title: Pragmatic replication trial of health promotion coaching for obesity in serious mental illness and maintenance of outcomes.
abstract: OBJECTIVE
  Few studies targeting obesity in serious mental illness have reported clinically significant risk reduction, and none have been replicated in community settings or demonstrated sustained outcomes after intervention withdrawal. The authors sought to replicate positive health outcomes demonstrated in a previous randomized effectiveness study of the In SHAPE program across urban community mental health organizations serving an ethnically diverse population.
  
  
  METHODS
  Persons with serious mental illness and a body mass index (BMI) >25 receiving services in three community mental health organizations were recruited and randomly assigned either to the 12-month In SHAPE program, which included membership in a public fitness club and weekly meetings with a health promotion coach, or to fitness club membership alone. The primary outcome measures were weight and cardiorespiratory fitness (as measured with the 6-minute walk test), assessed at baseline and at 3, 6, 9, 12, and 18 months.
  
  
  RESULTS
  Participants (N=210) were ethnically diverse (46% were nonwhite), with a mean baseline BMI of 36.8 (SD=8.2). At 12 months, the In SHAPE group (N=104) had greater reduction in weight and improved fitness compared with the fitness club membership only group (N=106). Primary outcomes were maintained at 18 months. Approximately half of the In SHAPE group (51% at 12 months and 46% at 18 months) achieved clinically significant cardiovascular risk reduction (a weight loss ≥5% or an increase of >50 meters on the 6-minute walk test).
  
  
  CONCLUSIONS
  This is the first replication study confirming the effectiveness of a health coaching intervention in achieving and sustaining clinically significant reductions in cardiovascular risk for overweight and obese persons with serious mental illness.
authors.affiliation: From the Department of Psychiatry, the Department of Community and Family Medicine, and the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, N.H.; the Division of Nutritional Sciences, Cornell University, Ithaca, N.Y.; the Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami; Ken Jue Consulting, Keene, N.H.; Massachusetts Mental Health Center, Boston; and Vinfen Corporation, Cambridge, Mass.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Bartels
authors.forename: Sarah I
authors.initials: SI
authors.lastname: Pratt
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Aschbrenner
authors.forename: Laura K
authors.initials: LK
authors.lastname: Barre
authors.forename: John A
authors.initials: JA
authors.lastname: Naslund
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Wolfe
authors.forename: Haiyi
authors.initials: H
authors.lastname: Xie
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: McHugo
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Jimenez
authors.forename: Ken
authors.initials: K
authors.lastname: Jue
authors.forename: James
authors.initials: J
authors.lastname: Feldman
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Bird
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications*; D015992:Body Mass Index; D003865:Major Depressive Disorder / Q000150:complications*; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000628:therapy*; D050177:Overweight / Q000150:complications / Q000628:therapy; D010809:Physical Fitness; D011618:Psychotic Disorders / Q000150:complications*; D015203:Reproducibility of Results; D012559:Schizophrenia / Q000150:complications*; D016896:Treatment Outcome; D015431:Weight Loss; D061217:Weight Reduction Programs / Q000379:methods*
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