Obesity rates are high among people with serious mental illness, often exceeding those of the general population, particularly for women. The physical health concerns linked to obesity are also more prevalent in this group, leading to significant health problems and higher healthcare costs. Traditional weight loss programs often fail to meet the unique needs of individuals with mental illness, who may require adapted programs that address cognitive deficits and limited social and economic resources. The Melamed weight loss method, specifically the RENEW program, offers a promising approach to address these challenges
The RENEW Program: An Overview
The RENEW (Recovering Energy Through Nutrition and Exercise for Weight Loss) program is a 12-month intervention designed to promote weight loss among individuals with serious mental illness. It comprises three phases:
Intensive Phase (3 months)
Participants attend weekly three-hour sessions. These sessions focus on nutrition education, physical activity, individualized goal setting, and shared meals. A key component is the encouragement to reduce daily calorie intake by 500 calories and engage in at least 30 minutes of physical activity daily. The intervention is delivered by trained professionals such as graduate nurses, occupational therapists, or dieticians. Participants receive two meal replacements daily, with side dishes and breakfast provided by themselves.
Maintenance Phase (3 months)
The maintenance phase involves monthly three-hour meetings and weekly phone support. Meal replacements are not provided during this phase.
Intermittent Support Phase (6 months)
This final phase provides ongoing support to help participants maintain their weight loss.
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Study on RENEW Program Effectiveness
A study published in Psychiatric Services (2011) assessed the effectiveness of the first two phases of the RENEW program. The study involved individuals with serious mental illness across four mental health centers and included a randomized controlled trial comparing the RENEW program to a control group receiving treatment as usual.
Study Design and Participants
A total of 136 individuals with serious mental illness participated in the study. Participants were clients at one of four community mental health programs, with three located in the Kansas City area and one in Las Vegas. To account for the varying risks of weight gain associated with different medications, participants were stratified into three groups:
- High Risk: Taking olanzapine, clozapine, or lithium.
- Moderate Risk: Taking risperidone, chlorpromazine, quetiapine, or valproate.
- Low or No Risk: Taking molindone, ziprasidone, fluphenazine, haloperidol, or aripiprazole.
Participants from each risk group were randomly assigned to either the RENEW program or a control group. The control group received treatment as usual, including medication, case management, and voluntary participation in day programming. Participants were not restricted from attending wellness programs offered by their mental health centers.
Results
The study found that participants who completed the RENEW program (N=47) experienced significantly greater weight loss compared to the control group (N=42) at both three and six months. Specifically, the RENEW group had an average weight loss of 5.3 pounds at three months and 4.4 pounds at six months, while the control group experienced a weight gain of 0.1 pounds at three months and a weight loss of 0.9 pounds at six months (F=5.74, df=2 and 82, p=.005).
Furthermore, 32% of participants in the RENEW intervention lost more than 10 pounds, compared to only 10% in the control group. At three months, 28% of the RENEW group lost 5% of their body weight, while only 5% of the control group achieved this. Notably, 15% of RENEW participants who lost weight at three months went on to achieve 10% weight loss at six months, compared to only 2% of the control group.
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The largest weight loss observed in the RENEW group was 34.5 pounds after three months and 47 pounds after six months. However, it's important to note that some RENEW participants gained weight, with gains as high as 24.6 pounds at three months and 49.8 pounds at six months. The control group also experienced weight fluctuations, with losses up to 31.5 pounds and gains up to 24.5 pounds at three months. At six months, the largest gain in the control group was 25 pounds, and the largest loss was 44 pounds.
Key Findings and Implications
The study's results suggest that the RENEW program can be effective in achieving modest weight loss for individuals with serious mental illness. Unlike many previous studies, this trial included a significant number of participants from minority groups and addressed both nutrition and physical activity. The findings align with other studies of weight loss interventions that reported a mean loss of 4.3±5.6 pounds.
Participants in the RENEW program maintained their weight loss at six months, consistent with other studies indicating that individuals with serious mental illness can maintain weight loss for up to one year through similar programs.
Factors Influencing Treatment Responsiveness
The variability in weight loss outcomes indicates that the RENEW program's effectiveness varied among participants. Initial analyses suggested that factors such as gender, race, diagnosis, attendance at RENEW sessions, and medication-related weight gain risk were not significant predictors of treatment responsiveness. However, the small sample size may have limited the ability to detect such predictors. The type of medication used did not appear to be related to either baseline weight or weight loss, emphasizing that obesity is a concern for individuals with serious mental illness regardless of their medication status.
Limitations
One limitation of the study was the significant number of participants lost to follow-up, preventing an intent-to-treat analysis. However, the retention rate of 65% was within the range of other weight loss intervention studies with similar populations, which reported mean retention rates of 70%±17%. The higher percentage of female dropouts suggests that women may be less likely to continue with the RENEW program, potentially due to unrealistic weight loss goals or discouragement with their progress. Additionally, the intensity of the intervention, particularly the use of meal replacements, may not be feasible in all settings.
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Practical Strategies Inspired by the RENEW Program
While the RENEW program provides a structured framework, several practical strategies inspired by its principles can be adopted to support weight loss, especially for individuals over 50. Here are some key recommendations:
Dietary Adjustments
- Increase Fruit and Vegetable Intake: Focus on consuming more fruits and vegetables, which are low in calories but rich in essential vitamins, minerals, and fiber. Fiber promotes satiety, helping to manage hunger between meals.
- Incorporate Beans and Legumes: Beans are packed with fiber and protein, promoting gut health and aiding in weight loss.
- Reduce Sugar Consumption: Avoid sugary drinks and foods, which provide empty calories without satisfying appetite.
- Choose Whole Grains: Opt for whole grains over refined grains to burn more calories and excrete more fat.
Exercise and Physical Activity
- Mix Up Workouts: Combine aerobic exercise and resistance training to reduce body fat and build muscle.
- Incorporate Yoga: Practice yoga to enhance mobility and promote relaxation, which can be beneficial for weight management.
Mindful Eating Habits
- Focus on Food: Practice mindful eating by plating food, sitting down, and chewing slowly to enjoy each bite.
- Track Food Intake: Keep a food diary or use a tracking app to increase awareness of food choices and portion sizes.
- Eat When Hungry, Stop When Satisfied: Pay attention to hunger cues and stop eating when you're no longer hungry, not just when you're full.
Lifestyle Adjustments
- Prioritize Sleep: Adequate sleep is essential for regulating hormones that control appetite and metabolism.
- Manage Stress: Implement stress-reduction techniques to avoid emotional eating and promote overall well-being.
Medical Considerations
- Review Medications: Consult with a healthcare provider to review medications that may contribute to weight gain.
The Role of Probiotics: H2 Biotics
In addition to diet and exercise, maintaining a healthy gut microbiome can play a significant role in weight loss. H2 Biotics is a probiotic supplement specifically formulated to support weight loss by restoring beneficial gut bacteria needed for proper digestion.
What are Probiotics?
Probiotics are live bacteria that thrive in the gut and support the immune system. They promote good digestion, which is crucial when starting a new diet or introducing new foods. Some probiotics also support oral health and sinus health. Antibiotics and other medications can kill beneficial gut bacteria, making probiotic supplements essential for restoring gut health.
H2 Biotics: A Superior Probiotic Formula
H2 Biotics contains 37.5 billion live cells and is designed to target obesity by providing live strains of bacteria specifically for weight loss. It is intended to be used in conjunction with a healthy diet and exercise program to optimize nutrition and maintain optimal gut health.