Narut Pakunwanich

Commentary on summer internship

Obesity and mental health: Pilot survey findings from ‘A Weight off Your Mind’

Image 1: The A Weight off Your Mind Logo

An opportunity

An email pops into the inbox, it’s from Dr Jennifer Logue, to whom I have gained much under her research tutelage. She tells me of this fantastic internship opportunity at Teesside University.  After applying, I was most ecstatic to hear back from Dr Giles that I was actually invited for an interview!

The interview went well, and I felt a very strong connection when talking to Jo and Emma. I felt that we were on a similar wavelength, a sort of academic ‘vibing’ so to speak. This was particularly important to me as it is imperative in research that a student has good compatibility with their respective research supervisors. Either way, at the end of the day, I was sent an offer – which I confirmed instantaneously!

During the upcoming week I read into the project so we could hit the ground running. The welcome session was very heart warming, and I felt most at home when Emma said ‘welcome to the crazy team’.  We got on very well from the beginning and I felt extremely supported and guided in the first week to be able to engage in the project fully in the following weeks. The reason I applied for the internship was to learn as much as possible and do as much as possible – to build my research career.

The project

People with mental health and/or learning disabilities are significantly more likely to have obesity. As obesity causes significant health problems, weight management in these groups is important. A confidential inquiry identified significantly poorer health outcomes for people with intellectual disability than the general population, leading to increased disease and death¹.  There are significant links between intellectual disability and mental health – often termed the ‘dual diagnosis phenomenon’^2-4, and this link can be made worse by the impact of obesity on physical and mental health. People with mental health conditions without the intellectual disability also suffer from significant poverty, social exclusion and health inequalities⁵.

Recently, a report by Public Health England, ‘Excess weight and COVID-19’, identified the disproportional effects of weight gain in individuals living with Serious Mental Illnesses (SMI), with the prevalence of obesity being double than the average patient in adults aged 15-74⁸. Serious mental illnesses (SMIs) are conditions with an aspect of emotional, mental or behavioural disorder, which results in significant functional impairment in one or more life activities. Some of the most common are schizophrenia, bipolar disorder, major depression or post-traumatic stress disorder. The SMI population has always been more vulnerable to weight gain due to, among other things, the obesogenic effects of antipsychotics, marginalised socioeconomic conditions and the interference of mental health on weight monitoring⁷.

During their inpatient stay, a pathway called the nutrition and body mass index person centred clinical link pathway (NBMI CLiP) is used to help with patient weight management. This is part of a much wider intervention in the North East called ‘A Weight off Your Mind’.  In this study, we surveyed staff on their attitudes towards the pathway and what they found to be barriers and facilitators in implementation and any recommendations for improvement.

In this pilot survey we obtained 15 responses. Participants were primarily female (86.7%) and Registered Nurses (73.3%). Only 35.7% found it easy or very easy to use the NBMI CLiP and only 42.9% strongly agreed they understood it. The SANSI (the BMI screening tool) was most positively rated with 80% rating confident or very confident in using it, and 73.3% of staff found this the most useful element of the NBMI CLiP. Statistically speaking, staff were 28 times more likely to rate the training as ‘good’ if they were given face-to-face training. For future training in the NBMI CLiP, results suggest having a named ward dietitian as a trainer means it is 33 times more likely that staff will find it easy to use the NBMI CLiP and 15 times more likely to understand it. These are important findings for recommending training models in the intervention.

The Nutrition and BMI Clinical Link Pathway Algorithm

Learning from the internship

Overall, the most valuable thing that I gained during my internship is the massive amount of knowledge I accumulated and the immeasurable enjoyment I experienced from working with Jo and Emma – two of the most inspiring and respectable researchers I’ve ever had the pleasure and privilege of learning from. Every meeting was exciting, and the continuous honest encouragement was absolutely fantastic. I thank both my supervisors and NIHR SPHR for this fantastic experience! To this day, we still keep in regular contact and correspondence to ensure the continuation of our research project and to continue nurturing its output and dissemination. May we continue to collaborate, to dedicate ourselves, to advocate for change: for a fairer, healthier, happier society.

