title: Sex Differences in Weight Loss among Veterans with Serious Mental Illness: Observational Study of a National Weight Management Program.
abstract: Obesity disproportionately burdens individuals with serious mental illness (SMI), especially women. This observational study investigated whether there were sex differences in weight loss and program participation among veterans with SMI enrolled in the Veterans Health Administration's (VHA) MOVE! weight management program.
  
  
  
  Participants were identified from a national cohort of 148,254 veterans enrolled in MOVE! during fiscal years 2008 through 2012 who attended two or more sessions within 12 months of enrollment. The cohort included those with International Classification of Disease, 9th Edition, Clinical Modification (ICD-9-CM) diagnoses for SMI, age less than 70 years, and weight data at baseline and one or more follow-up timepoints within approximately 1 year of enrollment (n = 8,943 men; n = 2,245 women). Linear mixed models assessed associations of sex with 6- and 12-month weight change from baseline, adjusting for demographic- and site-level variables.
  
  
  
  Both sexes averaged 6.4 (standard deviation, 4.6) sessions within 12 months; however, women with and without SMI participated at rates double their respective proportion rates among all VHA users. Participants averaged statistically significant weight loss at 6 months (men, -2.5 lb [95% CI, -2.8 to -2.1]; women, -2.4 lb [95% CI, -3.1 to -1.7]) and 12 months (men, -2.5 lb [95% CI, -2.8 to -2.2]; women, -2.9 lb [95% CI, -3.6 to -2.2]), but no sex-based difference in absolute weight loss at either timepoint. Slightly more women achieved 5% or greater (clinically significant) weight loss at the 12-month follow-up than did men (25.7% vs. 23.0%; p < .05).
  
  
  
  Women with SMI participated in MOVE! at rates equivalent to or greater than men with SMI, with comparable weight loss. More women were Black, single, had bipolar and posttraumatic stress disorder, and higher service-connected disability, suggesting areas for program customization.
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: David E
authors.initials: DE
authors.lastname: Goodrich
authors.affiliation: VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland; Department of Psychiatry, University of Maryland School of Medicine, Division of Psychiatric Services Research, Baltimore, Maryland. Electronic address: Elizabeth.klingaman@va.gov.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Klingaman
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Lilia
authors.initials: L
authors.lastname: Verchinina
authors.affiliation: VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland; Department of Psychiatry, University of Maryland School of Medicine, Division of Psychiatric Services Research, Baltimore, Maryland.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Goldberg
authors.affiliation: Epidemiologic Research and Information Center, VA Puget Sound Medical Center, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington.
authors.forename: Alyson J
authors.initials: AJ
authors.lastname: Littman
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Janney
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Center for Statistical Consultation & Research, University of Michigan, Ann Arbor, Michigan.
authors.forename: Hyungjin Myra
authors.initials: HM
authors.lastname: Kim
authors.affiliation: San Francisco VA Medical Center, San Francisco, California; Department of Psychiatry, University of California, San Francisco, California.
authors.forename: Shira
authors.initials: S
authors.lastname: Maguen
authors.affiliation: Mental Health Service, VA Puget Sound Healthcare System, Seattle, Washington; University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, Washington.
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Hoerster
authors.affiliation: VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas; Department of Psychiatry, Psychiatric Research Institute, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Owen
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Holleman
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Pia
authors.initials: P
authors.lastname: Roman
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Zongshan
authors.initials: Z
authors.lastname: Lai
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Ann Arbor, Michigan.
authors.forename: Nicholas W
authors.initials: NW
authors.lastname: Bowersox
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D012727:Sex Characteristics; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data; D058014:Veterans Health / Q000706:statistics & numerical data*; D015431:Weight Loss; D061217:Weight Reduction Programs / Q000706:statistics & numerical data*