Nutrition and Exercise for Wellness and Recovery

Obesity is a major public health concern in the United States with over one-third of adults (35.7%) in the United States identified as obese (Ogden et al, 2012). The rates of obesity for individuals in recovery appear to be even higher with one study finding rates of 50% for women and 41% for men (Dickerson et al, 2006). Obesity is associated with many health conditions such as cardiovascular disease, diabetes, and arthritis; however, these common health concerns can be prevented or better managed with lifestyle changes in nutrition and physical activity (Bartels & Desilets, 2012).This article provides information about development, content, and access to the Nutrition and Exercise for Wellness and Recovery (NEW-R) curriculum, an eight week weight management and wellness class designed specifically to meet the needs of people in recovery.

A multi-disciplinary team (including people in recovery) worked in collaboration with the University of Illinois at Chicago’s Center on Psychiatric Disability and Co-Occurring Medical Conditions (funded by NIDRR and CMHS) to revise the evidence-based RENEW weight loss program. The team designs a curriculum that is applicable in diverse, real-world settings to provide wellness services for people in recovery. The process of developing the NEW-R curriculum involved identifying the most successful components of RENEW and incorporating strategies and input from national experts with experience in weight management and wellness. The topics addressed in the NEW-R classes include:

• I can make a change
• ABCs of healthier eating
• Reading food labels and portion control
• Let’s get moving
• Eating out
• Meal planning and thrifty shopping
• Let’s get cooking without all the fat
• Celebrating accomplishments and keeping up the good work

The curriculum guides participants through interactive learning experiences and enhances motivation by focusing on small, manageable changes that can result in big success. In addition to a participant manual, a step-by-step leader manual includes general principles for implementation along with learning objectives, a list of materials, discussion questions, and learning activities for each session. A popular component of the manuals is testimonials from peers who are meeting their goals for wellness.

A study of 89 individuals in the RENEW program found that at the end of three months the intervention group lost an average of 5.4 pounds and maintained this weight loss over a six month time period (Brown, Goetz & Hamera, 2011). Many individuals in the intervention lost more than 20 pounds. Last fall a team of eight Occupational Therapy students from Midwestern University facilitated NEW-R at Recovery Innovation in Phoenix. Testimonials from participants include:

“I lost weight and felt healthier. I felt not so much pain because of the exercise work we did that helped loosen up my muscles and joints and it helped me to just get motivated.”

“I read labels when I go to the grocery store. I am very careful what to eat and where to eat when I go out. When I go to restaurants I look at my calorie book.”

Perhaps the best summation comes from Recovery Services Administrator Michael Zeeb who stated, “A wonderful thing about the people involved in the NEW-R course at Recovery Innovations was the way there was no division between the Midwestern University students/faculty and the people who work and receive services at Wellness City. Though the focus of the class was to inspire positive health and weight loss outcomes in people who have experienced mental health challenges, they were just people in the class. No one was the expert. Everyone was the expert on him or herself. Everyone did some teaching and some learning. Everyone gave and received support and encouragement. Everyone laughed, and on graduation day I think almost everyone did a really cool aerobic line dance.”

References:
Bartels, S., & Desilets, R. Health Promotion Programs for People with Serious Mental Illness (Prepared by the Dartmouth Health Promotion Research Team). Washington, D.C. SAMHSA-HRSA Center for Integrated Health Solutions (2012).
Brown, C., Goetz, J. & Hamera, E. Weight Loss Intervention for People with Serious Mental Illness: A randomized controlled trial of the RENEW program. Psychiatric Services, 62, 800-803 (2011).
Dickerson, F.B., Brown, C. H., Dreyenbuhl, J. A., Fang., L.,Goldberg, R. W., Wohlheiter, K., & Dixon, L. B. Acta Psychiatrica Scandinavica,113, 306-313 (2006).
Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. Prevalence of Obesity in the United States 2009-2010, NCHS Data Brief, 82. Hyattsville, MD: National Center for Health Statistics (2012).

About the authors:
Catana Brown is an Associate Professor at Midwestern University, Glendale
Judith Cook and Jessica Jonikas are at University of Illinois at Chicago’s Center on Psychiatric Disability and Co-Occurring Medical Conditions
Michael Zeeb is at Recovery Innovations in Phoenix, and Jeannine Goetz is at the University of Kansas Medical Center