People with serious mental illnesses such as schizophrenia, bipolar disorder and major depression can lose weight and keep it off through a modified lifestyle intervention program, a National Institute of Mental Health (NIMH)-funded study reported online today in The New England Journal of Medicine.
This is one of those studies I read that made my head a’splode. Not because I don’t agree with the mentally ill losing weight, you know I certainly support healthy behaviors regardless of a weight loss goal, but because it is one of those studies where they draw their conclusions based on things that will never work in the real world.
…factors that preclude people with serious mental illnesses from losing weight include memory impairments or residual psychiatric symptoms that impede learning and adopting new behaviors such as counting calories. Socioeconomics are also a factor as many can’t afford or can’t get to physical activity programs like fitness gyms. Some patients additionally suffer from social phobia or have poor social interactions, and are simply afraid to work out in a public area.
I like their coverage of the socioeconomic factor, especially pointing out the social anxiety issues of working out in public; that’s a problem I have. However, their work-arounds for the issue still don’t seem like something that is going to work very well outside of the carefully structured, monitored, & grant funded study.
Daumit’s group attempted to solve these issues by bringing the gyms and nutritionists to places most of these patients frequent — psychiatric rehabilitation outpatient programs. Under the trial name ACHIEVE, the researchers randomized 291 participants in 10 rehab centers around Maryland to receive the usual care , consisting of nutrition and physical activity information, or six months of intensive intervention consisting of exercise classes three times a week along with individual or group weight loss classes once a week. Both groups were followed for an additional year, during which the weight loss classes of the intervention arm tapered down but the exercise classes remained constant. The intervention arm included goals such as reducing caloric intake by avoiding sugar-sweetened beverages and junk food; eating five servings of fruits and vegetables daily; choosing smaller portions and healthy snacks; and moderate intensity aerobic exercise.
I would love to see more activity & nutrition guidance used in mental health care, but budgets are cut so slim these days you are lucky if you can get actual mental healthcare in mental health centers. A few things that struck me in particular about this study:
- As someone in a rural area, I can tell you traveling to the MHC for exercise classes three times a week is not going to happen. Cost of gas, travel time, & coordinating rides for those who don’t drive would just be too much for most people. Sure they could work out at home for free, but if they were going to do that these interventions wouldn’t be necessary would they?
- As they pointed out, there are socioeconomic factors. If you’re dealing with the severely mentally ill population you are likely to be dealing with people who are on disability, many of whom may have never been able to hold down gainful employment so they are living below the poverty line. Not only would the extra expense of travel for exercise classes be a kick in the wallet, the extra expense of nutritionist visits, fresh/healthier foods, etc, wouldn’t be something they can reasonably afford. If you’re barely getting by month to month, you are not going to prioritize those things. Not to mention, most people I have known in that position use food banks which typically means boxes, bags, & cans.
- It’s one thing to be successful when everything is provided for free & you are getting paid (most research participants are compensated in some way), but keeping it up when the financial incentive isn’t there, you have to start getting those services on your own, & real life starts to get in the way (as it always does) is a whole nother ball game.
- And as a parting note, as someone living with mental illness, I would love for them to focus on fixing my brain instead of my butt. Tell me how diet & exercise can affect my Bipolar Disorder & we have something to talk about. Tell me how it can help me lose weight & you are just telling me more of the same thing blahblahblah I can get from any fashion magazine.