FINDINGS
Online weight management tools and weekly peer coaching resulted in greater weight loss for people with serious mental illness than when they visited health professionals in person in clinics, according to a new study led by Dr. Alexander Young, a professor of psychiatry at UCLA.
BACKGROUND
About 5 percent of the U.S. population has a serious mental illness such as schizophrenia or bipolar disorder. People with these disorders die 10 to 20 years prematurely, mostly as a result of cardiovascular disease or cancer, studies have shown. A major risk factor contributing to these outcomes is obesity.
An estimated 40 to 60 percent of individuals with serious mental illness are obese, compared to about 30 percent of the general population. Research has found that even modest weight loss mitigates some of the harmful effects of obesity.
Despite widespread recognition of the importance of weight loss, people with schizophrenia or bipolar disorder rarely receive services to help with weight. It has been too expensive to have clinicians provide these services, and people with serious mental illness often do not want to travel each week to clinics to participate in weight groups, according to Young.
METHOD
Researchers recruited 276 overweight people who were taking antipsychotic medication for serious mental illness and who were receiving care at a Veterans Health Administration medical center. Young serves on the executive committee of a national Veterans Administration program to improve mental health care. Participants were randomly assigned to receive in-person weight services, web-based weight services or to continue with their usual care.
The web-based system differed from standard, online weight loss interventions or apps designed for the general public. The system provided specialized audio and text-based education tailored for cognitive deficits seen in this population. Other features of the program included educational videos, pedometer tracking, goal setting, homework, diet plans and knowledge quizzes. Participants also were contacted regularly by phone by trained peer coaches who had personal experience with mental illness.
At six months, participants in the web services group lost, on average, 6.2 pounds. People in the in-person services group had no change in weight; the treatment as usual group gained 2 pounds, on average.
IMPACT
Delivering weight-management services online would be far more convenient for people and could produce substantial improvements in health, at a relatively low cost, Young said. While this study’s approach is designed for a population with serious mental illness, it could be effective in other populations with cognitive disabilities, inconsistent literacy or socioeconomic challenges.
AUTHORS
The study’s authors are Young, Amy Cohen, Gerhard Hellemann, Noosha Niv, Dr. Nancy Nowlin-Finch and Fiona Whelan, all of the UCLA Department of Psychiatry and Biobehavioral Sciences; Richard Goldberg and Julie Kreyenbuhl of the University of Maryland School of Medicine; and Rebecca Oberman of the Veterans Affairs Greater Los Angeles Healthcare System.
JOURNAL
The study appears online today in the Journal of General Internal Medicine.
FUNDING
This study was supported by the Department of Veterans Affairs Health Services, the National Institute of Mental Health, the VA Desert Pacific Mental Illness Research Education Clinic (MIRECC), the VA Capitol Healthcare Network MIRECC, and the VA Health Services Research and Development Service Center for the Study of Healthcare Innovation, Implementation and Policy.
