Use of an Interactive Obesity Treatment Approach in Individuals With Severe Mental Illness: Feasibility, Acceptability, and Proposed Engagement Criteria

Ginger Nicol; Madeline Jansen; Rita Haddad; Amanda Ricchio; Michael D Yingling; Julia A Schweiger; Katie Keenoy; Bradley A Evanoff; John W Newcomer

doi:10.2196/38496

Use of an Interactive Obesity Treatment Approach in Individuals With Severe Mental Illness: Feasibility, Acceptability, and Proposed Engagement Criteria

JMIR Form Res. 2022 Dec 13;6(12):e38496. doi: 10.2196/38496.

Authors

Affiliations

¹ Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States.
² Division of Child and Adolescent Psychiatry, Department of Psychiatry, Los Angeles David Geffen School of Medicine, University of California, Los Angeles, CA, United States.
³ Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States.
⁴ Washington University School of Medicine, St. Louis, MO, United States.
⁵ Division of General Medical Sciences, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States.

^# Contributed equally.

PMID: 36512399
PMCID: PMC9795399
DOI: 10.2196/38496

Abstract

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 (F_1,16=22.54, P<.001). Conversely, high symptom severity and lower text message response rates were associated with trend-level increases in weight (F_1,7=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.

Keywords: health services; mentally ill people/persons; mobile health; obesity.

©Ginger Nicol, Madeline Jansen, Rita Haddad, Amanda Ricchio, Michael D Yingling, Julia A Schweiger, Katie Keenoy, Bradley A Evanoff, John W Newcomer. Originally published in JMIR Formative Research (https://formative.jmir.org), 13.12.2022.

Abstract

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