Health Professional's Guide to Treatment of Overweight and Obesity

Weight loss interventions can also be tailored to patients or clients with seri-

ous mental illnesses who may not be able to participate in traditionally delivered interventions. Rates of obesity are high among people with serious mental illnesses, and many medications traditionally prescribed for serious mental illnesses have weight gain as a side effect. Furthermore, cardiovascular disease, a consequence of obesity, is a leading cause of death in this population, thus highlighting the need for effective weight-management interventions for this group. Interventions can be modified for this patient or client population to accomnodate cognitive deficits as well as barriers to healthy eating and physical activity.117

Interventions that are

longer in duration; that target deficits in motivation, memory, and executive func- tion; and that include group exercise sessions have been shown to be effective for this population.117,118

Delivery Modality

Generally, CBT and ABT interventions are delivered in a weekly, in-person format, and there is some indication that group-based interventions may be more effec- tive than individual treatment.119

Alternative modalities have also been explored.

In particular, technology-based weight-management interventions have garnered much attention among researchers in recent years (refer to Chapter 17). Because in-person treatment sessions can be burdensome to patients or clients in that they require time, means of transportation, and proximity to programs and centers, interventions delivered via the internet or smartphone applications (eHealth interventions) have been developed to address these barriers. The amount of interaction of patients or clients with each other (in the case of group-based inter- ventions) and with practitioners varies in eHealth interventions. A meta-analysis published in 2019 suggests that eHealth interventions are effective at producing clinically significant weight loss, but the amount of weight lost is less than with in-person interventions.120

High heterogeneity between eHealth intervention trials

suggests that more research is needed to identify intervention components that are associated with positive outcomes. Some components of eHealth interventions that have been shown to improve outcomes are financial incentives,121 engagement with treatment materials,122

frequent and support from practitioners with per-

sonalized feedback.123,124 ABT interventions are typically delivered via in-person groups, but some

researchers are investigating remotely delivered ABT. Although eHealth ABT inter- ventions have not been extensively studied, results from one trial indicated that an online, guided, self-help, ABT-based program achieved significant improvements in healthy eating, psychological inflexibility, and weight self-stigma, but not in phys- ical activity.125

More research is warranted. Another intriguing alternative method

for delivering ABT-based interventions is through relatively brief, in-person work- shops. Some evidence suggests that these types of workshops can increase par- ticipants’ level of physical activity and satisfaction with their bodies in as little as one 4-hour session, and participants also showed decreases in internalized weight stigma and food dependence. Although ABT workshop interventions have not been shown to improve weight loss outcomes, the other benefits make them a promising area of future research.47,126

246 SECTION 3: Interventions for the Treatment of Overweight and Obesity

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