A supervisor view

“We were very fortunate to be funded by ummer of 2020. The project was linked to an ongoing collaborative relationship between Teesside University and Tees, Esk, and Wear Valleys NHS Foundation Trust. We were pleased to welcome Narut to the project in July 2020, and were blown away with Narut’s interest in the project. Through early discussions we learned that during Narut’s medical school teaching, obesity, as a chronic disease, was only minimally touched upon, especially in the disabilities and psychiatric contexts. However, given that obesity affected 28.7% of adults in England in 2017⁹, it is likely to be a condition that Narut will see often in his future as a practicing medic. Furthermore, obesity prevalence in those with severe mental illness can be as high as 80% for those in mental health units¹⁰.

Overall, Narut was an exceptional student intern. Not only was his medical background complementary to our expertise – behaviour change and dietetics – but his enthusiasm to learn about all aspects of research was exceptional. By interrogating the data in a number of ways, he was able to highlight further areas for research. Indeed, Narut outlined some of these areas in a webinar, and is finalising an editorial, in the area of COVID-19 and its impact on those with SMI and obesity. We would like to thank Narut and SPHR for the opportunity; long may our research collaboration with Narut last!”

References

1. Heslop P, Blair PS, Fleming P, Hoghton M, Marriott A, Russ L. The Confidential Inquiry into premature deaths of people with intellectual disabilities in the UK: a population-based study. Lancet [Internet]. 2014;383(9920):889–95. Available from: http://www.sciencedirect.com/science/article/pii/S0140673613620267
2. Surjus LT de L e S, Campos RTO. Interface between intellectual disability and mental health: hermeneutic review. Rev Saude Publica [Internet]. 2014 Jun;48(3):532–40. Available from: https://pubmed.ncbi.nlm.nih.gov/25119948
3. Martorell A, Gutierrez-Recacha P, Irazabal M, Marsa F, Garcia M. Family impact in intellectual disability, severe mental health disorders and mental health disorders in ID. A comparison. Res Dev Disabil. 2011;32(6):2847–52.
4. Hogan AJ. Social and medical models of disability and mental health: evolution and renewal. CMAJ [Internet]. 2019 Jan 7;191(1):E16–8. Available from: https://pubmed.ncbi.nlm.nih.gov/31009368
5. Krishnan L. Social Exclusion, Mental Health, Disadvantage and Injustice. Psychol Dev Soc. 2015 Sep 1;27:155–73.
6. McAllister A, Fritzell S, Almroth M, Harber-Aschan L, Larsson S, Burström B. How do macro-level structural determinants affect inequalities in mental health? – a systematic review of the literature. Int J Equity Health [Internet]. 2018 Dec 6;17(1):180. Available from: https://pubmed.ncbi.nlm.nih.gov/30522502
7. Bradshaw T, Mairs H. Obesity and Serious Mental Ill Health: A Critical Review of the Literature. Healthc (Basel, Switzerland) [Internet]. 2014 Apr 1;2(2):166–82. Available from: https://pubmed.ncbi.nlm.nih.gov/27429268
8. Blackshaw J, Feeley A, Mabbs L, Niblett P, Atherton E, Elsom R, et al. Excess weight and COVID-19: insights from new evidence [Internet]. London; 2020. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907966/PHE_insight_Excess_weight_and_COVID-19__FINAL.pdf
9. Baker, C (2019) Obesity statistics. Available from: https://commonslibrary.parliament.uk/research-briefings/sn03336/#:~:text=28.7%25%20of%20adults%20in%20England,bariatric%20surgery%20and%20international%20comparisons (accessed 23^rd October 2020).
10. Day, M. and Johnson, M. (2017) Obesity in secure mental health units: A call to action. Available from: https://publichealthmatters.blog.gov.uk/2017/02/15/obesity-in-secure-mental-health-units-a-call-to-action/ (accessed 23^rd October 2020).