Introduction and Rationale

1. Weight management by group interventions. The longer term outcomes at 20 months in an Irish cohort of patients with serious mental illness (SMI) Bushe C, 2 Haley C, 1 McNamara D,2Fleming McCrossan M,4 Devitt P,3, 1Letterkenny General Hospital, Donegal. 2Eli Lilly and Company Limited, Adelaide Road, Dublin, 3Tallagh Hospital, Dublin, 4Cleary House Letterkenny Weight change in cohort with consecutive 18 monthly visits SFW – Completion Rates ABSTRACT Introduction: Weight gain is commonly found in many SMI patients and is associated with most psychotropic agents. Current evidence supports behavioural approaches to prevention of weight gain and weight loss as being superior to pharmacological strategies. The group model may have inherent benefits in providing group therapy in addition to an educational component. Most current data report on short term interventions. Method: A group programme (Solutions for Wellness) designed to address weight and other cardiovascular risk factors commenced 2002 in 15 geographically diverse centres in Ireland. Each group provided open-ended access to referred SMI patients. Weekly group sessions consisted of weighing, discussion and an 8-week rotational cycle of educational topics on aspects of weight, dietary choices and lifestyle changes, designed to create long term changes to lifestyle and eating patterns. Groups were led by trained healthcare professionals. Weight, quality of life, nutrition and fitness knowledge were monitored. Results: Since May 2003, 167 patients enrolled with mean baseline weight 91.25 kg (SD 20.75). Programme completion rates were 99% at 3 months, 80% at 6 months and 37% at 12 months. There was progressive and statistically significant mean weight and BMI reduction over 18 months in those continuing to attend with no evidence of plateau. Cohort sizes beyond 18 months are small. At baseline 72% BMI >30 reducing to 45% at 18 months .Weight loss (53%) or maintenance (37%) were seen in 90% at final clinic visit. Mean weight 12 months 86 kg (SD 23.55) and 20 months 80.73 kg (SD 15.1). In 134 patients consecutively attending 6 months mean weight loss 2.33 kg. In 11 patients consecutively attending 18 months mean weight loss 10.5 kg. Mean BMI reduction at 20 months 4.68 (SD 4.35). Conclusion: SMI patients continuing to attend a weight clinic over 20 months lose weight incrementally with no evidence of plateau. Reductions in BMI are clinically significant and likely to confer longer term health benefits. The weight benefits are likely to be understated as in the absence of a control group it is not possible to estimate the probable weight gain that may have ensued without intervention. Our data support the use of open ended simple group programmes in SMI patients to manage weight and are consistent with current evidence. Average weight of 11 individuals who had at least 18 monthly weighings 99.00 97.00 95.00 93.00 91.00 89.00 87.00 Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth 1 Mth 2 Mth 3 Mth 4 Mth 5 Mth 6 Mth 7 Mth 8 Mth 9 10 11 12 13 14 15 16 17 18 98.93 98.26 96.48 96.24 95.82 95.05 95.41 94.51 93.85 93.22 93.45 91.60 89.64 89.72 88.66 88.62 88.46 87.88 Ave Sdev 33.60 34.46 33.11 32.97 32.46 31.87 32.32 32.58 34.36 35.37 34.61 35.35 33.72 32.89 30.30 29.59 27.99 26.38 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 Obs Confidence 19.85 20.36 19.56 19.49 19.18 18.83 19.1 19.25 20.3 20.9 20.46 20.89 19.93 19.44 17.9 17.49 16.54 15.59 This chart shows the start and end BMI category for the 55 clients who had at least 12 weigh sessions Weight Change over 20 months Average weights over 20 weighings (sequential observations) 94 The chart shows the clients with starting BMI categories at the back - for those clients, the number that ended the 12 weigh periods as either Obese, Overweight or Normal