Background/Rationale: Obesity has reached epidemic proportions, and often has serious adverse health consequences. The VA has been deploying a "MOVE! Weight Management Program" nationally in the general veteran population. Since individuals with serious mental illness (SMI) usually have cognitive problems, specialized psychoeducational interventions are required in this population. Specialized psychoeducational interventions for weight have been developed and studied in populations with SMI. This evidence-based practice has been adapted for use in VA, resulting in a "MOVE! SMI" intervention. However, it has proven to be quite difficult to disseminate this intervention. Patients with SMI often have limited transportation options, and may not want to participate in groups. Also, in-person MOVE! SMI requires substantial time from mental health clinicians. This clinician time has been difficult to redeploy or not available at many VA locations. It is very likely that these barriers can be addressed with a computerized, web-based version of MOVE! that is tailored for veterans with SMI. Specialized web-based approaches have been studied and found to be successful in this population, and can deliver content that is intensive and engaging with minimal requirements for staff time. Objectives: The VISN 5 and 22 MIRECCs have developed a prototype web-based system that provides computerized counseling regarding diet to veterans with SMI. The proposed project will expand this system. This project's objectives are to: 1) develop a comprehensive web-based system that delivers MOVE! using design features that meet the needs of individuals with SMI;2) evaluate the effectiveness, in veterans with SMI, of web-based MOVE! compared with in-person MOVE! and a control group;and, 3) characterize, from the patient's perspective, the strengths, weaknesses, and barriers to the use of in-person and web-based MOVE!. Methods: This is a prospective, randomized, controlled trial in 300 veterans with SMI who are overweight and receiving treatment with medications that often have weight gain as a major side-effect. Participants are assigned to in-person MOVE! SMI, web-based MOVE! SMI, or a control group. Research assessments occur at 0, 3, and 6 months. Changes in outcomes are compared over time between the three groups. Significance: By losing weight, veterans with SMI can decrease their risk for medical problems that have a serious negative effect on their quality of life and life expectancy. A web-based system that helps veterans lose weight could be feasible to disseminate broadly at VA sites, including medical centers and community based outpatient clinics serving both rural and urban areas.
Obesity and physical inactivity have reached epidemic proportions, resulting in increased rates of a variety of chronic diseases, increased risk of death, and substantial health care costs. Veterans with serious mental illness are even more likely to be overweight or obese, which likely contributes to the high rate of co- morbid medical disease and early mortality found among this population. Specific individual and group-based psychoeducational interventions have repeatedly and consistently been shown to help adults with serious mental illness lose weight. However, these require substantial time from mental health clinicians, and frequent visits by patients to mental health clinics. This creates challenges for patients who may need to travel long distances to a medical center that provides these services, and who often have limited transportation options. It is likely that these barriers can be addressed with a computerized, web-based intervention focused on diet and exercise education, and tailored for veterans with serious mental illness. Web-based systems can deliver content that is intensive, engaging, and tailored to the needs and preferences of specific patients. Web-based systems can be delivered using computers at Community Based Outpatient Clinics or other settings in the community. The objective of this project is to develop and evaluate the effectiveness of a web-based intervention to help patients with serious mental illness lose weight.