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Nutritional Counseling for Adults with Severe Mental Illness: Key Lessons Learned

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Description of Research

A randomized controlled Department of Veterans Affairs research study assessed the efficacy of a behavioral weight loss program for 120 US veterans with SMI (men and women, aged 18 to 70 years) who have gained weight as a result of their medications. This program has proven to be effective in preliminary findings.7 A multisite extension of this study is currently underway. Subjects assigned to the intervention group receive educational group lessons on nutrition and exercise, along with

Case 1

A 52-year-old male veteran with paranoid schizophrenia, dyslipidemia, and obesity was prescribed aripiprazole, a second generation antipsychotic medication. With a starting weight of 230 lb, his weight increased by 70 lb to 300 lb during the next year. With a BMI of 41, a waist circumference of 54 inches, and triglyceride levels of 240 mg/dL (2.71 mmol/L), the patient sought help through the behavioral weight management research study. Having already lost 30 lb on his own before starting the

Identifying Challenges

Providing nutrition counseling and education using a behavioral weight loss approach for overweight and obese adults with SMI presents many challenges.

Conclusion

RDNs are well-equipped to provide health promotional activities to prevent and manage disease and optimize nutritional health for individuals with SMI. The use of psychotherapeutic techniques and other tools for metabolic management have all contributed to successful outcomes (Figure 2). These strategies, along with a hopeful attitude for the individual's wellness and recovery, are recommended for any RDN interested in working with this population.

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Cited by (10)

  • Sex Differences in Weight Loss among Veterans with Serious Mental Illness: Observational Study of a National Weight Management Program

    2016, Women's Health Issues
    Citation Excerpt :

    Such guidelines are needed particularly for those with SMI because veterans with SMI report many pragmatic barriers to weight loss even with the support of MOVE! providers (Goldberg et al., 2013; Klingaman, Viverito, Medoff, Hoffmann, & Goldberg, 2014; Kwan et al., 2014). For example, one study found no differences in weight loss outcomes between veterans with SMI randomized to standard treatment versus early MOVE!

  • Detecting and Managing Adverse Effects of Antipsychotic Medications: Current State of Play

    2016, Psychiatric Clinics of North America
    Citation Excerpt :

    Because diabetes is a chronic and progressive disease, patients should be educated about maintaining a long-term, balanced diet with restrictions of carbohydrate intake. Additionally, increased physical activity should be recommended to promote calorie expenditure and weight loss and to improve cardiovascular outcomes.41–43 Education regarding the microvascular and macrovascular risks associated with diabetes is especially important for patients with SMI who are less likely to be evaluated for retinopathy or diabetic foot complications compared with the general population.72

  • Meal replacements as a weight loss tool in a population with severe mental illness

    2015, Eating Behaviors
    Citation Excerpt :

    Individuals with severe mental illness (SMI) may have a greater likelihood of obesity and chronic disease development than the general population due to weight gain and other metabolic side effects associated with second generation antipsychotic medications (Das, Mendez, Jagasia, & Labbate, 2012; Meyer et al., 2006; Newcomer & Haupt, 2006; Rosen & Wirshing, 2008; Tandon, Nasrallah, & Keshavan, 2010; Wirshing, 2004). Cognitive deficits, motivational barriers, substance use disorders, and limited financial resources may also be prevalent in this population, and can inhibit healthy lifestyles (Kwan et al., 2014). To address medication-associated obesity, a randomized, controlled research study of a behavioral weight management program specifically designed for an SMI population was undertaken for 120 male and female United States Veterans (Kwan et al., 2014).

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FUNDING/SUPPORT Funding was provided by a Department of Veterans Affairs Merit Review grant (D7358R). This material is based on work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Greater Los Angeles Healthcare System.

This publication does not represent the views of the Department of Veterans Affairs or the United States Government.

This article was written by Crystal L. Kwan, MPH, RD, clinical dietitian, Medical Research, Department of Veterans Affairs Medical Center, Greater Los Angeles, CA; Hollie A.L. Gelberg, PhD, RD, clinical dietitian, Medical Research, Department of Veterans Affairs Medical Center, Greater Los Angeles, CA; Jennifer A. Rosen, PharmD, BCPP, co-investigator, Long Beach VA, and clinical pharmacist, PGY-2 pharmacy residency program director in psychiatry, Department of Pharmacy, Department of Veterans Affairs Medical Center, Long Beach, CA; Valery Chamberlin, MD, co-investigator, Sepulveda VA, psychiatrist, Mental Health, associate clinical professor, UCLA, and associate residency director, UCLA-SFV Psychiatry, Department of Veterans Affairs Medical Center, Greater Los Angeles, CA; Chandresh Shah, MD, co-investigator, Los Angeles Ambulatory Care Center VA, and psychiatrist, Mental Health, Department of Veterans Affairs Medical Center, Greater Los Angeles, CA; Charles Nguyen, MD, co-investigator, Long Beach VA, and psychiatrist, Mental Health, Department of Veterans Affairs Medical Center, Long Beach, CA; Joseph M. Pierre, MD, co-investigator, West Los Angeles VA, associate director of residency education, UCLA Semel Institute for Neuroscience & West Los Angeles VA Medical Center, co-chief, Schizophrenia Treatment Unit, West Los Angeles VA Medical Center, and associate clinical professor, Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Department of Veterans Affairs Medical Center, Greater Los Angeles, CA; Zachary D. Erickson, program manager, Medical Research, Department of Veterans Affairs Medical Center, Greater Los Angeles, CA; Shirley J. Mena, MSN, RN, research assistant, Medical Research, Department of Veterans Affairs Medical Center, Greater Los Angeles, CA; Michael King, Jr, research assistant, Medical Research, Department of Veterans Affairs Medical Center, Greater Los Angeles, CA; Irina Arnold, MS, MD (MD obtained in Russia), research assistant, Medical Research, Department of Veterans Affairs Medical Center, Greater Los Angeles, CA; Matthew R. Baker, research assistant, Medical Research, Department of Veterans Affairs Medical Center, Greater Los Angeles, CA; Hilary B. Meyer, research assistant, Medical Research, Department of Veterans Affairs Medical Center, Greater Los Angeles, CA; and Donna Ames, MD, principal investigator, Program Leader, VA Psychosocial Rehabilitation and Recovery Center, and professor in residence, David Geffen School of Medicine at UCLA, Department of Veterans Affairs Medical Center, Greater Los Angeles, CA.

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