Wearable devices and mobile technologies for supporting behavioral weight loss among people with serious mental illness

Abstract

Promoting physical activity is essential for addressing elevated cardiovascular risk and high obesity rates affecting people with serious mental illness. Numerous challenges interfere with exercise participation in this high-risk group including mental health symptoms, low motivation, and limited access to safe and affordable options for physical activity. Wearable devices and mobile health technologies may afford new opportunities for promoting physical activity and supporting behavioral weight loss efforts. This exploratory study examined whether daily step count measured using Fitbit wearable devices was associated with weight loss and improved fitness among individuals with serious mental illness enrolled in a 6-month lifestyle program. Participants (n=34) had a schizophrenia spectrum disorder (23.5%), major depression (50.0%), or bipolar disorder (26.5%), and wore Fitbits most of the days (M=86.2%; SD=18.4%) they were enrolled in the study. At 6-months, higher average daily step count was associated with greater weight loss (F=5.07; df=1,32; p=0.0314), but not improved fitness (F=1.92; df=1,31; p=0.176). These findings demonstrate that encouraging participants with serious mental illness enrolled in lifestyle interventions to collect more steps may contribute to greater weight loss. This suggests that wearable devices may offer a feasible and potentially effective strategy for supporting behavioral weight loss in community mental health settings.

Mobile Apps for the Management of Comorbid Overweight/Obesity and Depression/Anxiety: A Systematic Review

“…Another study included people with no clinical diagnosis of mental disorder but with psychological distress. e studies by Williams et al [44], Ma et al [45], and their colleagues included patients with clinically significant depression, the studies by Naslund and colleagues [46,47] included patients with diagnoses of severe mental health illness (i.e., schizophrenia, bipolar disorder, major depressive disorder), and the study by Levinson and colleagues [48] included exclusively patients with eating disorders. Actual sample sizes ranged from 10 (pilot study with patients with severe mental illness recruited from one community mental health centre) to 219 (randomized control trial including people with psychological distress recruited by advertisements in local newspapers from three Finnish cities).…”

“…Regarding the use of mobile apps, the studies by Ma et al [45], Naslund et al [46,47], and their colleagues included apps to monitor physical activity alone or with dietary intake: MyFitnessPal, Fitbit, and Nike FuelBan; the last two were designed to synchronize with their corresponding physical devices. e study by Levinson and colleagues [48] described a mobile app aiming at keeping track of not only comportments but also cognitions and emotions in relation to eating disorders, behaviours, and anxiety.…”

“…Regarding the studies' main outcomes, Naslund and colleagues [47] found patients with severe mental illnesses to be highly satisfied and motivated with the use of a mobile app to improve their physical activity and even their social interactions. Levinson and colleagues [48] identified some cognitions (e.g., worry about gaining weight) that could predict higher anxiety before, during, and after the meal and eating disorder pathology.…”

“…Regarding interventional designs, Järvelä-Reijonen and colleagues [49] reported benefits of Acceptance and Commitment therapy on eating behaviours in people with psychological distress; for instance, increment in eating for physical rather than emotional reasons and decrement in uncontrolled eating and using food as a reward. Also, Naslund and colleagues [47] reported that their lifestyle behavioural intervention on patients with severe mental illness increased physical activity (i.e., step count) and weight loss, although not fitness. Altazan and colleagues [50] found in the group of pregnant women an association between higher weight gain and worse mood and an increment of depressive symptoms over time; yet, regarding the SmartMoms intervention, no significant effects were found on mood and quality of life.…”

“…Although not initially considered, it is worth to mention some features regarding the quality of the designs. e two studies by Naslund and colleagues [46,47] and the one by Levinson and colleagues [48] were neither randomized nor blinded. Although the other four studies [44,45,49,50] were randomized controlled trials, only the study by Ma and colleagues [45] was blind.…”