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Young AS, Cohen AN, Goldberg R, Kreyenbuhl J, Hellemann G, Whelan F. Improving Weight in Veterans with Serious Mental Illness: A Randomized Controlled Trial of Computerized Weight Services with Peer Coaches. Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 8; Philadelphia, PA.
Objectives: Veterans with serious mental illness have high rates of obesity and related medical problems, and die years prematurely, most commonly from cardiovascular disease. Guidelines recommend specialized, in-person psychoeducational interventions, and these result in weight loss in efficacy trials with motivated patients. In usual practice, these interventions are rarely provided, and patient retention is low. Barriers to providing high quality, proactive care in this population include limitations in patient cognition and motivation, and insufficient clinician resources to provide these very time-intensive interventions. We studied whether barriers could be addressed with computerized provision of diet and exercise education and decision support, combined with motivation and support from peer coaches at mental health clinics. Methods: Randomized, controlled study with overweight Veterans with serious mental illness. 276 patients were recruited from Veterans Affairs mental health clinics. Patients were randomized to 1) online weight management with peer coaching, 2) in-person clinician-led weight services, or 3) care as usual. Online weight management included 30 computerized modules plus weekly telephonic peer coaching. The computer application provided audio and text-based education, video, pedometer tracking, goal setting, homework, diet plans, and quizzes. Coaching was delivered by individuals with lived experience with mental illness using motivational interviewing. A mixed measures repeated model predicted Body Mass Index (BMI) at 6 months. Results: In obese patients, there was a significant group by time interaction (F = 3.4, p = .03). The online and peer coaching group had weight loss averaging 0.8 +/- 0.2 BMI points (5 pounds; p < .01). No change was seen in care as usual (p = .42) or in-person services (p = .57). No effect was seen in patients with BMI < 30. 21% of patients completed the on-line program compared to 0% completing all in-person groups (chi-sq = 19.7; p < .0001). Implications: On-line weight management with peer supports can provide educational content and decision support that is tailored to individuals, convenient, and patient-centered. It produces weight loss, enhances motivation, and may have greater effectiveness than clinician-led services. Impacts: Integration of peers and technology into care is well received and can effectively support services for vulnerable Veterans. Marginal costs are low, and this approach is amenable to broad dissemination.