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Addressing Obesity in Individuals with Serious Mental Illness | DII


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2017 Southern California Dissemination, Implementation and Improvement (DII) Science Symposium

Addressing Obesity in individuals with Serious Mental Illness
Amy Cohen, PhD - VA Greater Los Angeles HealthCare System

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Addressing Obesity in Individuals with Serious Mental Illness | DII

  1. 1. Addressing Obesity in Individuals with Serious Mental Illness Amy N. Cohen, PhD Co-Director, Health Services, VA Desert Pacific MIRECC Associate Research Psychologist, UCLA Department of Psychiatry Funding from VA Health Services Research & Development (IIR 09-083)
  2. 2. The problem…. People with serious mental illness have high rates of obesity and die 15 years prematurely
  3. 3. WebMOVE: Online + Peer Coaching The first interactive web-based system paired with peer coaches designed for people with serious mental illness in order to self- manage their weight, and live a sustainable, healthy life
  4. 4. WebMOVE: Online • Tailored: read aloud, 5th grade reading level, minimal text, simple presentations, clear navigation • Educates users on diet and exercise (30 modules) • Provides choices for weekly goals • Tracks weight and exercise progress • Manages data (for research, peers, and supervision)
  5. 5. Module Flow Administrator Site
  6. 6. Printouts: Progress, Summary, Goals, Tips
  7. 7. Peer Coach: Hiring, Training, Supervision Hiring: competitive hire, salaried staff Peerness: Veteran, serious mental illness, weight Recruitment: Veteran’s organizations; 1+ female Training: Didactic and experiential training: • Manualized coaching protocol • Motivational interviewing techniques • “packaging” their story, phone skills, multi-disciplinary team work, confidentiality Supervision: 1 hour/week individual with master therapist
  8. 8. WebMOVE: Peer Coaching • By phone, weekly • Manualized session content • Dashboard • Call Log with key benchmarks •Review education •Review barriers/facilitators to goals • Provide motivation/support for behavior change
  9. 9. Research Design Participants 276 individuals with serious mental illness, antipsychotic medication, BMI > 28 (200 were obese) Randomized controlled trial – 3 arms for 6 months 1) WebMOVE 2) in-person groups with same curriculum 3) usual care Assessments at 0, 3, 6 months • compare changes in weight over time • acceptability of peer coaches
  10. 10. Results: Weight At 6 months, in obese patients: •WebMOVE lost significant weight (avg 6.2 lbs) •In-person and usual care, no weight change •WebMOVE had higher percentage who lost 5% of weight •In-person and usual care, significantly fewer lost 5% •WebMOVE had higher percentage of the program completed (49%); some completers (31%) •In-person, significantly less of the program completed (41%); no completers (0%)
  11. 11. Results: Peers Participants: “Without one-on-one coaching, the web program would not have been as good.” “(The coach) would explain things differently to me … that was the most helpful.” “He wouldn’t let me give up on myself, he was very supportive. It was helpful that he was there once a week, I had somebody to lean on a little bit.”
  12. 12. Conclusions • Online weight management with peer coaches • feasible • well received • led to lower weight • patient centered (service on demand) • little clinician burden • easy to update, modify • inexpensive to broadly disseminate Want to learn more details? JGIM, April 2017
  13. 13. WebMOVE Team Alexander S. Young, MD, MSHS (Study PI) Amy N. Cohen, PhD Richard Goldberg, PhD Julie Kreyenbuhl, PharmD, PhD Noosha Niv, PhD Gerhard Hellemann, PhD Fiona Whelan, MA Taeho Jung, MS Jim O’Halloran Rebecca Oberman, MSW, MPH Joya Chrystal, LCSW Sona Hovsepian, MSW Dawn Glover, MA Nikki Panasci, PhD Lauren Bennett, MA Andia Heydari Nick Goldenson Adrian Alexandrino Jorge Avila April Ward , MA Dan Radding Ernest Tolbert