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Article Title

Improving Lifestyle Interventions for People With Serious Mental Illnesses: Qualitative Results from the STRIDE Study

Publication Date

4-30-2015

Keywords

serious mental illnesses, behavioral change

Abstract

Background/Aims: Overweight and obesity are disproportionately prevalent among individuals with serious mental illnesses, in part due to psychiatric medications, poor dietary habits and sedentary lifestyles. Behavioral lifestyle-change interventions are effective yet require more than training participants on energy balance. Interventions must address factors relevant to the context within which people attempt to lose weight and improve health, such as lack of the following: nutrition education, access to and affordability of healthy foods, safe places to exercise and skills.

Methods: As part of a randomized controlled trial (N=200) that was successful in producing significant weight loss at 12 months, we conducted 101 semistructured interviews with 84 participants to understand barriers and facilitators of weight loss and lifestyle changes associated with the intervention, or with efforts at losing weight and remaining physically active more generally. Interviews were coded by a team (with 79% agreement among coders) and were analyzed using Atals.ti.

Results: Interviewees averaged 48 years old; 36% were men, 21% were nonwhite, and 24% were from the control group. Participants had diagnoses of schizophrenia or schizoaffective disorder (41%), bipolar disorder (20%), affective psychosis (37%) or posttraumatic stress disorder (2%). Thematic analyses revealed a number of key facilitators and barriers. Facilitators included: 1) current health concerns that precipitated the decision to engage in a lifestyle intervention; 2) group camaraderie facilitating participation and weight loss during the intervention; and 3) social support for exercise. Barriers included: 1) loss of structured support and subsequent difficulties continuing with lifestyle improvements postintervention; 2) bad weather as a deterrent to exercise; 3) the interaction of mental health symptoms (e.g. depression, anxiety) with disinhibited eating; and 4) all-or-nothing thinking that led to defeatist attitudes about weight loss.

Discussion: Successful weight loss can be achieved among individuals with serious mental illnesses with the right intervention. We found a strong preference for consistent, group-based support to foster a sense of accountability, which motivated behavior changes. Lifestyle change interventions for this population should also help participants develop flexible cognitive restraint and the ability to iteratively cope and adapt to changes in mood and subsequent changes in motivation to eat healthfully and exercise regularly.

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