Health Improvement programs – what works what doesn’t

By David Joel Miller.

Have you seen any shortage of weight loss programs?

Not from what I can see. Weight loss especially quick weight loss and get in shape fast programs are everywhere. In the vast literature of “self-improvement,” weight loss and fitness is king. Some programs work, at least a little. Many do not, especial in the long run.

SAMHSA recently looked at health improvement programs targeted towards the mentally ill. It is especially difficult for people on psychiatric meds to maintain or reduce their weight. Fitness is a goal that eludes many mentally ill. Psychiatric meds pack on the pounds or demolish the appetite and result in severe weight loss. There seems to be no middle ground.

So what worked and what did not?

Short-term improvement programs did not work!

The longer the program the better! We have all heard about quick weight loss programs. A very few really do take some weight off quickly in time for that reunion. The problem with quick weight loss programs is that the weight comes right back on a, d usually brings some of its friends. The net result – you weigh more after the crash diet than before.

For long-term permanent weight loss, even weight management to stabilize weight, six months was a minimum time. The longer the length of time in the program the more effective it was.

Wellness education by itself did not work!

Reading books and taking classes do not work unless coupled with a set of activates that produce the desired results. Having a guide or a partner who does the activities with you is much more effective that listening to a teacher tell you how to do something healthy and then having to do the activity on your own.

Diet alone rarely works.

Programs that include diet or improved nutrition were only effective when they also included an increase in activities. Conversely an increase in activity is often offset when the increase in appetite which makes you hungry and you eat more. It takes both an increase in activity and a reduction in food intact to result in significant weight loss.

Interestingly though, people who increased their activity and exercised more, had improved health even when they did not diet and lost no weight.

Conclusions about health improvements programs for the mentally ill.

While these are important ideas for everyone, they are especially important to those with mental illnesses. More than 42% of adults with serious mental illness are obese. Over 80 % of those with schizophrenia do not physically exercise despite the fact the anti-psychotics are notorious for causing weight gain. Research suggests that as little as a 5% weight loss improves health.

It is important to reiterate that more than half of all the cigarettes smoked in America are consumed by someone with a mental health or substance abuse disorder. There has been some research that suggests that nicotine is soothing to those with emotional problems. Anyone who has worked in the mental health field learns to identify the person with psychosis by the scent of tobacco even before they see the client. People with psychosis often are two and three packs per day smokers. Even if nicotine may have an effect on some of the brains receptors and make people with psychosis feel better I remain concerned about the poisonous effects of nicotine. Additionally anything on fire is likely to cause damage to body when sucked into the lungs.

A healthy lifestyle for someone with a mental illness should include not just weight loss but an improved activity level and other lifestyle changes that result in a healthier life. Those changes are more likely to be effective when the health improvement program includes others as active participants, continues over a long time frame and involves exercise, diet and improved lifestyle choices.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog there is also a Facebook authors page, in its infancy, up under David Joel Miller. Posts to the books, trainings and classes category will tell you about those activities. If you are in the Fresno California area information about my private practice is at Thanks to all who read this blog.


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