Are There Any Weight Loss Programs for People With Serious Mental Illness?

Summary: Yes, there are weight loss programs for people with serious mental illness (SMI), appropriate for people with diagnoses such as major depressive disorder (MDD), bipolar disorder (BD I&II), and schizophrenia (SCZ).

Key Points:

• Evidence shows people with serious mental illness are at increased risk of overweight, obesity, and weight-related health problems.
• Various programs are currently offered by providers around the country, tailored to meet the specific needs of this population.
• A new study designed by the Veterans Administration (VA) tested a remote weight loss program for veterans with SMI.

Mental Illness, Obesity, and Overweight

Recent studies indicate that around the world, people with SMI show consistently higher levels of obesity and overweight than people without SMI.

Before we go further, we need to define what we mean by obesity and overweight. Both are defined using body mass index (BMI), which is recognized as a “useful, albeit crude, measure of population-level obesity and overweight.”

There are more accurate – and non-stigmatizing – methods for identifying weight levels that increase risk of chronic health problems, but they’re not in widespread use, yet, and studies worldwide use BMI by default. Therefore, the relatively archaic BMI is what we can report here.

With that said, the National Institutes of Health (NIH) define obesity and overweight as follows:

• Obesity: BMI over 30
• Overweight: BMI 25-25.9

To further clarify by example that BMI is not the be all and end all metric for weight and health: Olympic rugby star Ilona Maher has a BMI of 29.3 and she’s a healthy professional athlete.

Now let’s get to that data.

Researchers who conducted the study “Prevalence of Overweight and Obesity in People with Severe Mental Illness: Systematic Review and Meta-Analysis” analyzed data from 120 studies conducted in 43 countries. Disorders in the analysis included major depressive disorder (MDD) with psychosis, bipolar disorder (BD I&II), and schizophrenia (SCZ).

Their data indicate the following:

• Prevalence of obesity among people with SMI: 25.9%
• Combined prevalence of obesity and overweight: 60.1%

Expressed as odds ratios (OR), they further identified risk of obesity and overweight, or obesity only, by disorder:

• Any SMI:
  • Overweight: OR of 1.07 or 7% increased risk
  • Obesity: OR of 3.45 or 245% increased risk
• Bipolar disorder:
  • Obesity: OR of 2.9 or 190% increased risk
• Schizophrenia:
  • Obesity: OR of 2.95 or 295% increased risk

That data is why researchers here in the U.S. are interested in finding effective interventions for people with SMI that may have levels of weight that increase risk of weight-related health problems. Let’s take a look at the study by the Veterans Administration (VA) we mention in our Key Points above.

Remote, Coach-led Weight Loss Programs for People With Serious Mental Illness: CoachToFit (CTF)

CoachtoFit (CTF) is a weight loss programmed purpose-designed for veterans with serious mental illness. Although not the first weight loss program for veterans, and not the first remote weight loss program for veterans with mental health challenges, it’s the first program with the following characteristics:

• 6 months long, greater duration than previous programs
• Weekly phone calls with VA peer specialist facilitator
• Bluetooth fitness tracker
• Bluetooth weight tracker
• Smartphone app with dashboard including:
  • Health education
  • Workout tips
  • Step tracker
  • Goal tracker
• Peer specialist monitoring through app

How the intervention – i.e. CTF – worked:

1. Veterans and facilitators set weekly goals via phone call
2. Goals were achieved by completing selected 15-minute learning/training modules
3. Modules included 12 on nutrition, 10 on exercises, as well as 8 review modules
4. Facilitators reviewed data each week
5. After the first call, weekly calls reviewed the previous week and planned/previewed plans and goals for the upcoming week

Researchers collected individual data on weight, 6-MWT (meters walked in 6 minutes), and BMI at the start of the study (baseline) and after six months.

Let’s take a look at the outcomes. Did the weight loss program for people with serious mental illness work?

SMI and a Remote, Facilitated Weight Loss Program

Weight:

• Baseline: 110 kg (242 lbs.)
• 6 months: 107.6 kg (237.2 lbs.)
• Change: 3.2 kg reduction (7.05 lbs.)

Compared to usual care, i.e. independent weight loss effort, with periodic advice, participants lost 50% more weight.

6-MWT:

• Baseline: 401.5 meters
• 6 months: 415 meters
• Change: Increase of 18.3 meters across all subjects

Compared to usual care, i.e. independent weight loss effort, with periodic advice, participants increased walking distance by 5 meters, or about 33%.

BMI:

• Baseline: 36.4
• 6 months: 35.3
• Change: decrease of 1.1

Compared to usual care, i.e. independent weight loss effort, with periodic advice, participants reported 75% greater decrease in BMI.

We’ll discuss these results below.

Tailored Interventions, Weight Loss, and Serious Mental Illness

In addition, over the course of the study, the data showed:

• 33% of veterans in CTF lost 5% body weight
  • 22% of veterans in usual care lost 5% body weight
• 25% of veterans in CTF lost 7% body weight
  • 8% of veterans in usual care lost 7% body weight

Those findings are meaningful for people with SMI and weight issues that can affect their physical health.

That’s the primary reason measuring weight in people with SMI matters.

Research shows the presence of serious mental illness is associated with increased risk of chronic physical illness, including hypertension, respiratory illness, vascular disease, kidney and gastrointestinal diseases, and diabetes.

That’s why exploring different weight-loss approaches for people with SMI matters.

Obesity and overweight can exacerbate all the physical conditions for which SMI increases risk. Therefore, studies like this enable us, as mental health providers specializing in serious mental illness, to offer truly integrated care that supports the whole person, including the mind, the emotions, and the body.

Here’s how the study authors describe the outcomes of this research:

“Overall, according to the results of this randomized clinical trial, the CTF program offers a scalable, remote, and cognitively accessible weight loss intervention for veterans with SMI.”

While this study may not revolutionize weight loss for people with SMI, the program it analyzed – CoachToFit (CTF) – pushes treatment for serious mental health one step further toward full holistic integration, and offers people with SMI and obesity/overweight an effective, viable option to improve overall health and wellness.