weights 92 90 88 Kg 86 84 82 80 Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth 1 Mth 2 Mth 3 Mth 4 Mth 5 Mth 6 Mth 7 Mth 8 Mth 9 10 11 12 13 14 15 16 17 18 19 20 91.25 90.51 89.51 88.58 88.16 87.86 87.23 85.44 85.11 84.74 85.70 86.04 85.95 87.66 88.20 87.10 87.10 87.88 86.41 80.73 Ave 20.75 20.38 20.16 19.20 19.25 19.13 19.46 20.90 21.55 22.04 22.46 23.55 25.52 25.46 24.81 25.17 24.41 26.38 25.03 15.10 Sdev 167 167 165 158 148 134 125 89 77 75 68 61 34 30 28 22 21 11 8 5 Obs 3.147 3.092 3.077 2.993 3.101 3.24 3.411 4.342 4.813 4.988 5.338 5.909 8.578 9.112 9.189 10.52 10.44 15.59 17.35 13.24 Confidence Mean BMI Change over 20 months Introduction and Rationale Average BMI over 20 weighings (sequential observations) (NB Observations reduced due to availability of height data) • Weight gain during treatments is commonly found in many patients with severe mental illness (SMI) and is found during treatment with most psychotropic agents. • Current evidence supports behavioural approaches to prevention of weight gain and to achieve weight loss as being superior to pharmacological strategies. • A number of differing types of behavioural intervention models have been trialled . These range from 1:1 nursing interventions to large groups. Some focus on weight reduction only whereas others focus on the range of cardiovascular risk factors ( diet, physical activity, smoking). • Dietary education may be important to sustain weight benefits in the longer term. • The group model may have inherent benefits in providing group therapy in addition to an educational component. • Most current data report on short term interventions and have not been able to evaluate adherence rates to long term group attendance. • This data reports on weight outcomes over 20 months in patients attending a group intervention programme. 35 34 33 Quality Of Life change - clients with recorded data for both start and end points BMI 32 31 30 84 29 82 Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth 1 Mth 2 Mth 3 Mth 4 Mth 5 Mth 6 Mth 7 Mth 8 Mth 9 10 11 12 13 14 15 16 17 18 19 20 34.30 33.97 33.57 33.31 33.06 33.35 33.07 31.73 31.77 31.75 32.11 32.40 31.61 31.70 31.93 31.20 30.88 30.27 29.91 29.62 80 Ave BMI 7.64 7.47 7.12 7.06 6.80 6.79 6.68 6.21 6.41 6.56 6.73 7.03 7.00 6.90 6.72 6.25 5.83 6.32 4.92 4.35 Sdev 78 141 141 139 134 125 112 104 78 71 69 62 55 34 30 28 22 21 11 8 5 Obs 1.261 1.233 1.184 1.195 1.192 1.257 1.283 1.379 1.49 1.549 1.676 1.859 2.352 2.469 2.49 2.614 2.492 3.733 3.408 3.809 Confidence 76 74 Categorical Weight Change at programme end 72 End weight loss - grouped by % weight loss Categorical analysis of weight loss/gain at end of trial showing skew to weight loss 70 QOL Start QOL End 70 Methodology 32 32 Obs 62 Average QOL 73.53 81.00 • A group programme (Solutions for Wellness) designed to address weight and other cardiovascular risk factors in SMI patients commenced 2002 in geographically diverse centres in Ireland. • Each group provided open-ended access to referred SMI patients. Weekly group sessions consisted of weighing, discussion and an 8-week rotational cycle of educational topics on aspects of weight, dietary choices and lifestyle changes, designed to create long term changes to lifestyle and eating patterns. Groups were led by trained healthcare professionals. Weight, quality of life, nutrition and fitness knowledge were monitored. • The programme is currently in operation in 143 sites throughout Ireland. • The original design of the programme was such that it was not planned as a long term intervention in all sites. • In some sites the programme was discontinued after 6-12 months due to factors including staff rotation. • Not all centres routinely collected any data for analysis. • Data in this analysis is reported from 15 centres in which data was collected. 