Dr. Joseph Abate stood at an unfamiliar starting line.

He wasn’t alone. With him were some teammates from Heritage Health and Coeur d’Alene’s Kroc Center. Rounding out the group was a handful of patients battling obesity, diabetes, depression, reliance on multiple medications — sometimes, all of the above.

That was one year ago. Dr. Abate, Heritage Health’s medical director and a former longtime cardiologist, had decided he just wasn’t going to take it any more.

“For me it was the frustration of having patients say they wanted to change their lives but not be able to get past their obstacles,” he said. “I was constantly asking myself how could I help the patient get past those obstacles.”

The answer was, “We’ll meet you at the gym.”

The answer was Kroc Rx, where patients exercise at a level they can handle while receiving nutritional and emotional support services from Heritage Health.

“As a society, we’ve convinced ourselves that the way to get people better is to do high tech imaging and hand out prescriptions,” said Dr. Abate, who turns 60 in April. “It’s so much simpler than that. Getting people moving. Getting people feeling better about themselves. It’s a pretty simple prescription.”

That simple prescription has been such a success in North Idaho that Kroc Rx could soon go nationwide.

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Dr. Abate’s race against people’s over-reliance on prescription drugs and unhealthy lifestyle choices is packed with winning participants — 500 of them, in fact. He tells the story of one Heritage Health patient who was in physical agony, subsisting on high levels of pain medication.

“When I first saw her she could barely walk,” he said. “Now I see her all over town. She still has pain but she’s smiling. She has her life back.

“There’s hundreds of stories like that. We know it works because we see the patients change. Anybody who comes in gets better.”

One of Dr. Abate’s medical assistants, Isabelle Soive, has been there since before the advent of Kroc Rx. She’s helped every one of these program graduates through their transformations.

“This has given us an opportunity to help patients in a whole different manner emotionally and physically,” she said. “The relationship we build with our patients who come to the Kroc are much stronger now, I think because of the time we get to spend and talk to them in a different environment. The joy isn’t just seeing the weight come off. It’s seeing how good they feel and the new hope they have for their well-being.”

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Now seven weeks into the eight-week Kroc Rx program, Heather Hjelmstrom of Post Falls is no longer invisible.

That’s not just a good thing. It’s life-changing.

Hjelmstrom, 37, is a former methamphetamine addict who traded one bad habit for another.

“I combatted a very serious meth addiction and I replaced that with food,” said the wife and mother of two children, a 16-year-old daughter and 9-year-old son. “I began to associate every emotion with food. You know, like when you’re happy, you celebrate with cake or pizza. When something amazing or sad happened, food was always involved. And so I never really thought I had a food addiction until I literally could not go a full day without snacking on some unhealthy food. That’s when I started to reach out for help.”

Not that the transition was easy.

“I made a decision that I was going to go full bore and beat this ... ” she said, her voice trailing off as tears flowed “ ... I call it my fat suit, because I know underneath it is something better.”

Something better is emerging beautifully.

“This program has changed my life,” Hjelmstrom said. “When I walk through the doors, everybody smiles at me. Several people even know my name now. For a person who felt invisible for the better part of my life, I don’t feel invisible anymore. Quite the contrary, actually. I feel like I’m a superstar!”

Hjelmstrom admits that even after seven weeks, the workouts aren’t easy. But she’s making progress and that, she says, is what matters most.

“When I first started here I could barely do two or three laps around the track,” she said. “I hurt so bad I’d leave here and go cry in my car. I have a whole slew of ailments because of my size.

“But I did 20 laps yesterday on that track. My health coach, Sean Andrews, he’s made all the difference. All these coaches care about you. Sean, he’ll walk with me and he’ll talk to me about my life, and before you know it we’re a mile and a half in. I’m tired and I’m sweating but I’m not crying, and I know I can do more.”

Hjelmstrom isn’t just doing more for herself, either.

“I haven’t always been the best parent because I was feeling miserable about myself,” she said. “So it manifested with anger and frustration toward everything. Now I’m trying to model better behaviors, better action — I’m trying to show my children, not just tell them. With my better choices, they’re learning to make better decisions as well.”

Hjelmstrom said she prepaid for six months at the Kroc “so I wouldn’t back out.” And she hasn’t. Far from it, in fact.

“I’m so excited about the future, and I can’t imagine not being here,” she said, “not coming here and seeing these people and being involved.”

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The big picture for Kroc Rx could be huge.

Some two weeks ago, Dr. Abate spoke to a Salvation Army group that included eight western region Kroc community centers, and he was able to share with them some of the Kroc Rx success stories.

“They got a chance to hear this and they’re very interested in looking in their communities and finding out what medical facilities they can partner with to try to replicate this program,” he said.

The nationwide Federally Qualified Health Centers, who completed a site visit in Coeur d’Alene and gave Heritage Health a perfect 100 percent score this month, is also interested.

“The site reviewers saw this as a unique program and they would like me to speak statewide and on a national basis to show them what this program looks like and to talk to them about how they might be able to create more change in their patients’ lives,” he said.

Dr. Abate estimates there are 1,200 or more FQHCs in the U.S.

There’s more.

“The insurance companies are now very interested because they see that for a $30 a month [gym] membership, we can change people in a way that’s equivalent to thousands of dollars in medications,” he said. “If an insurance company doesn’t have to spend a thousand dollars a month on an antidepressant medication, they’re thinking that they’re very willing to support a patient who wants to spend $30 a month on getting better.”

Dr. Abate said that in the first year, at least 95 percent of Kroc Rx patients who started the program, finished it.

“I think there’s only about 5 percent of patients who either find it too overwhelming or their life circumstances prevent them from completing the eight-week program,” he said. “There are people who miss some of their visits, some who don’t come as often as we’d like them to, but they’re making the best effort they can.”

Even locally, the program’s prognosis is extremely positive. Dr. Abate said Heritage Health is trying to get all 500 to 600 of its patients in a high-dosage chronic pain program into Kroc Rx. Just in the past month or so, Kroc Center and Dr. Abate worked out a way to virtually double participation, so now there are about 150 people per month in the Kroc Rx program.

In another change, Dr. Abate said the program has accepted about 20 patients from outside providers, bridging a gap that could help many more people locally.

“We don’t want to be competitors to private practices,” he said. “We’ve always been collaborative. We don’t want to interfere, but if this is a service that’s helpful, we’re more than happy to provide that service.”

Looking back on the first year of Kroc Rx, Dr. Abate is pleased, but not satisfied. He knows there’s untold potential for the program to help many, many other people. And he also knows where the credit should go.

“I’m overwhelmed by ... ” he said, then paused while he fought back tears. “I’m very passionate about this. It’s not of me. I’m just trying to do what God wants me to do. I don’t think I can take any personal credit for the success of this.”

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For more information on Kroc Rx, call Heritage Health at (208) 292-0292 or click on: http://www.myheritagehealth.org/krocrx/