Arlene Dalcin

Johns Hopkins Medicine | JHUSOM · Department of Medicine

Background: Among people with serious mental illness (SMI), obesity contributes to increased cardiovascular disease (CVD) risk. The Achieving Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE) randomized controlled trial (RCT) demonstrated that a behavioral intervention tailored to the needs of individuals with SMI results in clinically si...

Background: Clinical trials for weight loss in cancer survivors have been shown to be safe and effective. Pragmatic approaches are needed to facilitate broader adoption. The ASPIRE study evaluates real-world, lifestyle weight loss programs in Maryland on reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) outcomes. Here we repo...

BACKGROUND Among people with serious mental illness (SMI), obesity contributes to increased cardiovascular disease (CVD) risk. The Achieving Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE) randomized controlled trial (RCT) demonstrated that a behavioral intervention tailored to the needs of individuals with SMI results in clinically sign...

BACKGROUND Motivational Interviewing (MI) is an evidence-based, patient-centered communication method shown to be effective in helping persons with serious mental illness (SMI) improve health behaviors. In clinical trials where study staff conducted lifestyle interventions incorporating an MI approach, cardiovascular disease (CVD) risk profiles of...

Background Motivational interviewing (MI) is an evidence-based, patient-centered communication method shown to be effective in helping persons with serious mental illness (SMI) to improve health behaviors. In clinical trials where study staff conducted lifestyle interventions incorporating an MI approach, cardiovascular disease (CVD) risk profiles...

BACKGROUND Tobacco smoking is highly prevalent among persons with serious mental illness (SMI) and the largest contributor to premature mortality in this population. Evidence-based smoking cessation therapy with medications and behavioral counseling is effective for persons with SMI but few receive this treatment. Mental health providers have exten...

Background: Tobacco smoking is highly prevalent among persons with serious mental illness (SMI) and is the largest contributor to premature mortality in this population. Evidence-based smoking cessation therapy with medications and behavioral counseling is effective for persons with SMI, but few receive this treatment. Mental health providers have...

Introduction: Overweight and obesity in youth with serious emotional disturbance (SED) is exceedingly common. In 2015 the AHA called attention to mental illnesses in youth as important risk conditions for early CVD and the need for transformational change in management of overweight and obesity in this group. Our objective was to test a 12-month, i...

Youth with mental illness have higher levels of obesity than children in the general population. Both regular physical activity and limited screen time have been recommended to reduce and prevent childhood obesity. This study examines accelerometer-based moderate–vigorous physical activity (MVPA) and screen time among youth with overweight/obesity...

People with serious mental illnesses (SMIs) experience excess mortality, driven in large part by high rates of cardiovascular disease (CVD), with all cardiovascular disease risk factors elevated. Interventions designed to improve the cardiovascular health of people with SMI have been shown to lead to clinically significant improvements in clinical...

Objective This study investigates predictors of weight loss among individuals with serious mental illness participating in an 18-month behavioral weight loss intervention, using Lasso regression to select the most powerful predictors. Methods Data were analyzed from the intervention group of the ACHIEVE trial, an 18-month behavioral weight loss in...

People with serious mental illness (SMI) have a 2–3-fold higher mortality than the general population, much of which is driven by largely preventable cardiovascular disease. One contributory factor is the disconnect between the behavioral and physical health care systems. New care models have sought to integrate physical health care into primary me...

Objective To compare the effect of Healthy for Two/Healthy for You (H42/H4U), a health coaching program, in prenatal care clinics that serve a racially and economically diverse population, on total gestational weight gain (GWG) (vs. usual care). We hypothesize that compared to usual prental care, intervention participants will have lower GWG and lo...

Background: Low-cost, automated interventions that increase knowledge and skills around diet and lifestyle modifications are recommended for cardiovascular disease risk reduction. Methods: We initiated a quality improvement program to assess the impact of a web-based diet and lifestyle intervention utilizing short animated videos in adults with...

