Citation

Bartels SJ, Aschbrenner KA, Pratt SI, Naslund JA, Scherer EA, Zubkoff L, Cohen MJ, Williams GE, Wolfe RS, Jue K, Brunette MF. Psychiatr. Serv. 2018; 69(6): 664-670.

Affiliation

Dr. Bartels, Dr. Aschbrenner, Dr. Pratt, Dr. Zubkoff, Ms. Williams, Ms. Wolfe, and Dr. Brunette are with the Department of Psychiatry, and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Bartels is also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, where Dr. Scherer is affiliated. Dr. Zubkoff is also with the Engineering Resource Center, White River Junction Department of Veterans Affairs Medical Center, White River Junction, Vermont. Dr. Naslund is with the Department of Global Health and Social Medicine, Harvard Medical School, Boston. Mr. Cohen is with MJC Health Solutions LLC, Amherst, New Hampshire. Mr. Jue is with Ken Jue Consulting, Keene, New Hampshire.

Copyright

(Copyright © 2018, American Psychiatric Association)

DOI

10.1176/appi.ps.201700368

PMID

29606077

Abstract

OBJECTIVE: The purpose of this study was to evaluate health outcomes of a state-supported implementation in community mental health settings of an evidence-based lifestyle intervention for overweight and obese adults with serious mental illness.

METHODS: Weight and fitness outcomes were evaluated for 122 overweight or obese adults with serious mental illness in four community mental health centers (CMHCs) that were participating in a phased statewide implementation of the In SHAPE lifestyle intervention. Six- and 12-month outcomes were compared between two CMHCs that implemented In SHAPE in the first 12 months and two CMHCs with similar characteristics that implemented In SHAPE in a subsequent phase in the statewide implementation 12 months later.

RESULTS: Participants in the two In SHAPE sites (N=63 participants) lost significantly more weight (p=.003) and showed greater improvement in fitness (p=.011) compared with participants at the two usual care control sites (N=59 participants). At six months, nearly half (49%) of In SHAPE participants and at 12 months more than half (60%) of In SHAPE participants showed clinically significant cardiovascular risk reduction defined as ≥5% weight loss or improved fitness (>50 m [164 feet] increase on the six-minute walk test). The difference between the In SHAPE and control groups was not statistically significant.

CONCLUSIONS: This natural experiment demonstrated promising public health benefits of a practical implementation of health promotion programming for overweight and obese adults with serious mental illness and offers a potential model for reducing risk of early mortality among individuals served by state-funded mental health centers nationwide.

Language: en

Keywords

Community mental health centers; Obesity; implementation research; lifestyle intervention; serious mental illness