Abstract P115: Effect of an Environmental Intervention on the Nutrient Content of Food Served at Psychiatric Rehabilitation Centers: Results From the ACHIEVE Trial

Abstract

Introduction: Institutions that serve on-site meals provide an unrealized opportunity to improve health on a broad scale, especially for underserved populations. Psychiatric rehabilitation programs commonly serve meals to adults with serious mental illness (SMI; schizophrenia and bipolar disorder), a population with a markedly increased prevalence of obesity and high risk of cardiovascular disease mortality. In the context of a behavioral weight-loss trial incorporating weight management counseling for persons with SMI, we delivered an environmental-level intervention, focused on the food environment. Hypothesis: We hypothesized the environmental intervention would reduce the overall calories served at the psychiatric rehabilitation program study sites. Methods: We partnered with kitchen supervisors to reduce calories and improve the nutritional quality of meals served at psychiatric rehabilitation programs. Intervention staff met with kitchen staff at the beginning and followed up quarterly to assess progress and to reinforce key nutritional messages. Environmental interventions included decreasing sugar sweetened beverages, increasing whole grains, and reducing saturated fat in meals. Breakfast and lunch menus were collected at baseline and 18 months after intervention. We calculated mean (SD) total energy and nutrient content of each meal. Results: Ten psychiatric rehabilitation programs participated. Eight sites served breakfast and all sites served lunch. Compared to baseline, average breakfast calories decreased significantly after 18-months from 568.4 to 457.1 (p=0.0048) and average lunch calories decreased from 729.4 to 623.8 (p<0.0001). Saturated fat in breakfast decreased by 1.9g (p=0.015) and 1.8g for lunch (p=0.0061). Total sugars at breakfast decreased from 53.3g to 40.1g (p=0.0008) and at lunch from 38.9g to 33.7g (p=0.004). Sodium was not significantly changed for breakfast (713.5mg to 557.3mg, p=0.148) but decreased by 412.4mg (1527.4mg to 1115.1mg, p=0.0008) for lunch. Conclusions: The environmental intervention implemented at psychiatric rehabilitation programs successfully reduced the amount of calories, saturated fat, sugars, and sodium served. This study suggests that modifying the food environment at psychiatric rehabilitation programs is feasible. Such programs can likely be applied to other institutions that serve on-site meals, and may be especially important in preventing cardiovascular disease in other underserved populations.