Context: Higher levels of insulin-like growth factor-1 (IGF-1) are associated with increased risk of cancers and higher mortality. Therapies that reduce IGF-1 have considerable appeal as means to prevent recurrence. Design: Randomized, 3-parallel-arm controlled clinical trial. Interventions and outcomes: Cancer survivors with overweight or obe...

Background People with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder experience excess mortality driven in large part by high rates of poorly controlled and under-treated cardiovascular risk factors. In the USA, integrated “behavioral health home” models in which specialty mental health organizations coordinate and manag...

Introduction: Tobacco smoking is the largest contributor to markedly elevated CVD and preventable death in persons with SMI. Trials of combined pharmacologic and behavioral treatments improve abstinence rates, but have targeted those ready to quit right away, and evidence-based treatments are rarely used in the community. Weight gain often accompan...

Many of the most pressing health issues in the USA and worldwide require complex, multi-faceted solutions. Delivery of such solutions is often complicated by the need to reach and engage vulnerable populations facing multiple barriers to care. While the fields of quality improvement and implementation science have made valuable gains in the develop...

Importance Persons with serious mental illness have a cardiovascular disease mortality rate more than twice that of the overall population. Meaningful cardiovascular risk reduction requires targeted efforts in this population, who often have psychiatric symptoms and cognitive impairment. Objective To determine the effectiveness of an 18-month mult...

Introduction Gestational weight gain (GWG) and postpartum weight retention (PPWR) are significant, potentially modifiable, contributors to women's future weight and health trajectories. There is a need for feasible and patient‐centered (i.e., convenient, remotely‐delivered, technology‐enhanced, and accessible through the prenatal care setting) beha...

Purpose: We initiated a clinical trial to determine the proportion of breast cancer survivors achieving ≥5% weight loss using a remotely-delivered weight loss intervention (POWER-remote) or a self-directed approach, and to determine the effects of the intervention on biomarkers of cancer risk including metabolism, inflammation, and telomere length...

Background: Overweight and obesity are significant concerns for first responders (firefighters and emergency medical service providers). Objective: This pilot study examines the feasibility of a weight loss program for career first responders. Methods: Participants were career first responders with BMI≥30 and interest in losing weight. Baselin...

Use of salt substitutes containing potassium chloride is a potential strategy to reduce sodium intake, increase potassium intake, and thereby lower blood pressure and prevent the adverse consequences of high blood pressure. In this review, we describe the rationale for using potassium-enriched salt substitutes, summarize current evidence on the ben...

Background Tobacco smoking is the single largest contributor to cardiovascular disease and preventable death in persons with serious mental illness (SMI). The majority of smokers with SMI state they would like to quit. Combination pharmacotherapy and behavioral treatment increases abstinence rates in trials but has not been tested or widely used in...

Background Persons with SSD and other SMI die 10–20 years earlier than those without. Much premature death in this population is attributable to cardiovascular disease (CVD) with CVD-related mortality rates twice those of the overall population. Accordingly, this vulnerable group has a high burden of modifiable CRF including smoking, obesity, hyper...

To determine whether initial engagement, continued participation, and weight loss vary by subsidy and promotional strategies in a beneficiary‐based, commercial weight‐loss programme. We conducted a retrospective analysis of data from 2013 to 2016. Our dependent variables included initial engagement (≥1 calls; ≥2 weights), coach calls and weight cha...

Obesity presents an important public health problem that affects more than a third of the U.S. adult population and that is associated with increased morbidity, mortality, and costs. Previously, we documented that two primary care-based weight loss interventions were clinically effective. To encourage the implementation of and reimbursement for the...

Background: Weight loss programs often start with an initial phase of intensive lifestyle coaching to facilitate early weight loss, with a typical weight loss goal of ≥ 5%. While early weight loss is associated with long-term weight loss success, less is known about those who do not lose weight in the initial phase. This study examines those withou...

Background: Persons with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder have an increased risk of obesity and related chronic diseases and die 10-20years earlier than the overall population, primarily due to cardiovascular disease. In the ACHIEVE trial, a behavioural weight loss intervention led to clinically significant...

