Serious Mental Illness Does Not Make Weight Management ImpossibleTuesday, March 26, 2013
Regular readers will recall that in the 4Ms of Obesity Assessment, the first M refers to mental health. This is because uncontrolled mental health problems can can make weight management difficult – but not impossible.
This is the finding of a paper by Daumit and colleagues published in the New England Journal of Medicine.
The investigators randomised 291 overweight or obese adults (mean BMI 36) from 10 community psychiatric rehabilitation outpatient programs to tailored group and individual weight-management and group exercise sessions or a control intervention.
Of the participants, 58% had schizophrenia or a schizoaffective disorder, 22% had bipolar disorder, and 12% had major depression.
Over the 18 months of the trial, weight loss in the intervention group increased progressively and differed significantly from the control group at each follow-up visit – the mean between-group difference was about 3 Kg at the end of the trial with almost 40% of participants in the intervention group losing 5% of their initial weight (vs. 22% in the control group).
These effects are very much in line with the expected benefits of such a behavioural intervention in previous studies in people without mental illness.
Thus, behavioural weight-loss interventions can significantly reduce weight even in people with severe mental illness. Or, as the authors put it,
“….our results show that overweight and obese adults with serious mental illness can make substantial lifestyle changes despite the myriad challenges they face. “
Given the fact that obesity and mental health problems often co-exist and people with severe mental health issues are at high risk of weight gain, mental health programs should encourage and support weight management interventions in their clients.
Daumit GL, Dickerson FB, Wang NY, Dalcin A, Jerome GJ, Anderson CA, Young DR, Frick KD, Yu A, Gennusa JV 3rd, Oefinger M, Crum RM, Charleston J, Casagrande SS, Guallar E, Goldberg RW, Campbell LM, & Appel LJ (2013). A Behavioral Weight-Loss Intervention in Persons with Serious Mental Illness. The New England journal of medicine PMID: 23517118