title: Improving Weight in People with Serious Mental Illness: The Effectiveness of Computerized Services with Peer Coaches.
abstract: BACKGROUND
  People with serious mental illness have high rates of obesity and related medical problems, and die years prematurely, most commonly from cardiovascular disease. Specialized, in-person weight management interventions result in weight loss in efficacy trials with highly motivated patients. In usual care, patient enrollment and retention are low with these interventions, and effectiveness has been inconsistent.
  
  
  OBJECTIVE
  To determine whether computerized provision of weight management with peer coaching is feasible to deliver, is acceptable to patients, and is more effective than in-person delivery or usual care.
  
  
  METHODS
  Mixed-methods randomized controlled trial.
  
  
  METHODS
  Two hundred seventy-six overweight patients with serious mental illness receiving care at a Veterans Administration medical center.
  
  
  METHODS
  Patients were randomized to 1) computerized weight management with peer coaching (WebMOVE), 2) in-person clinician-led weight services, or 3) usual care. Both active interventions offered the same educational content.
  
  
  METHODS
  Body mass index; and feasibility and acceptability of the intervention.
  
  
  RESULTS
  At 6 months, in obese patients (n = 200), there was a significant condition by visit effect (F = 4.02, p = 0.02). The WebMOVE group had an average estimated BMI change from baseline to 6 months of 34.9 ± 0.4 to 34.1 ± 0.4. This corresponds to 2.8 kg (6.2 lbs) weight loss (t = 3.2, p = 0.001). No significant change in BMI was seen with either in-person services (t = 0.10, p = 0.92), or usual care (t = -0.25, p = 0.80). The average percentage of modules completed in the WebMOVE group was 49% and in the in-person group was 41% (t = 1.4, p = 0.17). When non-obese patients were included in the analyses, there was a trend towards a condition by visit effect (F = 2.8, p = 0.06). WebMOVE was well received, while the acceptability of in-person services was mixed.
  
  
  CONCLUSIONS
  Computerized weight management with peer support results in lower weight, and can have greater effectiveness than clinician-led in-person services. This intervention is well received, and could be feasible to disseminate.
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. ayoung@ucla.edu.|Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA. ayoung@ucla.edu.|VA Greater Los Angeles, MIRECC, 11301 Wilshire Blvd, 210A, Los Angeles, CA, 90073, USA. ayoung@ucla.edu.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Young
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.|Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Amy N
authors.initials: AN
authors.lastname: Cohen
authors.affiliation: VA Capitol Healthcare Network Mental Illness Research, Education, and Clinical Center (VISN 5 MIRECC), Baltimore, MD, USA.|Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Goldberg
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hellemann
authors.affiliation: VA Capitol Healthcare Network Mental Illness Research, Education, and Clinical Center (VISN 5 MIRECC), Baltimore, MD, USA.|Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Kreyenbuhl
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.|VA Long Beach Healthcare System, Long Beach, CA, USA.
authors.forename: Noosha
authors.initials: N
authors.lastname: Niv
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.|Los Angeles County Department of Mental Health, Los Angeles, CA, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Nowlin-Finch
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Oberman
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Fiona
authors.initials: F
authors.lastname: Whelan
mesh_terms: D000328:Adult; D000368:Aged; D001521:Behavior Therapy / Q000379:methods; D001835:Body Weight; D003376:Counseling / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D000071252:Mentoring / Q000379:methods; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D000073319:Obesity Management / Q000379:methods*; D010353:Patient Education as Topic / Q000379:methods; D010379:Peer Group; D013813:Therapy, Computer-Assisted / Q000379:methods*; D014728:Veterans / Q000523:psychology; D015431:Weight Loss
keywords: comparative effectiveness; counseling; information technology; mental illness; obesity