Access to weight loss counseling services among patients with bipolar disorder

Abstract 

Background

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.

Methods

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.

Results

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≥ 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 ≥ 2 exercise consultations. Zero-inflated Poisson regression found SGA treatment was associated with more diet consultations (β=35, p<0.05) while SGA treatment (β=29, p<0.05) and women (β=76, p<0.001) were associated with more exercise consultations. Illicit substance use (β=−0.36, p<0.05), binge drinking (β=32, p<0.05) and other ethnicity (β=−0.57, p<0.05) were associated with fewer exercise consults.

Limitations

Single-site study and limited chart detail.

Conclusion

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.

Keywords: Bipolar disorder, Weight loss, Physical activity, Nutritional counseling, Atypical, Antipsychotics, Service access