Abstract
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.
Highlights
People with serious mental illnesses (SMIs) die 10–20 years earlier than the general population, primarily due to cardiovascular disease, and [1,2,3,4,5,6] obesity is one of the driving forces of cardiovascular risk in this group [7]
One intervention shown to be effective in a randomized clinical trial (RCT) is the ACHIEVE behavioral weight loss intervention for people with SMI [23]
A RCT testing the InSHAPE behavioral weight loss intervention for people with SMI showed no effects of the intervention on weight loss among people with SMI over 12 months, but found 24% of participants with SMI randomized to the intervention had both an increase of at least 50 meters on the 6 min walk physical activity measure and a 5% or greater reduction in body weight, compared to 9% of control group participants [26]
Summary
People with serious mental illnesses (SMIs) die 10–20 years earlier than the general population, primarily due to cardiovascular disease, and [1,2,3,4,5,6] obesity is one of the driving forces of cardiovascular risk in this group [7]. A 2015 review concluded that tailored behavioral weight loss interventions can lead to clinically significant weight loss in this group [22]. Spreading implementation of these evidence-based interventions to the mental health organizations that serve people with SMI is a priority for the field. One intervention shown to be effective in a randomized clinical trial (RCT) is the ACHIEVE behavioral weight loss intervention for people with SMI [23]. In this Perspective, we consider strategies for widespread implementation of ACHIEVE.
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