Objective: Given the high prevalence of obesity and diabetes in patients with serious mental illness (SMI) and the lack of evidence on the effects of weight loss programs in SMI patients with diabetes, we evaluated the effectiveness of a behavioral weight loss intervention among SMI participants with and without diabetes. Research design and meth...

Persons with serious mental illness (SMI) comprise a high-risk group for cardiovascular disease (CVD)-related mortality with rates at least twice those of the overall US. Potentially modifiable CVD risk behaviors (tobacco smoking, obesity, physical inactivity, unhealthy diet) and risk factors (hypertension, diabetes, dyslipidemia) are all markedly...

People with serious mental illnesses (SMIs) die 10–20 years earlier than the general population, mainly due to cardiovascular disease. Obesity is a key driver of cardiovascular risk in this group. Because behavioral weight loss interventions tailored to the needs of people with SMI have been shown to lead to clinically significant weight loss, achi...

Figure S1 . Selection of Study Sample. Figure displays process for selection of participants included in the analytic sample.

Objective Minimizing program dropout is essential for weight‐loss success, but factors that influence dropout among commercial programs are unclear. This study's objective was to determine factors associated with early dropout in a commercial weight‐loss program. Methods A retrospective analysis of a remotely delivered, employer‐based commercial p...

The aim of this study is to examine factors associated with long‐term retention in a commercial weight‐loss programme. We conducted a retrospective analysis of an employer‐based, commercial programme from 2013 to 2016. Our dependent variable was ‘long‐term retention’, defined as continuously enrolled participants who actively engaged through coach...

Background/aims: Despite widespread Internet adoption, online advertising remains an underutilized tool to recruit participants into clinical trials. Whether online advertising is a cost-effective method to enroll participants compared to other traditional forms of recruitment is not known. Methods: Recruitment for the Survivorship Promotion In...

This study examined cardiorespiratory fitness (CRF) among adults with serious mental illness (SMI) participating in group exercise classes. Overweight and obese adults with SMI were randomized to either a control condition or a weight management condition with group exercise classes (n=222). Submaximal bicycle ergometry was used to assess CRF at ba...

Objective: In the ACHIEVE randomized controlled trial, an 18-month behavioral intervention accomplished weight loss in persons with serious mental illness who attended community psychiatric rehabilitation programs. This analysis estimates costs for delivering the intervention during the study. It also estimates expected costs to implement the inte...

Background: The majority of women diagnosed with breast cancer are overweight or obese, and gain weight after diagnosis. The Practice-based Opportunities for Weight Reduction (POWER) study reported that, in an obese population with cardiovascular risk factors, a scalable remote weight loss intervention with web support was equally effective to an i...

p> Objective: We studied whether care management is a pragmatic solution for improving population blood pressure (BP) control and addressing BP disparities between Blacks and Whites in routine clinical environments. Design: Quasi-experimental, observational study. Setting and Participants: 3,964 uncontrolled hypertensive patients receiving prim...

Objective: The purpose of this study was to describe perceptions of weight loss strategies, benefits, and barriers among persons with serious mental illness who lost weight in the ACHIEVE behavioral weight loss intervention. Methods: Semistructured interviews with 20 ACHIEVE participants were conducted and analyzed using an inductive coding appr...

Objective: In the Weight Loss Maintenance (WLM) Trial, a personal contact (PC) intervention sustained greater weight loss relative to a self-directed (SD) group over 30 months. This study investigated the effects of continued intervention over an additional 30 months and overall weight change across the entire WLM Trial. Methods: WLM had 3 phase...

Background Behavioural weight loss programs are effective first-line treatments for obesity and are recommended by the US Preventive Services Task Force. Gaining an understanding of intervention components that are found helpful by different demographic groups can improve tailoring of weight loss programs. This paper examined the perceived helpfuln...

Introduction Unhealthy diets, often low in potassium, likely contribute to racial disparities in blood pressure. We tested the effectiveness of providing weekly dietary advice, assistance with selection of higher potassium grocery items, and a $30 per week food allowance on blood pressure and other outcomes in African American adults with hypertens...

