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Damschroder LJ, Goodrich DE, Holleman RH, Kim M, Richardson CR. Association of Mental Health Diagnoses with Weight Loss in the Aspire Trial. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2014 Apr 24; Philadelphia, PA.
Prevalence of obesity is high for people with mental health (MH) disorders. This population often experiences lower benefit from weight management interventions. The ASPIRE randomized control trial enrolled 481 Veterans who were predominantly white (59%), male (85%), and mean age was 55 years. Participants were randomized into 2 versions of the ASPIRE 12-month program - coaching by phone or in groups with an intensive phase (13 weekly sessions) and then a less intensive phase (15 bi-weekly sessions) - or to the MOVE! usual care weight management program. At 12 months all study participants exhibited statistically significant, though small mean weight loss. Our aim in this analysis was to determine the impact of MH status on weight loss. Participants were classified into 3 groups: presence of serious mental illness (7%; SMI: bipolar, schizophrenia, other psychoses), depression (30%), or neither condition (63%); eligibility criteria did not include MH status. Linear mixed-effects modeling was used to assess weight outcomes at 3 and 12 months. At 3 months, all MH groups lost a comparable and significant amount of weight compared to baseline (-1.5 kg; 95% CI: -2.5 to -0.5). However, participants with SMI had significant weight gain between 3 and 12 months (+2.4 kg; 95% CI: 0.2-4.5) compared to the other two MH groups who continued to lose a small but insignificant amount of weight. By 12 months, the SMI group had a net gain of a small but insignificant amount of weight gain compared to baseline (+0.7 kg; p = .77) in contrast to the two non-SMI groups which had significant cumulative weight loss at 12 months (-2.2 and -1.7 kg for depression and neither, respectively). Findings suggest that individuals with MH disorders can lose significant weight through a behavioral lifestyle intervention in the short-term but individuals with SMI may require an intensified approach to help maintain weight loss over the longer term.