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Letters   |    
Serious Mental Illness and Weight Management Interventions
Amy M. Kilbourne, Ph.D., M.P.H.; Tisha Deeghan, L.C.S.W.; Kenneth R. Jones, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.640902
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Dr. Kilbourne is affiliated with the Health Services Research and Development Service, Center for Clinical Management Research, U.S. Department of Veterans Affairs Ann Arbor, Ann Arbor, Michigan. Ms. Deeghan is with the Genesee Health System in Flint, Michigan. Dr. Jones is with the VHA National Center for Health Promotion and Disease Prevention, Durham, North Carolina.

Copyright © 2013 by the American Psychiatric Association

To the Editor: Persons with serious mental illness are more likely than persons in the general population to be overweight, leading to increased risk of cardiovascular disease and premature mortality (1). Losing weight is especially challenging for this group, who face multiple barriers because of functional impairment, social isolation, and fragmentation of general medical and mental health care (1). In the August issue, Goldberg and colleagues (2) reported findings from a randomized controlled trial of a weight management program for veterans with serious mental illness initiated by the Veterans Health Administration (VHA). This study, which essentially yielded negative findings, nonetheless represents a growing and long overdue body of research focused on weight management interventions for persons with serious mental illness.

Goldberg and colleagues suggested a number of opportunities and challenges in implementing weight management interventions for persons with serious mental illness. They were able to take advantage of the VHA MOVE! national weight management program, notably by implementing an adapted version for persons with serious mental illness. Recent national data suggested that VHA patients who completed at least eight MOVE! sessions were more likely than those not completing eight sessions to achieve weight loss >5% after one year (25% versus 14%), suggesting the importance of maintaining engagement in the program.

As one of the largest U.S. employers of psychologists, medical trainees, and peer specialists, the VHA has pioneered the integration of behavioral interventions and the colocation of general medical care within mental health programs. As a result, VHA patients with serious mental illness have not experienced the substantial gaps in quality of general medical care and the early mortality seen among non-VHA populations with serious mental illness (3).

Nonetheless, patients with serious mental illness face unique barriers to engaging in weight management programs. In the study by Goldberg and colleagues, many participants depended on others for shopping and cooking, and most had at least one co-occurring general medical condition, notably arthritis and joint pain (51%) or diabetes (30%). Outside VHA, persons with serious mental illness face the additional challenge of accessing medical services, especially because the mental health system is their de facto source of care. Recent interventions—such as Project Achieve (4), which that resulted in significant weight loss (>5%) for persons with serious mental illness—have integrated healthy food options and physical activity for patients at outpatient mental health facilities (1). Emerging community-based initiatives, notably in Genesee County, Michigan (5), have addressed system- and community-level barriers to weight management, primarily through colocation of general medical and mental health providers and implementation of programs that involve community reintegration opportunities through local gyms and nutrition classes. One of the Genesee County weight management programs (InShape) was associated with >5% weight loss in a predominantly African-American population engaged in the program for at least a year.

Ultimately, for weight management interventions to be successful for persons with serious mental illness, they must be included as part of the existing system of care and be integrated within existing community resources.

Saint Louis  C: A battle plan to lose weight. New York Times, April 15, 2013. Available at well.blogs.nytimes.com/2013/04/15/a-battle-plan-to-lose-weight/?ref=health
 
Goldberg  RW;  Reeves  G;  Tapscott  S  et al:  “MOVE!”: outcomes of a weight loss program modified for veterans with serious mental illness.  Psychiatric Services 64:737–744, 2013
[CrossRef] | [PubMed]
 
Kilbourne  AM;  Ignacio  RV;  Kim  HM  et al:  Are VA patients with serious mental illness dying younger? Psychiatric Services 60:589, 2009
[CrossRef] | [PubMed]
 
Banas  T: Working out to save lives: mental health patients find fitness training at Genesee County agency. Flint Journal, Sept 12, 2009. Available at www.mlive.com/news/flint/index.ssf/2009/09/working_out_to_save_lives_ment.html
 
Daumit  GL;  Dickerson  FB;  Wang  NY  et al:  A behavioral weight-loss intervention in persons with serious mental illness.  New England Journal of Medicine 368:1594–1602, 2013
[CrossRef] | [PubMed]
 
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References

Saint Louis  C: A battle plan to lose weight. New York Times, April 15, 2013. Available at well.blogs.nytimes.com/2013/04/15/a-battle-plan-to-lose-weight/?ref=health
 
Goldberg  RW;  Reeves  G;  Tapscott  S  et al:  “MOVE!”: outcomes of a weight loss program modified for veterans with serious mental illness.  Psychiatric Services 64:737–744, 2013
[CrossRef] | [PubMed]
 
Kilbourne  AM;  Ignacio  RV;  Kim  HM  et al:  Are VA patients with serious mental illness dying younger? Psychiatric Services 60:589, 2009
[CrossRef] | [PubMed]
 
Banas  T: Working out to save lives: mental health patients find fitness training at Genesee County agency. Flint Journal, Sept 12, 2009. Available at www.mlive.com/news/flint/index.ssf/2009/09/working_out_to_save_lives_ment.html
 
Daumit  GL;  Dickerson  FB;  Wang  NY  et al:  A behavioral weight-loss intervention in persons with serious mental illness.  New England Journal of Medicine 368:1594–1602, 2013
[CrossRef] | [PubMed]
 
References Container
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