Access to weight loss counseling services among patients with bipolar disorder

VA Ann Arbor Health Services Research and Development Center of Excellence, Ann Arbor, MI, USA.
Journal of Affective Disorders (Impact Factor: 3.38). 04/2010; 126(1-2):75-9. DOI: 10.1016/j.jad.2010.02.138
Source: PubMed


Cardiovascular disease is the leading cause of mortality in persons with bipolar disorder but little is known about utilization of services for risk reduction. We assessed determinants of access to weight counseling in a sample of patients with bipolar disorder.
Patients enrolled in the Continuous Improvement for Veterans in Care: Mood Disorders (CIVIC-MD), a prospective study conducted from July 2004-July 2006. Patient data were obtained from a baseline questionnaire and chart review.
Out of 298 patients, 73% received some weight counseling, with utilization more likely for those with higher BMI (OR = 1.12, p < 0.001) or prescribed a second generation antipsychotic (SGA) (OR = 1.80, p = 0.05). About 41% received 2 > or = dietary consultations with consults more likely for those reporting illicit substance use (OR = 1.9, p < 0.05) or SGA treatment (OR = 2.4, p < 0.05). In approximately 25% of patients, increased BMI (OR = 1.06, p = 0.04) and SGA treatment (OR = 2.13, p = 0.04) were associated with greater likelihood of receiving > or = 2 exercise consultations. Zero-inflated Poisson regression found SGA treatment was associated with more diet consultations (beta = 35, p < 0.05) while SGA treatment (beta=29, p<0.05) and women (beta=76, p<0.001) were associated with more exercise consultations. Illicit substance use (beta = -0.36, p < 0.05), binge drinking (beta = 32, p < 0.05) and other ethnicity (beta = -0.57, p < 0.05) were associated with fewer exercise consults.
Single-site study and limited chart detail.
The majority of patients received some weight counseling, with obesity and SGA predicting service use over time. However, low utilization patterns underscore the need for research into determinants of long-term counseling utilization to improve patient health outcomes.

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    • "Obesity is strongly associated with CVD risk (Whitlock et al., 2009) and current findings underscore the need for health promotion efforts for patients with bipolar disorder in order to reduce weight and the onset of CVD morbidity. For example, one prospective study of patients with bipolar disorder found obese patients prescribed psychotropic drugs associated with weight gain received more exercise counseling and/or dietary consultations, yet overweight patients were less likely to receive preventive counseling (Goodrich et al., 2010). "
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