‘Don't just Screen, Intervene’: What are the barriers and facilitators to weight loss for people with a serious mental illness and obesity? . A systematic narrative metasynthesis
Individuals with a ‘serious mental illness’ (SMI) have increased morbidity and mortality relative to the normal population, largely due to a higher lifetime risk of cardio-metabolic disorders and are at risk of obesity due to a number of factors (medication side effects, social isolation, anhydonia).. The ‘Lester tool’ is an algorithm which has been developed to identify people with SMI’s at risk of physical health problems early, and to intervene. Screened individuals are within the ‘Red, at risk’ category of the algorithm if their BMI is >25kg/m2 (23 Chinese South Asian); recommended action is then to follow the NICE general guidelines for obesity prevention (CG43). None of the NICE guidance in this pathway cites evidence of behaviour change interventions which have been evaluated within a SMI patient population. An evidence synthesis of interventions applicable to primary care which may be offered to people with a SMI who are overweight is needed.
MESH terms (Schizophrenia, Schizophreniform disorder, schizoaffective disorder, bipolar disorder, serious mental illness, psychosis, obesity, overweight, weight loss/reduce/control/change/decrease): defined in consultation with the academic supervisory group and university systematic reviewer. Data Sources: Cochrane library, OVID - Medline, Embase, Psychinfo, CINAHL, SCOPUS, Web of science ( 1st Jan 1986 to 1st Oct 2016). Papers were hand searched for additional references. Inclusion criteria: English language, participants with a SMI and obesity, community setting, weight loss as primary outcome measure. , studies information on participants perceived factors relating to weight loss. Exclusion criteria: learning disability, cognitive impairment.The number of studies identified was small and methodologies diverse. The literature was appraised for quality using the CASP critical appraisal tool. Independent review by academic supervisor
16 publications were appraised. The studies were summarised by methodologies, critical appraisal of quality and emergent themes relating to barriers and facilitators to weight loss for people with a SMI and obesity. The most common facilitator was ‘regular support from peers or specially trained staff’. Barriers included the ‘interference of psychiatric symptoms’, lack of : ‘resources’, ‘support’, and ‘motivation to change’.
This systematic narrative metasynthesis has identified barriers and facilitators to weight loss as perceived by individuals who have a SMI and presents a taxonomy of weight loss behaviour change interventions for weight loss for people with an SMI, evaluated in primary care; unfortunately the evidence in this setting is sparse, Further research should incorporate co-production methodology to ensure that weight loss interventions for people with a SMI are acceptable within this group and applicable in