Identifying effective characteristics of behavioral weight management interventions for people with serious mental illness: A systematic review with a qualitative comparative analysis

Abstract

People with serious mental illness (SMI) have identified barriers to engaging in behavioral weight management interventions (BWMIs). We assessed whether BWMIs that addressed these barriers were more effective. First, we systematically reviewed qualitative literature and used a thematic analysis to identify the characteristics of BWMIs that promote engagement for adults with SMI. Second, we systematically reviewed randomized controlled trials (RCTs) of BWMIs in adults with SMI. Data on the characteristics that promoted engagement and weight outcomes were extracted. We then used a crisp-set qualitative comparative analysis (CsQCA) to identify which characteristics were associated with weight loss. For the qualitative review, 20 studies in 515 people with SMI were analyzed and nine characteristics were reported to promote engagement in BWMIs. For the systematic review, 34 RCTs testing 36 interventions in 4305 participants were included. The active interventions resulted in more weight loss (mean = À4.37 to +1 kg at 6 weeks to 18 months follow-up) compared with controls (À1.64 to +3.08 kg). The CsQCA showed BWMIs that offered regular contact, tools to support enactment, and tailored materials were associated with effectiveness. As these are all supplementary strategies, it may be possible to augment BWMIs available for the general population to engage people with SMI.

The psychological journey of weight gain in psychosis

“…Connecting with peers and experts‐by‐experience may foster much needed hope. Interventions that include regular support by a practitioner with mental health expertise have been shown to be more effective (Lee et al, 2021 ). Interventions tackling excess weight will likely benefit from integrated support across multi‐disciplinary teams, including peer, medical and psychological expertise.…”

“…that make adaptions for the patient group, for example, providing practical tools such as pedometers or interim support between sessions (Lee et al, 2021). Treatment improvement will likely benefit from understanding the potential interaction between the physical and psychological consequences of excess weight in patients with psychosis.…”

“…To date, weight loss interventions, including specific programmes designed for patients with psychosis, have shown limited clinical benefits for patients with psychosis (Álvarez‐Jiménez et al, 2008 ; Brown et al, 2018 ; Naslund et al, 2016 ; Speyer et al, 2019 ). Greater effectiveness is apparent for interventions that make adaptions for the patient group, for example, providing practical tools such as pedometers or interim support between sessions (Lee et al, 2021 ). Treatment improvement will likely benefit from understanding the potential interaction between the physical and psychological consequences of excess weight in patients with psychosis.…”

Understanding the implementation of ‘Making Every Contact Count’ (MECC) delivered by healthcare professionals in a mental health hospital: protocol for a pragmatic formative process evaluation

“…brief telephone calls), and tailored materials and content about the impact of being diagnosed with a mental illness (e.g. low motivation as a result of diagnosis) (Lee et al, 2022 ).…”

REalist Synthesis Of non-pharmacologicaL interVEntions for antipsychotic-induced weight gain (RESOLVE) in people living with severe mental illness (SMI)

“…Much work in this area is likely to be service evaluation type data or reports which may not be included in standard systematic reviews, but can be included in RESOLVE [14][15][16]. The interview component of the study will generate qualitative data on the lived experience of weight gain and what works to help manage weight from a diverse group of service users and practitioners.…”