Description of the research project: Obesity is an escalating health problem among Veterans that is associated with increased risk of chronic disease, disability and early mortality rates. Obese Veterans with co-existing mental illness experience greater difficulties with weight management in comparison to those without mental illness. Psychological variables create barriers to engagement and maintenance of obesity self-care habits. Decreased symptoms of depression and anxiety have been associated with successful weight management which in turn can lead to improved health status. Despite the high coexistence rates and evidence linking improvements in mental health symptoms to improved engagement and maintenance of appropriate weight management, most obesity self-care interventions provide minimal to no attention to improving co-existing anxiety and depression symptoms. The proposed research projects will: (1) examine psychological barriers to participation, adherence and outcomes of an evidenced based weight management program (MOVE!) and (2) integrate depression and anxiety treatment into MOVE! to improve retention rates, adherence and subsequent weight loss. My previous research, clinical and mentorship experiences make me uniquely poised to conduct this study. Candidate's immediate and long-term career goals: My overall career aim is to establish myself as an independent rehabilitation researcher with expertise in weight management among obese Veterans with co-existing mental illnesses. My short term career goals include securing a RR&D CDA-2 award that will provide the needed protected time and clinical, mentoring and research experiences to advance develop into an independent rehabilitation researcher. My long-term research goals are to modify evidenced based weight management strategies to improve physical health outcomes, clinical practice, and policy for obese Veterans at the greatest risk for disability. Key elements of the research career development plan: I will receive additional didactic and mentorship experiences to expanding my expertise in developing and testing evidence based obesity self-care behavioral interventions, integrating mental health treatments into weight management interventions using clinical trial methodology, gaining an understanding how to integrate evidenced based weight management strategies in a VA rehabilitation care line and VA RR&D project, and secure an RR&D IIR Merit award to attain research independence. Facilities &Other Resources: I am fortunate to be a junior BCM faculty member in the department of medicine with a primary appointment in the Houston Center for Quality of Care and Utilization Studies (COE) and secondary appointment in Atheroscleorsis and Vascular Medicine and to be an MIRECC Investigator for the Michael E. DeBakey VA Medical Center. Each setting has its own unique resources that are available for my use. Some of these resources include, electronic library access, research and career development didactics and workshops, statisticians, several senior NIH and VA investigators, grant writing workshops, and a variety of software packages.
of the proposed research to Veterans'health and/or healthcare issues Successful findings and implementation of the MH MOVE! project can demonstrate clinical and economic benefits. Improved weight loss and depression management among Veterans can reduce the risk of development and increase maintenance of chronic health conditions, decrease risk for disability, and increase health related quality of life. Thus, it is essential to combine weight management and psychological treatment to improve health outcomes among Veterans at high risk for disability and poor health. Also, obese and mentally ill Veterans have more hospitalizations, prescription drugs, out-patient visits, and are absent from work. The medical expenditures related to obesity were estimated at 1.6 billion per year. Better weight management and mental health can lead to decreased medical expenses in the VA system.