EFFECTIVENESS OF COMPUTERIZED WEIGHT MANAGEMENT WITH PEER SUPPORTS FOR PEOPLE WITH MENTAL ILLNESS
Method: 234 patients with serious mental illness were recruited from a Veterans medical center, and 54 from a county mental health clinic. We randomized patients to 1) online weight management with peer coaching, 2) in-person clinician-led services, or 3) to continue with treatment as usual. Online weight management included 30 modules plus weekly telephonic peer coaching. The online system could be accessed from clinic kiosks, or anywhere there is internet access. It provided simultaneous audio and text-based education, video, pedometer tracking, goal setting and homework, diet plans, and quizzes to ensure learning. Coaching was delivered by individuals with lived experience with mental illness, was phone-based, and utilized motivational interviewing principles. In-person weight management included 24 sessions of a weight management intervention, and had the same curriculum as the online program. At 6 months, patient outcomes were assessed and semi-structured interviews conducted with participants.
Result: A mixed measures repeated model predicted Body Mass Index at 6 months. In VA clients, there was a significant group by time interaction (F=3.1, p=.05). The online and peer coaching group had weight reduction averaging 0.5 BMI points (5.2 pounds, p=.03), while neither treatment as usual (p=.29) nor in-person services (p=.86) had a substantial change. Groups at the county clinic had similar effects in the same direction. 42% of clients completed the on-line program compared to 0% completing all in-person groups (Chi-Sq=16.4; p<.0001). On-line services and peer coaching were well received.
Conclusion: On-line weight management with peer supports is feasible, and well received. It allows the provision of educational content and decision support that is tailored to individual patients, convenient, and patient-centered. This produces weight loss, and may have greater effectiveness than clinician-led services. Marginal costs are low, and this approach is amenable to broad dissemination.