CIHS: New Research Review of Wellness Programs

Research Review: Effective Characteristics of Wellness Programs for People with Mental Illness

The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) has completed a review of published research literature analyzing non-pharmacological wellness programs aimed at reducing obesity and improving fitness for people with serious mental illness. The review, conducted by the Dartmouth Health Promotion Research Team, found that lifestyle interventions inconsistently achieve clinically significant weight loss for overweight people with serious mental illness, and that programs that last at least 6 months and include education and activity-based approaches are most effective in promoting weight loss and better health.

People with serious mental illnesses are at risk of premature death, largely due to complications from untreated, preventable chronic illnesses like obesity, hypertension, diabetes, and cardiovascular disease, which are aggravated by poverty-driven health choices, like poor nutrition, lack of exercise, and smoking.

Overall, current research demonstrates that lifestyle interventions inconsistently achieve clinically significant weight loss for overweight individuals with serious mental illness. When successful, these interventions result in clinically significant weight loss for only a minority of participants. To date, it is unknown why some individuals participating in lifestyle interventions achieve significant weight loss, and others do not. However, some program characteristics (e.g., program duration and design) seem to facilitate greater success than others do. It is important to note that improving cardiorespiratory fitness has substantial health benefits, independent of weight loss.

Obesity and sedentary behavior are major risk factors for cardiovascular disease, diabetes, and reduced life expectancy. More than 42% of adults with serious mental illness are obese, and fewer than 20% of people with schizophrenia exercise regularly. 

Weight loss and fitness interventions improve health outcomes and longevity, and a mere 5% weight loss for individuals who are overweight or obese is considered clinically significant and results in reduced risk factors for metabolic disorders and cardiovascular disease. In addition, improving cardiorespiratory fitness by just one metabolic equivalent per day is associated with a 10-17% reduced mortality risk, independent of weight loss.

A limited but growing number of behavioral health settings provide services that actively engage consumers in integrated health promotion, including agencies involved in the SAMHSA Primary and Behavioral Health Care Integration Program for which CIHS provides ongoing support. This research review will help them tailor effective approaches.

Access the full research review, Health Promotion Programs for People with Serious Mental Illness: What Works?, and check out a recent webinar on the research review.