To evaluate the association between the patient-provider relationship, satisfaction with primary care provider's (PCP) involvement and weight loss in a practice-based weight loss trial. POWER was a practice-based randomized controlled behavioral weight loss trial. Participants completed questionnaires about patient-provider relationship and satisfa...

Background: African Americans and persons with low income have greater exposure to poor food environments and are more likely to have deficiencies in micronutrients that lower blood pressure (BP). Objective: We conducted a 2-arm randomized trial to test the hypothesis that delivery of nutritional advice to adopt a diet rich in potassium, tailored t...

Introduction: Institutions that serve on-site meals provide an unrealized opportunity to improve health on a broad scale, especially for underserved populations. Psychiatric rehabilitation programs commonly serve meals to adults with serious mental illness (SMI; schizophrenia and bipolar disorder), a population with a markedly increased prevalence...

Objective In behavioral studies of weight loss programs, participants typically receive interventions free of charge. Understanding an individual's willingness to pay (WTP) for weight loss programs could be helpful when evaluating potential funding models. This study assessed WTP for the continuation of a weight loss program at the end of a weight...

Background Examining responders and non-responders to behavioral lifestyle interventions among overweight/obese adults with additional comorbidities may aid in refining and tailoring obesity treatment. Purpose The purpose of this study is to demonstrate the use of latent class analysis to identify patterns of response to behavioral lifestyle int...

Background: Websites and phone apps are increasingly used to track weights during weight loss interventions, yet the longitudinal accuracy of these self-reported weights is uncertain. Objective: Our goal was to compare the longitudinal accuracy of self-reported weights entered online during the course of a randomized weight loss trial to measure...

Objective To examine the behavioral processes through which lifestyle interventions impacted weight loss. Design and Methods We limited our analyses to overweight and obese Black and White adults randomized to a PREMIER lifestyle intervention (N = 501). Structural equation modeling was conducted to test the direct and indirect relationships of ses...

Introduction: Obesity is epidemic among adults with serious mental illness (SMI) (e.g., schizophrenia, bipolar disorder) and evidenced-based weight loss programs are needed for this group. We examined the association between attendance to program sessions and weight change among adults with SMI who were enrolled in a lifestyle-based weight loss tri...

AimDietary changes occurring during weight loss interventions can vary. The present study tested if pretreatment psychosocial, dietary and demographic factors were associated with changes in fat intake and fruit and vegetable intake during a weight loss intervention. Methods This analysis includes participants who lost at least four kilograms durin...

The Weight Loss Maintenance Trial tested strategies for maintenance of weight loss. Personal contact was superior to interactive technology and self-directed conditions. We aimed to identify behavioral mediators of the superior effect of personal contact vs. interactive technology and of personal contact vs. self-directed arms. Overweight/obese adu...

Background Racial disparities in blood pressure control have been well documented in the United States. Research suggests that many factors contribute to this disparity, including barriers to care at patient, clinician, healthcare system, and community levels. To date, few interventions aimed at reducing hypertension disparities have addressed fact...

Purpose: To evaluate effects of two behavioral weight-loss interventions (in-person, remote) on health-related quality of life (HRQOL) compared to a control intervention. Methods: Four hundred and fifty-one obese US adults with at least one cardiovascular risk factor completed five measures of HRQOL and depression: MOS SF-12 physical component s...

Background: Overweight and obesity are epidemic among persons with serious mental illness, yet weight-loss trials systematically exclude this vulnerable population. Lifestyle interventions require adaptation in this group because psychiatric symptoms and cognitive impairment are highly prevalent. Our objective was to determine the effectiveness of...

Objective: Cigarette smoking is the most preventable cause of disease and death in the US. We examined the prevalence of smoking and the association between smoking status and health characteristics in persons with serious mental illness. Methods: A total of 291 overweight or obese adults with serious mental illness were enrolled in a behavioral we...

The benefits of regular physical activity are particularly salient to persons with serious mental illness (SMI) who have increased prevalence of obesity, diabetes, and earlier mortality from cardiovascular disease. The Activating Consumers to Exercise through Peer Support (ACE) trial will examine the effectiveness of peer support on adherence to a...

