TY - JOUR
T1 - Use of an Interactive Obesity Treatment Approach in Individuals with Severe Mental Illness
T2 - Feasibility, Acceptability, and Proposed Engagement Criteria
AU - Nicol, Ginger
AU - Jansen, Madeline
AU - Haddad, Rita
AU - Ricchio, Amanda
AU - Yingling, Michael D.
AU - Schweiger, Julia A.
AU - Keenoy, Katie
AU - Evanoff, Bradley A.
AU - Newcomer, John W.
N1 - Funding Information:
GN has received grant support from the National Institutes of Health (NIH), Health Resources and Services Administration, Barnes Jewish Hospital Foundation, McDonnell Center for Systems Neuroscience, and Usona Institute (drug only) and has served as a consultant for Alkermes Inc, Otsuka, and Sunovion. BAE has received funding from the NIH and the Centers for Disease Control and Prevention. JWN has received grant support from the NIH and the Substance Abuse and Mental Health Services Administration; served as a consultant for Alkermes Inc, Intra-cellular Therapies Inc, Sunovion, and Merck; and served on a Data Safety Monitoring Board for Amgen. MJ, AR, JAS, MDY, RH, and KK have no disclosures.
Funding Information:
The authors would like to thank the clinical leadership, clinicians, staff, and consumers at BJC Behavioral Health, Independence Center and Places for People in St. Louis Missouri, and Fellowship House and Thriving Mind South Florida in Miami, FL. This study was funded by the Washington University School of Medicine (WUSM) Center for Diabetes Translational Research; grant P30DK092950 from the National Institute of Diabetes and Digestive and Kidney Diseases, the WUSM Center for Brain Research in Mood Disorders, and grant UL1 TR000448 from the WUSM Dissemination & Implementation Research Core and the WUSM Institute of Clinical and Translational Sciences. The WUSM Mobile Health Research Core and the Dissemination Implementation Research Core, both part of the WUSM Institute of Clinical and Translational Sciences, the Psychiatry Resident Research Education Program (R25 MH112473), and the Washington University Applied Health Behavior Research Program also contributed to this work.
Publisher Copyright:
©Ginger Nicol, Madeline Jansen, Rita Haddad, Amanda Ricchio, Michael D Yingling, Julia A Schweiger, Katie Keenoy, Bradley A Evanoff, John W Newcomer.
PY - 2022/12
Y1 - 2022/12
N2 - Background: Digital and mobile health interventions are increasingly being used to support healthy lifestyle change, including in certain high-risk populations such as those with severe mental illnesses (SMIs). Life expectancy in this population lags 15 years behind counterparts in the general population, primarily due to obesity-related health conditions. Objective: We tested the feasibility and usability of a 12-week interactive obesity treatment approach (iOTA) to adults with chronic SMIs (depression, bipolar disorder and schizophrenia spectrum disorder) receiving treatment in community settings. The iOTA incorporates short message service (SMS) text messages to supplement monthly in-person health coaching. Methods: Factors hypothesized to be associated with weight change were illness severity and treatment engagement. Severe psychiatric symptoms were defined as baseline Clinical Global Impression severity score of >5. Criterion engagement was defined as a text messaging response rate >80% during the first 4 weeks of treatment. Disordered eating, assessed with the Loss of Control Over Eating Scores, was also evaluated. Participants provided qualitative data, further informing assessment of intervention feasibility, usability, and acceptability. Results: A total of 26 participants were enrolled. The mean age was 48.5 (SD 15.67) years; 40% (10/26) were Black and 60% (15/26) female. Participants with lower symptom severity and adequate engagement demonstrated significantly decreased weight (F1,16=22.54, P<.001). Conversely, high symptom severity and lower text message response rates were associated with trend-level increases in weight (F1,7=4.33, P=.08). Loss-of-control eating was not observed to impact treatment outcome. Participants voiced preference for combination of live health coaching and text messaging, expressing desire for personalized message content. Conclusions: These results demonstrate the feasibility of delivering an adapted iOTA to SMI patients receiving care in community settings and suggest testable criteria for defining sufficient treatment engagement and psychiatric symptom severity, two factors known to impact weight loss outcomes. These important findings suggest specific adaptations may be needed for optimal treatment outcomes in individuals with SMI.
AB - Background: Digital and mobile health interventions are increasingly being used to support healthy lifestyle change, including in certain high-risk populations such as those with severe mental illnesses (SMIs). Life expectancy in this population lags 15 years behind counterparts in the general population, primarily due to obesity-related health conditions. Objective: We tested the feasibility and usability of a 12-week interactive obesity treatment approach (iOTA) to adults with chronic SMIs (depression, bipolar disorder and schizophrenia spectrum disorder) receiving treatment in community settings. The iOTA incorporates short message service (SMS) text messages to supplement monthly in-person health coaching. Methods: Factors hypothesized to be associated with weight change were illness severity and treatment engagement. Severe psychiatric symptoms were defined as baseline Clinical Global Impression severity score of >5. Criterion engagement was defined as a text messaging response rate >80% during the first 4 weeks of treatment. Disordered eating, assessed with the Loss of Control Over Eating Scores, was also evaluated. Participants provided qualitative data, further informing assessment of intervention feasibility, usability, and acceptability. Results: A total of 26 participants were enrolled. The mean age was 48.5 (SD 15.67) years; 40% (10/26) were Black and 60% (15/26) female. Participants with lower symptom severity and adequate engagement demonstrated significantly decreased weight (F1,16=22.54, P<.001). Conversely, high symptom severity and lower text message response rates were associated with trend-level increases in weight (F1,7=4.33, P=.08). Loss-of-control eating was not observed to impact treatment outcome. Participants voiced preference for combination of live health coaching and text messaging, expressing desire for personalized message content. Conclusions: These results demonstrate the feasibility of delivering an adapted iOTA to SMI patients receiving care in community settings and suggest testable criteria for defining sufficient treatment engagement and psychiatric symptom severity, two factors known to impact weight loss outcomes. These important findings suggest specific adaptations may be needed for optimal treatment outcomes in individuals with SMI.
KW - health services
KW - mentally ill people/persons
KW - mobile health
KW - obesity
UR - http://www.scopus.com/inward/record.url?scp=85145574418&partnerID=8YFLogxK
U2 - 10.2196/38496
DO - 10.2196/38496
M3 - Article
C2 - 36512399
AN - SCOPUS:85145574418
SN - 2561-326X
VL - 6
JO - JMIR Formative Research
JF - JMIR Formative Research
IS - 12
M1 - e38496
ER -