Imagine once being thin, with a job, a home, and a social life and then, because of some painful changes in the neurochemistry of your brain, becoming fat, jobless and socially isolated. The combination of your medication, which is causing you to eat excessively, coupled with your isolation from companionship normally found in work and friends, causes you to gain 75 pounds or more. Your body is now unrecognizable. You find it hard to walk, let alone do the vigorous exercise you did before getting sick. Food is the only friend you have left.
Now try going on a diet. It is usually hopeless.
Fortunately, for the very many battling both mental illness and obesity, there may be some hope that they can restore their bodies to a lower, healthier weight and become fit. In a very important study, Dr. Gail Daumit and her colleagues at Johns Hopkins University School of Medicine, carried out an 18-month study with almost 300 seriously mentally ill patients to see if a multifaceted weight-loss intervention program might be successful. All the participants received basic nutritional information, but a test group also exercised together and attended weight-management support sessions. As reported in the New England Journal of Medicine, both groups lost weight, but the group that received exercise and support lost more.
Perhaps the most important outcome of the study is that the participants no longer felt hopeless about their weight and how it changed their bodies. They learned how to make better food choices and to overcome reluctance to exercise in public. Most important, they realized that their many excess pounds could be lost.
Some years ago, when I ran a weight-management center at a Harvard University-associated hospital, a psychiatrist and I carried out a small study with about 20 mentally ill patients to see whether similar types of interventions might help them lose weight. Early on it was apparent that the tried and true formula for losing poundsâeating lots of vegetables, low-fat dairy products, whole grains and lean protein along with regular exerciseâwasnât going to work. The participants lived alone, depended on buses to get to a supermarket, had very little money and aside from some volunteer jobs, little to do outside their homes. It was hard for them to carry heavy bundles like bulky vegetables, and when the weather was warm they didnât like carrying perishables such as milk or raw chicken. It was easier for them to go to a neighborhood fast-food restaurant for their meals. And where could they exercise? When it was either very hot or very cold, they were stuck inside, and perceved that those who lived near community centers with exercise classes felt they would not be welcome if people knew they had serious mental illnesses. So they stayed home and watched television. Some had been employed at very high-level jobs before getting sick, but their lives now were empty of the work and activities that filled them previously. So our intervention, like that of Dr. Daumitâs program, included ways of helping them buy and carry home foods that were healthier than fast food. We also convinced them that they were capable of exercising. It turned out that dancing was one of the research participantâs favorite activities and, as one subject told us, âWhen I am dancing, I can close my eyes and remember what it was like before I got sick.â
The most important aspect to help our research subject's, we theorized, was figuring out how to decrease their social isolation. Fortunately, most of the group lived close enough to each other so they could meet on a weekend to go for a walk, attend an outdoor concert in the summer, or the movies. Some decided to go to community center exercise classes together so they would not be embarrassed by going alone. Months after our program ended, they were still getting together. Nonetheless, weight loss did not come easily and some, who were hospitalized after the program ended, gave up trying.
But as one of the volunteers in Dr. Daumitâs study said, even losing a few pounds was a victory.
Helping those who are struggling with mental illness and obesity may require a team of nutritionists, trainers, and even social workers. Indeed, perhaps Departments of Psychiatry should develop their own weight-loss programs for the very many whose substantial weight gain is a direct consequence of the medications prescribed for their illness. Dr. Daumitâs study gives us hope that such programs may work. Any victory, however small, must be acknowledged and pursued for its repetition potential.