Despite the encouraging results of behavioral weight-loss interventions in effi cacy trials, primary care providers (PCPs) have expressed a lack of confidence that proven weight management models can be implemented in a primary care setting [1]. The Practice-Based Opportunities for Weight Reduction (POWER) trial conducted at Johns Hopkins Universit...

Dietary components effective in weight maintenance efforts have not been adequately identified. To determine the effects of changes in dietary consumption on weight loss and maintenance during the Weight Loss Maintenance clinical trial. Weight Loss Maintenance was a randomized controlled trial. Successful weight loss participants who completed Phas...

Obesity and its cardiovascular complications are extremely common medical problems, but evidence on how to accomplish weight loss in clinical practice is sparse. We conducted a randomized, controlled trial to examine the effects of two behavioral weight-loss interventions in 415 obese patients with at least one cardiovascular risk factor. Participa...

Suboptimal diet may be related to the high prevalence of obesity and cardiovascular disease (CVD) in persons with serious mental illnesses, but few studies have characterized dietary intake in this population. Participants were 102 overweight/obese adults with serious mental illnesses who were being screened for a weight loss trial in psychiatric r...

To assess the effectiveness of an intervention to reduce the calorie content of meals served at two psychiatric rehabilitation programs. Intervention staff assisted kitchen staff with ways to reduce calories and improve the nutritional quality of meals. Breakfast and lunch menus were collected before and after a 6-month intervention period. ESHA so...

Overweight and obesity are highly prevalent among persons with serious mental illness. These conditions likely contribute to premature cardiovascular disease and a 20 to 30 percent shortened life expectancy in this vulnerable population. Persons with serious mental illness need effective, appropriately tailored behavioral interventions to achieve a...

Overweight and obesity are epidemic in populations with serious mental illnesses. We developed and pilot-tested a behavioral weight-loss intervention appropriately tailored for persons with serious mental disorders. We conducted a single-arm pilot study in two psychiatric rehabilitation day programs in Maryland, and enrolled 63 overweight or obese...

The Weight Loss Maintenance Trial (WLM) compared two long-term weight-maintenance interventions, a personal contact arm and an Internet arm, with a no-treatment control after an initial six-month Phase I weight loss program. The Internet arm focused on use of an interactive website for support of long-term weight maintenance. There is limited infor...

This study objectively measured physical activity levels in overweight and obese adults with severe mental illness and examined relationships among psychiatric symptoms, cognitive functioning and physical activity. A diverse sample (50% female, 50% African American) of overweight and obese adults (n=55) with mental illness were asked to wear accele...

To improve methods for long-term weight management, the Weight Loss Maintenance (WLM) trial, a four-center randomized trial, was conducted to compare alternative strategies for maintaining weight loss over a 30-month period. This paper describes methods and results for the initial 6-month weight-loss program (Phase I). Eligible adults were aged > o...

Behavioral weight loss interventions achieve short-term success, but re-gain is common. To compare 2 weight loss maintenance interventions with a self-directed control group. Two-phase trial in which 1032 overweight or obese adults (38% African American, 63% women) with hypertension, dyslipidemia, or both who had lost at least 4 kg during a 6-month...

Background: Obesity is epidemic in persons with severe mental illness (SMI), and interventions adapted to persons with SMI are needed. The ACHIEVE Study piloted a weight loss intervention tailored to persons with SMI. We examined whether baseline participant characteristics were associated with program attendance and weight loss, and hypothesized t...

The purpose of this study was to evaluate participants' perceptions of the weight-loss intervention used in a hypertension prevention clinical trial. A total of 308 overweight and moderately obese subjects participated in the weight-management intervention. After the 18-month program, 281 participants completed a questionnaire designed to evaluate...

Objective: To provide a firmer basis for preventing high blood pressure (BP), we tested interventions to promote weight loss, dietary sodium reduction, and their combination for lowering diastolic BP, systolic BP, and the incidence of hypertension during a 3- to 4-year period. Methods: We conducted a randomized, 2x2 factorial, clinical trial, with...