A unique health program, called In SHAPE, developed specifically for people with serious mental illness was found to be far more successful in helping its participants achieve weight loss and fitness compared to a typical gym membership.
The key component of the program was the addition of a trained health coach. The findings offer new hope for those with severe mental illness — schizophrenia, schizoaffective disorder, bipolar disorder, or major depressive disorder in this study — who often struggle with their weight.
“Upwards of 80 percent of people with serious mental illness are overweight or obese, and rates of obesity among people with serious mental illness are nearly double the rate within the general population, which represents an alarming public health concern,” said psychiatrist Dr. Stephen Bartels of the Dartmouth Centers for Health and Aging.
The study, published in the American Journal of Psychiatry, showed that more than half of the participants in the In SHAPE program achieved a clinically significant reduction in cardiovascular risk. An even more impressive fact was that these benefits remained six months after the program had ended.
The 12-month program included a gym membership and a health promotion coach who met with participants on a weekly basis. Before the program began, the coaches received one-week training in fitness goal setting, healthy nutrition, strategies for health behavior change, and tracking eating and physical activity behaviors.
The In SHAPE program, first developed in 2004, was previously evaluated in a 2013 randomized controlled trial — set in a community mental health center in a predominantly white setting in New Hampshire. These first findings showed a 49 percent reduction in cardiovascular risk in In SHAPE participants with serious mental illness.
The new study found that the In SHAPE program achieved and exceeded the same clinically meaningful results across multiple community mental health providers, in greater Boston and within an ethnically heterogeneous sample where 46 percent of participants were nonwhite.
This finding is very important as it is very challenging to replicate study results across diverse settings.
One of the most important findings in the study was that participants had maintained their reductions in cardiovascular risk six months after they discontinued the program. (Cardiovascular risk is defined as clinically meaningful weight loss of five percent or more or clinically significant improved fitness.)
This was in addition to the fact that the findings had been successfully repeated, and had even exceeded, those of the prior randomized controlled trial.
One limitation of this study was that the sample size of 210 participants was not quite large enough to determine whether there were differences in weight loss among people with different psychiatric disorders or between different racial or ethnic groups.