The Barriers to Weight Loss

Are you having trouble losing weight? I’ve made it no secret that I am. I blog an update of my weight loss journey every week. If you are struggling with weight you are not alone. Over 80 percent of people with serious mental illnesses, such as schizophrenia, bipolar disorder and major depression, are overweight or obese. This contributes to them dying at three times the rate of overall population. There is good news from a National Institute of Mental Health (NIMH) funded study reported in The New England Journal of Medicine. Those with mental illness can lose weight and keep it off through a modified lifestyle intervention program.

According to the study, being overweight, the mentally ill succumb mostly to the same things the rest of the population experiences, such as cardiovascular disease, diabetes and cancer. Although antipsychotic medications increase appetite and cause weight gain in these patients, it is not the only culprit. Like the general population, sedentary lifestyle and poor diet also play a part. Lifestyle modifications such as diet and exercise should work for these patients, yet they are often left out of weight loss studies

“People with serious mental illnesses are commonly excluded from studies to help them help themselves about their weight, said Gail L. Daumit, M.D., of Johns Hopkins University, Baltimore, and the study’s lead author. “We’re showing that serious mentally ill patients can make successful, sustained changes with proper interventions.”

Several years ago, my doctor referred me to a surgeon who specializes in gastric-bypass surgery. The surgeon described the process to me. Having my intestines detached, then having my stomach reduced to a small sleeve, then reattaching my intestines made me uneasy. When the surgeon informed me that everyone is required to lose 10% of their weight before the surgery I decided I heard enough. If I was capable of losing 10% of my weight, why wouldn’t I just choose to continue? As a result, I decided to join Weight Watchers and have lost 45 lbs. so far – far beyond a 10% decrease.

“Until now, obesity among those with serious mental illnesses has not received adequate attention,” said NIMH Director Thomas R. Insel, M.D. “People with serious mental illnesses need more attention to their physical health. This study provides convincing evidence these individuals can make substantial lifestyle changes and therefore should suffer fewer medical complications as they age.”

There are other factors which impede people with mental illness from losing weight. These include memory problems which make it difficult to adapt to new behavior, such as counting calories. Socioeconomics are also a factor as many can’t afford or can’t get to physical activity programs like fitness gyms. Economics is a big factor for friends of mine who are trying to lose weight. They have more barriers to contend with. They can’t hire a nutritionist, join a gym, the YMCA or even Weight Watchers.

A Solution

Daumit’s group came up with an excellent plan. They attempted to solve these issues by bringing the gyms and nutritionists to places most of these patients frequent—psychiatric rehabilitation outpatient programs. Under the trial name ACHIEVE, the researchers randomized 291 participants in 10 rehab centers around Maryland to receive the usual care, consisting of nutrition and physical activity information, or six months of intensive intervention consisting of exercise classes three times a week along with individual or group weight loss classes once a week. Both groups were followed for an additional year, during which the weight loss classes of the intervention arm tapered down but the exercise classes remained constant. The intervention arm included goals such as reducing caloric intake by avoiding sugar-sweetened beverages and junk food; eating five servings of fruits and vegetables daily; choosing smaller portions and healthy snacks; and moderate intensity aerobic exercise. Basically they just described the Weight Watchers program. I don’t mean to favor Weight Watchers other than the fact that it works for me.

The Results

Participants in the program lost seven pounds more than the controls—and continued to lose weight and did not regain, despite the reduced frequency of classes and counseling sessions. In contrast, the general population tends to experience peak weight loss in the first six months and then rebound and gain part or all of their weight back.

On average, each participant was on three psychotropic medications all known to cause weight gain. But no matter what they were on, they lost the weight.

“We’re showing behavioral interventions work regardless of what they’re taking,” Daumit said. Her group is now looking for ways to spread the program. I hope they are successful expanding to other areas, including throughout the entire U.S.A.

Source: New England Journal of Medicine