Recognizing the Weight of Apathy and Level of Readiness to Change in Evaluating Feasibility of a Weight Management Program for Individuals with a Severe Mental Illness

Background: Individuals with a severe mental illness (SMI) have obesity rates that are nearly double the levels of those of the general population. Individuals with SMI have health disparities that have additional physical, behavioral, social, and medication-related risk factors. Weight management efforts are affected by altered levels of motivation and apathy. Aims: This compendium seeks to (1) clarify the definition of clinical apathy, (2) compare and contrast available instruments measuring readiness to lose weight, and (3) explore the feasibility of an adapted, theory-based weight loss program for overweight and obese individuals with SMI. Design: This compendium is comprised of a concept analysis of apathy, an integrative review of instruments measuring readiness to lose weight, and a randomized controlled feasibility trial of an adapted weight management program. Findings: Attributes of apathy included lack of motivation, initiative, and interest. Antecedents included psychiatric disorders and medical comorbidities such as diabetes mellitus. Eleven instruments measuring readiness to lose weight were compared and contrasted in the integrative review. Instruments can be utilized for various settings and purposes, though a lack of generalizability was found. Ten participants were recruited in the feasibility study. The attrition rate for these 10 patients was 60%. Conclusion: Apathy is an independent clinical syndrome and a psychological factor predicting more inactive approaches to weight management. Nurses have available instruments to measure readiness to lose weight pending on purpose. Pilot study did not demonstrate feasibility to conduct the adapted weight loss program with individuals with SMI in the tested setting. Several additional adaptations are needed for successful future implementation