Monitoring and Managing Weight Gain in the Mentally Ill

Narrator: Welcome to the E-View Series “Strategies to Integrate Physical Health Care Into Mental Health,” chaired by John W. Newcomer, MD, from the Department of Psychiatry, Washington University School of Medicine in St. Louis, Missouri. This E-View, entitled “Monitoring and Managing Weight Gain in the Mentally Ill,” includes presentations by Rohan Ganguli, MD, and Betty Vreeland MSN, APRN, NP-C, BC.

Ms. Vreeland: My Healthy Living Study was looking at people with schizophrenia or schizoaffective disorder and losing weight. We have 31 subjects in 2 day-treatment programs. This was not a randomized trial. We incorporated nutrition, exercise, and behavioral interventions, and we followed the NHLBI obesity guidelines, the USDA Dietary Guidelines for Americans. We utilized a modularized approach solution for wellness. We did a walking video and weekly weights on the same scale. We did have a comparison group.

Ms. Vreeland: When compared to the major weight loss diets of Atkins, Zone, Weight Watchers, and Ornish, if we look at completers, at 12 months my Healthy Living Study subjects actually had the weights that compared with Weight Watchers and Zone.

Ms. Vreeland: We had about a 6.6-pound weight reduction in people who got Healthy Living and a 7-pound increase in treatment as usual.

Ms. Vreeland: We had a significant reduction in systolic and diastolic blood pressure.

Ms. Vreeland: We also had a significant reduction in hemoglobin A1C. Also, people between double and tripled their physical activity level by self-report, which was almost all walking.

Ms. Vreeland: We saw that very simple things were what really added up to make a big difference: teaching people to use the food label, look at portion size, eat more slowly, and reduce fast food intake. We actually had comparisons of different fast foods in restaurants. Probably some of the biggest changes were increasing physical activity by walking and minimizing soft drinks and sugar.

Narrator: Think about your answer.

Narrator: Mr. C, a 47-year-old man with schizophrenia, completed the 12-month Healthy Living Program and achieved dramatic improvements in health, including decreased weight, BMI, and blood pressure, and increased exercise.

Ms. Vreeland: In summary, people with mental illness have poor physical health. We know that the metabolic effects of our medications are making this worse and that we need to have improvement in health Screening, monitoring, and definitely in prevention. We also know the common causes of death and disability are influenced by behavior. People with major mental illness can really adopt healthier lifestyle behaviors just like someone without a psychiatric problem.

Ms. Vreeland: This integration between physical and mental healthcare is really critical, and there are so many things that we can do, small steps to improve access and utilization of primary care. Certainly think about utilizing nurses and others as part of the multi-disciplinary team to help to move this initiative forward. Preventive services are essential, and we need to really empower consumers to make healthier choices because with this knowledge they can change their lifestyle. Transforming the nation's mental health system is going to require organizational change, but we actually see that, as we are putting together many of these agencies across the nation using a multi-disciplinary approach, this can help to bridge the gap between physical and mental health. Thank you very much.

Complete this E-view

Ms. Vreeland: I wanted to put up some clinical practice guidelines for hypertension, diabetes, and dyslipidemia.

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Abbreviations

BID = twice a day

BMI = body weight index

FDA = Food and Drug Administration

LDL = low density lipoprotein

NHLBI = National Heart, Lung, and Blood Institute

USDA = United States Department of Agriculture