Janney Carol A, Masheb Robin M, Lutes Lesley D, Holleman Robert G, Kim Hyungjin Myra, Gillon Leah R, Damschroder Laura J, Richardson Caroline R
VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, United States; Michigan State University College of Human Medicine - Midland Regional Campus Center, 4611 Campus Ridge Drive, Midland, MI 48670, United States.
Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States; VA Connecticut Healthcare System, PRIME Center/11ACSLG, 950 Campbell Avenue, West Haven, CT 06516, United States.
J Affect Disord. 2017 Jun;215:197-204. doi: 10.1016/j.jad.2017.03.003. Epub 2017 Mar 11.
Individuals with mental health (MH) disorders have an increased risk of being overweight/obese; however research on behavioral weight loss interventions has been limited. A priori hypothesis was that Veterans with serious mental illness (SMI) and/or affective disorders (AD) would lose significantly less weight and have a different pattern of weight loss than Veterans without these diagnoses.
Secondary data analysis of ASPIRE-VA study, three-arm randomized, effectiveness weight loss trial among Veterans (n=409) categorized by MH diagnoses: 1) SMI, 2) AD without SMI, or 3) No SMI/No AD. Linear mixed-effects model analyzed weight changes from baseline thru 24 months.
SMI and AD were diagnosed in 10% (n=41) and 31% (n=125). Participants attended approximately 15 sessions from baseline to 24 months. On average, participants lost a modest amount of weight over 24 months regardless of MH diagnosis. Longitudinally, no statistically significant differences were found in weight loss patterns by MH diagnosis. Unadjusted average weight loss (kg) was 1.6±4.0 at 3 months (n=373), 1.9±6.5 at 12 months (n=361), 1.5±7.8 at 18 months (n=289), and 1.4±8.0 at 24 months (n=279).
ASPIRE-VA study was not designed or powered to detect weight loss differences among MH diagnostic groups.
Veterans achieved and maintained modest weight loss, through 24 months, with the three behavioral weight loss interventions. Contrary to our hypotheses, the amount and pattern of weight loss did not differ by MH diagnosis. Greater inclusion of individuals with MH diagnoses may be warranted in behavioral weight loss interventions not specifically tailored for them.
患有心理健康（MH）障碍的个体超重/肥胖的风险增加；然而，关于行为减肥干预措施的研究一直有限。先验假设是，患有严重精神疾病（SMI）和/或情感障碍（AD）的退伍军人与没有这些诊断的退伍军人相比，体重减轻会显著更少，且减肥模式不同。
对“提升-退伍军人事务部”（ASPIRE-VA）研究进行二次数据分析，这是一项针对退伍军人（n = 409）的三臂随机有效性减肥试验，按MH诊断分类：1）SMI，2）无SMI的AD，或3）无SMI/无AD。线性混合效应模型分析了从基线到24个月的体重变化。
10%（n = 41）的人被诊断为SMI，31%（n = 125）的人被诊断为AD。从基线到24个月，参与者大约参加了15次课程。无论MH诊断如何，参与者在24个月内平均都减轻了适量的体重。纵向来看，按MH诊断的减肥模式没有发现统计学上的显著差异。未调整的平均体重减轻（千克）在3个月时为1.6±4.0（n = 373），12个月时为1.9±6.5（n = 361），18个月时为1.5±7.8（n = 289），24个月时为1.4±8.0（n = 279）。
“提升-退伍军人事务部”研究并非设计用于检测或没有足够能力检测MH诊断组之间的体重减轻差异。
通过三种行为减肥干预措施，退伍军人在24个月内实现并维持了适度的体重减轻。与我们的假设相反，减肥的量和模式在MH诊断方面没有差异。在未专门为患有MH诊断的个体量身定制的行为减肥干预措施中，可能需要更多地纳入这类个体。
