title: Randomized trial of achieving healthy lifestyles in psychiatric rehabilitation: the ACHIEVE trial.
abstract: BACKGROUND
  Overweight and obesity are highly prevalent among persons with serious mental illness. These conditions likely contribute to premature cardiovascular disease and a 20 to 30 percent shortened life expectancy in this vulnerable population. Persons with serious mental illness need effective, appropriately tailored behavioral interventions to achieve and maintain weight loss. Psychiatric rehabilitation day programs provide logical intervention settings because mental health consumers often attend regularly and exercise can take place on-site. This paper describes the Randomized Trial of Achieving Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE). The goal of the study is to determine the effectiveness of a behavioral weight loss intervention among persons with serious mental illness that attend psychiatric rehabilitation programs. Participants randomized to the intervention arm of the study are hypothesized to have greater weight loss than the control group.
  
  
  METHODS
  A targeted 320 men and women with serious mental illness and overweight or obesity (body mass index ≥ 25.0 kg/m2) will be recruited from 10 psychiatric rehabilitation programs across Maryland. The core design is a randomized, two-arm, parallel, multi-site clinical trial to compare the effectiveness of an 18-month behavioral weight loss intervention to usual care. Active intervention participants receive weight management sessions and physical activity classes on-site led by study interventionists. The intervention incorporates cognitive adaptations for persons with serious mental illness attending psychiatric rehabilitation programs. The initial intensive intervention period is six months, followed by a twelve-month maintenance period in which trained rehabilitation program staff assume responsibility for delivering parts of the intervention. Primary outcomes are weight loss at six and 18 months.
  
  
  CONCLUSIONS
  Evidence-based approaches to the high burden of obesity and cardiovascular disease risk in person with serious mental illness are urgently needed. The ACHIEVE Trial is tailored to persons with serious mental illness in community settings. This multi-site randomized clinical trial will provide a rigorous evaluation of a practical behavioral intervention designed to accomplish and sustain weight loss in persons with serious mental illness.
authors.affiliation: Welch Center for Prevention, Epidemiology, Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Casagrande
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Jerome
authors.forename: Arlene T
authors.initials: AT
authors.lastname: Dalcin
authors.forename: Faith B
authors.initials: FB
authors.lastname: Dickerson
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Anderson
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
authors.forename: Jeanne
authors.initials: J
authors.lastname: Charleston
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Crum
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Young
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.forename: Richard W
authors.initials: RW
authors.lastname: Goldberg
authors.forename: Meghan
authors.initials: M
authors.lastname: Oefinger
authors.forename: Joseph
authors.initials: J
authors.lastname: Finkelstein
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Gennusa
authors.forename: Oladapo
authors.initials: O
authors.lastname: Fred-Omojole
authors.forename: Leslie M
authors.initials: LM
authors.lastname: Campbell
authors.forename: Nae-Yuh
authors.initials: NY
authors.lastname: Wang
authors.forename: Gail L
authors.initials: GL
authors.lastname: Daumit
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D003156:Community Mental Health Services / Q000379:methods; D015897:Comorbidity; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008019:Life Style; D008297:Male; D008396:Maryland / Q000453:epidemiology; D001523:Mental Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D009765:Obesity / Q000453:epidemiology / Q000628:therapy*; D050177:Overweight / Q000453:epidemiology / Q000628:therapy*; D011615:Psychotherapy, Group; D012050:Rehabilitation, Vocational / Q000379:methods; D012107:Research Design; D011795:Surveys and Questionnaires; D015431:Weight Loss