Tuesday, October 21, 2014: 11:45 AM

Alexander S. Young, MD, MSHS1, Amy N. Cohen, PhD2, Richard Goldberg, PhD3, Julie Kreyenbuhl, PharmD4, Gerhard Hellemann, PhD5, Fiona Whelan, MS5 and Nancy Nowlin-Finch, MD6, (1)Greater Los Angeles VA and UCLA, Los Angeles, CA, (2)Greater Los Angeles VA, Los Angeles, CA, (3)University of Maryland & Baltimore VA, Baltimore, MD, (4)VA Baltimore MIRECC, Baltimore, MD, (5)UCLA Department of Psychiatry, Los Angeles, CA, (6)LA County Department of Mental Health, Edelman Center, Los Angeles, CA
Purpose:  People with serious mental illness are at high risk for obesity and related medical problems, and die 10 to 20 years prematurely, most commonly from cardiovascular disease.  Current guidelines recommend specialized, in-person weight management interventions, and these result in weight loss in efficacy research.  In clinical practice, these interventions are typically not provided, and, when provided, client enrollment and retention is low.  Barriers could be addressed using computerized provision of diet and exercise education and decision support, combined with motivation and support from peer coaches.

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.