Elsevier

General Hospital Psychiatry

Volume 53, July–August 2018, Pages 32-37
General Hospital Psychiatry

Does mental health influence weight loss in adults with prediabetes? Findings from the VA Diabetes Prevention Program

https://doi.org/10.1016/j.genhosppsych.2018.04.001Get rights and content

Abstract

Objectives

Mental illness may impact outcomes from structured behavioral weight loss interventions. This secondary analysis investigated the influence of mental health on weight loss among Veterans with prediabetes enrolled in either an in-person diabetes prevention program (DPP) or the usual care weight management program (MOVE!) designed to help patients achieve weight loss through changes in physical activity and diet.

Methods

Prediabetes was defined by Hemoglobin A1c between 5.7 and 6.4% or Fasting Plasma Glucose 100–125 mg/dL and no use of antiglycemic medications during the past six months. Veterans Health Administrative data were used to assign Veterans into one of three mental health diagnoses: severe mental illness (SMI), affective disorder (AD) without SMI, or No SMI/No AD. The influence of mental health on weight changes at 6 and 12 months was modeled using linear mixed-effects regression.

Results

On average, Veterans with prediabetes (n = 386) were 59 years old (SD = 10.0 years), with a BMI of 34.8 kg/m2 (SD = 5.3 kg/m2) and A1c of 6.0% (SD = 0.2%). The sample consisted of 12% (n = 47), 39% (n = 150), and 49% (n = 189) diagnosed with SMI, AD and No SMI/No AD, respectively.

Across interventions, Veterans with SMI lost less weight than those with AD or No SMI/No AD. From baseline to 6 months, weight loss was significantly less for Veterans with SMI (1.53 kg) compared to Veterans with AD (3.85 kg) or No SMI/No AD (3.73 kg). This weight loss trend by mental health diagnosis continued from baseline to 12 months but was no longer statistically significant at 12 months.

Conclusion

Weight loss was not clinically or statistically different among Veterans with prediabetes diagnosed with AD or No SMI/No AD. However, Veterans diagnosed with SMI exhibited less weight loss over 6 months than Veterans with AD or No SMI/No AD and though not statistically significant, the trend continued to 12 months, suggesting that SMI may influence weight loss outcomes.

Section snippets

Background

According to the National Center for Health Statistics, the prevalence of obesity among adults in the United States is approximately 40% [1]. Approximately half of the adults diagnosed with depression (43%) [2], schizophrenia (52%), and bipolar disorder (55%) are obese [3]. Obesity is associated with an increased risk of many co- morbid conditions, including some cancers, type 2 diabetes, degenerative arthritis, sleep apnea, hypertension, and cardiovascular disease, among others. Health care

Study design

This study was a secondary data analysis of the VA-DPP Clinical Demonstration Trial (VA-DPP), a non-randomized, pragmatic, prospective comparative effectiveness study of two lifestyle change interventions for obese/overweight patients with prediabetes. Patients from three VA Medical Centers (VAMCs) who met eligibility criteria were systematically assigned to either the VA-DPP or to the existing VA weight loss program (MOVE!). Every 2 months, sites assigned the first 20 eligible Veterans to

Results

A detailed consort diagram for this study has been previously published [27]. Briefly, 1850 patients were screened or attended MOVE! orientation sessions. Of the 387 Veterans who met study eligibility criteria including being pre-diabetes, 273 were assigned to the VA-DPP intervention and 114 were assigned to the MOVE! intervention. Due to missing baseline weight, one of the 114 patients assigned to the MOVE! intervention was excluded from the analytical sample (n = 386). Among the remaining 386

Discussion

In this study we compared weight loss outcomes in standard lifestyle programs offered to Veterans with SMI, AD, and No SMI/No AD. We observed a statistically significant difference in weight loss at 6 but not 12 months among Veterans with SMI, with absolute weight loss being lowest among Veterans with SMI as compared to those with AD or No SMI/No AD. These findings suggest Veterans with SMI may benefit from tailored programs which can better meet their unique health needs and/or preferences.

Financial support

This work was funded by the VA Quality Enhancement Research Initiative program through two research grants (RRP12-440 and SDP 12-549) and clinical quality improvement funding (XVA41-048). CAJ was supported by the VA Center for Clinical Management Research, Health Services Research and Development as a post-doctoral fellow at the VA Ann Arbor Healthcare System (2013-2015). TM received support from the VA Office of Academic Affiliations through the VA Health Services Research and Development

Acknowledgements

The authors thank Samantha Lindenauer for her significant contributions as a research assistant throughout the project. We also thank all the Veterans who participated in this study and their services to our country.

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