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BEHANDLING-God og treffsikker diagnostikk, behandling og rehabilitering

Mental Health and Obesity (the MHOBY study).

Awarded: NOK 0.30 mill.

Background Patients with obesity and co-existing mental disorders are typically offered traditional weight loss approaches and/or bariatric surgery or receive no treatment at all due to their mental disorder. By ignoring possible comorbid mental disorders in their diagnosis (assessment) and treatment, patients often experience a worsening of their mental and/or physical health The main objective for the pre-project was to culminate a grant application for a main project on multimorbidity (morbid obesity and mental disorders). To reach the aims of this pre-project, we divided the pre-project into different activities. The pre-project included various types of preparatory work, activities and measures needed to clarify factors that are critical to realizing the three Work Packages in the main research study. This includeed a joint framing of research problem, identifying stakeholders, mapping needs, collaboration across medical specialties, and identification of possible solutions for collaboration across health care units. The results has lead to a co-creation of recommendations for the main project. The study has had a clear clinical focus, and we have communicated results from the project in scientific and societal practice. Partners in the pre-project were chosen on the basis of their association with treatment of morbid obesity and/or mental disorders in Norway. Health care systems are characterised by "silo thinking" (independent units with their own culture), which threatens hospitals from delivering coordinated obesity treatment. This project has established collaboration across medical specialties, identified possible solutions for collaboration across health care units, developed methodology, surveyed user groups and clinicians to clarify priorities to inform the research design of the interventions in the main study. Furthermore, the project has gathered a team of clinicians and researchers from mental health services with broad experience in psychological evaluation and implementation of psychological interventions. Keynote speakers and visiting researchers have been invited to attend workshops to deliver and discuss the latest research in obesity and mental health care. Structured workshops have explored experiences with today's obesity treatment from both clinicians, researchers and user organizations. Throughout the project periods, we have been particularly concerned with a dialogue with user organizations and have been particularly concerned with what users like and dislike about today's treatment, and how these can be improved ("What matters to you?" and "What is wrong?") . We have reached our ambition and raised clinicians' awareness of key issues in patients with morbid obesity and mental illness during the project period. Parallel with development and testing of interventions, an infrastructure for collaboration between different services has been made and piloted. In order to build networks and establish collaborative relationships that form the basis for the main study, we conducted various activities. The following activities have been undertaken to prepare the main study: teaching across medical specialties, workshops, obesity conference with gathering of experience, joint assessment and evaluation of patients' progress, lectures and regular meetings with user organizations (RoS & Landsforening for Overvektige).

Prosjektgruppen har utviklet og gjennomført en pilotstudie på en skreddersydd ny type intervensjon for fedme og overspisingslidelse. Parallelt har forprosjektet foreslått og gjennomført en driftsmodell for infrastruktur for samordning av tjenester og utnyttelse av innsamlede data for pasienter med sykelig overvekt og spiseforstyrrelsen "overspisningslidelser". Modellen tenkes å være overførbar til andre psykiske lidelser som er assosiert med sykelig overvekt. Ved prosjektets oppstart manglet mekanismer for å kanalisere midler til drift fra de relevante miljøene og aktørene i prosjektet. Dette er en tydelig utfordring for koordinerte tjenester for pasientgrupper med multimorbide lidelser. Gjennomføring av pilotstudien lot seg gjennomføre fordi det ble opprettet et dedikert tverrfaglig team for denne pasientgruppen ved DPS Stjørdal. I fremtiden kan våre funn bli oversatt til evidensbasert praksis for behandlingsforløp for pasienter med sykelig fedme og samtidig psykisk uhelse.

This study is part of strategy integrating Mental Health and Obesity (the MHOBY study), aiming to provide health care services with increased knowledge about the interplay between severe or morbid obesity and mental health. MHOBY addresses the ineffectiveness of current best practice in obesity treatment. The ‘one-size-fits-all’ approach in the current treatment of obesity, largely ignore comorbid mental health issues as underlying or contributing causes of obesity. The overall goal of the pre-project is to develop an academic environment, which can develop diagnosis and treatment interventions, plan research designs and identify barriers and possibilities related to the planned research project. The target group of the study is those suffering from morbid obesity (BMI>35), and experience obesity-related health conditions, such as high blood pressure or diabetes. This condition is potentially life threatening causing subsequent loss of personal and societal function if left untreated or ineffectively treated. Although, most individuals with morbid obesity are able to lose weight, the biggest challenge is to maintain weight loss long-term. Even with the help of professionals, weight regain typically occurs when professional contact ends. By 3–5 years post treatment, about 85% of adult patients with morbid obesity have regained weight or even exceeded their pretreatment weight. If sustained in the long term, even small weight losses (5-10% of initial body weight) can have large health benefits. Therefore, treatment alternatives other than lifestyle interventions need to be developed. Hence, the strategy in this project is to take the complexity of underlying psychological factors into account, tailor new obesity treatment, and increase the effect of current ineffective obesity treatment. In the future, our findings might be translated into evidence-based routines of treatment programs for patients with morbid obesity.

Funding scheme:

BEHANDLING-God og treffsikker diagnostikk, behandling og rehabilitering