60 57 50 40 CONCLUSIONS • SMI patients continuing to attend a weight clinic over 20 months lose weight incrementally with no evidence of plateau. • Patients continuing in SFW for longer had higher initial weight and BMI. • At final clinic visit 53% patients lose weight, 37% maintain original baseline weight and 10% gain weight. • Reductions in BMI are clinically significant and likely to confer longer term health benefits. The weight benefits are likely to be understated as in the absence of a control group it is not possible to estimate the probable weight gain that may have ensued without intervention. • Our data support the use of open ended simple group programmes in SMI patients to manage weight and are consistent with current evidence . • The challenge is to ensure continued long term attendance in clinics such as SFW. 30 20 20 12 10 6 4 2 1 1 1 1 0 0 -35% -30% -25% -20% -15% -10% -5% 0% +5% +10% +15% +20% Qty 1 1 2 1 6 20 57 62 12 4 0 1 BMI Categorical Changes Percentage observations in BMI categories over 20 weighings 80 70 60 Statistical Analysis 50 • As the data is derived from an audit descriptive data is presented to include mean values and standard deviations where appropriate. Spearman’s rho correlation coefficient was used to assess relationships between different variables. Statistical analyses were done using SPSS v.12 for Windows. Limitations of analysis 40 30 • This is an audit and therefore cannot give any indication of causality. The individuals were primarily self-selecting and it may be that people who entered the programme did so because they were perceived to have good motivation and an appropriate mental state, either by themselves or their clinicians. There is no information available on those who chose not to enter the programme. However, the population is drawn from diverse geographical and socio-economic areas and therefore the findings are likely to be generalisable to many other Ireland and UK areas. 20 10 0 Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth Mth 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 RESULTS Normal 6% 6% 6% 7% 6% 3% 5% 6% 4% 9% 6% 9% 9% 7% 11% 14% 14% 27% 25% 20% Overweight 23% 23% 27% 31% 33% 35% 34% 40% 44% 39% 44% 40% 47% 43% 36% 36% 33% 27% 25% 40% Obese 72% 70% 67% 63% 62% 63% 62% 54% 52% 52% 50% 51% 44% 50% 54% 50% 52% 45% 50% 40% Obs 141 141 139 134 125 112 104 78 71 69 62 55 34 30 28 22 21 11 8 5 Summary of the Results Declaration of Interest • Results: Since May 2003, 167 patients enrolled with mean baseline weight 91.25 kg (SD 20.75). • Programme completion rates were 99% at 3 months, 80% at 6 months and 37% at 12 months. • There was progressive and statistically significant mean weight and BMI reductions over 18 months in those continuing to attend with no evidence of plateau. • Cohort sizes beyond 18 months are small. • At baseline 72% BMI >30 reducing to 45% at 18 months. • Weight loss (53%) or maintenance (37%) were seen in 90% at final clinic visit. • Mean weight 12 months 86 kg (SD 23.55) and 20 months 80.73 kg (SD 15.1). • In 134 patients consecutively attending 6 months mean weight loss 2.33 kg. • In 11 patients consecutively attending 18 months mean weight loss 10.5 kg. • Mean BMI reduction at 20 months 4.68 (SD 4.35). Weight change in cohort with 6 consecutive monthly visits • The Solution for wellness programme is funded by Eli Lilly Ireland • The poster has been written by the named authors. • Chris Bushe and Dermot McNamara are employees of Eli Lilly Ireland. Average weight of 134 individuals who had at least 6 monthly weighings 91.00 90.50 90.00 89.50 89.00 88.50 88.00 87.50 87.00 Mth 1 Mth 2 Mth 3 Mth 4 Mth 5 Mth 6 Ave 90.19 89.59 88.74 88.52 88.01 87.86 Sdev 20.00 20.18 19.82 19.74 19.46 19.13 Obs 134 134 134 134 134 134 Confidence 3.39 3.42 3.36 3.34 3.29 3.24 Supported by funding from Eli Lilly and Company