapy faculty clinics at USC underwent a radical change in 2000. Under the leadership of Florence Clark, associate dean of USC"s occupational science and occupational therapy programs and CEO of this independent medical clinic with its own tax ID number, the clinician-educators re-focused their attention on lifestyle-related disorders, and created six programs to serve various populations with health-promoting interventions.

Lifestyle Redesign offers a weight loss program, an executive health lifestyle risk assessment, lifestyle options for students with disabilities, a campus-wide wellness program called Trojans for Healthy Lifestyles, an Optimal Living with MS Team, and the USC Pain Management Team.

By far the most successful has been the weight-loss clinic, which sees about 75 patients a year, referred by physicians in the southern California area.

"Obesity crosses many lines," explains Katie Salles-Jordan, OTD, OTR/L, director of the OT Faculty Practice (OTFP). "We now have about 80 doctors referring to us."

How do the clinicians get paid?

Much of the time, insurance contracts cover all or part of the treatment. The Motion Picture and Television Fund, Delta PPO, the USC Network PPO Plan and Genesis IPA all participate, and so does Blue Cross/Blue Shield, Salles-Jordan said. The OTFP has contracted with several insurers to offer its programs for free or at a low cost.

If the patient has a diagnosis, the treatment falls under the regular codes for occupational therapy claims. The ICD-9 code already applies to hypertension, diabetes or cardiovascular diagnoses, she said. The CPT code is usually initial evaluation, therapeutic group, ADL or functional therapeutic activity.

Because obesity is already known to play a large role in metabolic syndrome, weight loss is an acceptable medical goal. But therapists are trying to teach people to change their eating habits and sometimes their self-images so as to not just lose pounds, but keep them off and add other good habits to their routines.

"It is faulty reasoning to regard the chronic health problem of obesity as something that can be addressed successfully with a short-term solution such as "going on a diet,"" Salles-Jordan told AOTA"s Home and Community Health Special Interest Section Newsletter last year. But once diagnosed, patients still expect that only medicine can cure them, or at least keep them from getting worse. They need to learn how they have power over their health.

The 16-week program is modeled on a group structure and includes four elements: straight teaching of health facts related to obesity, discussion with people like themselves, an experiential module and exploration. Clients" body composition (lean body mass, fat mass and total body water) is monitored each week, along with blood pressure and heart rate. Group sessions help them to set realistic short- and long-term goals.

Over the past four years, there has been an average 4.4 percent of body mass loss, and an 8-percent fat loss for clients attending at least half the sessions.

Clients learn to enact and experience changes in their bodies and themselves that help them create health-promoting habits.

Though other Lifestyle Redesign programs follow slightly different models, they all help patients and students empower themselves.

USC is also participating with the California Health and Longevity Institute and Arcus, a subsidiary of Wellpoint health insurance, in a "healthy living" resort at the Four Seasons hotel in Westlake Village, not far from Los Angeles. The program is the brainchild of Dole Foods CEO David Murdoch.

USC"s division of OS and OT worked with social workers, psychologists, marriage and family counselors and other health care personnel to create a new kind of health care worker, the life consultant, to work there. OT wrote the training manual. The manual became a course in the OT department and is now becoming a CE offering. Twenty people will take the training in its first offering next month. It will be held at the Center for Occupation and Lifestyle Redesign, the off-campus home of the OTFP.

"We"re hoping that it will inspire OTs to think in a more preventive way," Salles-Jordan said.

E.J. Brown is editor of ADVANCE.