Bringing an effective behavioral weight loss intervention for people with serious mental to scale
- 1Bloomberg School of Public Health, Johns Hopkins, United States
- 2Division of General Internal Medicine, Johns Hopkins Medicine, United States
- 3Towson University, United States
- 4Sheppard Pratt Health System, United States
- 5Kaiser Permanente Division of Research, United States
People with serious mental illnesses (SMIs) die 10-20 years earlier than the general population, mainly due to cardiovascular disease. Obesity is a key driver of cardiovascular risk in this group. Because behavioral weight loss interventions tailored to the needs of people with SMI have been shown to lead to clinically significant weight loss, achieving widespread implementation of these interventions is a public health priority. In this Perspective, we consider strategies for scaling the ACHIEVE behavioral weight loss intervention for people with SMI, shown to be effective in a randomized clinical trial (RCT), to mental health programs in the U.S. and internationally. Given the barriers to high-fidelity implementation of the complex, multi-component ACHIEVE intervention in often under-resourced mental health programs, we posit that substantial additional work is needed to realize the full public health potential of this intervention for people with SMI. We discuss considerations for successful “scale-up,” or efforts to expand ACHIEVE to similar settings and populations as those included in the RCT, and “scale-out,” or efforts to expand the intervention to different mental health program settings/sub-populations with SMI. For both, we focus on considerations related (1) intervention adaptation and (2) implementation strategy development, highlighting four key domains of implementation strategies that we believe need to be developed and tested: staff capacity building, leadership engagement, organizational change, and policy strategies. We conclude with discussion of the types of future research needed to support ACHIEVE scale-up/out, including hybrid trial designs testing the effectiveness of intervention adaptations and/or implementations strategies.
Keywords: Exercise, Diet, Obesity, Weight Loss, Serious mental health conditions
Received: 31 Aug 2018;
Accepted: 29 Oct 2018.
Edited by:Andrea Fiorillo, Università degli Studi della Campania "Luigi Vanvitelli" Naples, Italy
Reviewed by:Karl Bechter, Universität Ulm, Germany
Michael Stephan, Hannover Medical School, Germany
Copyright: © 2018 McGinty, Gudzune, Dalcin, Jerome, Dickerson, Gennusa, Goldsholl, Yong and Daumit. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dr. Gail Daumit, Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, United States, firstname.lastname@example.org