Highlights
- A tailored, technology-supported weight loss program incorporating peer support demonstrated promising weight reduction in veterans with serious mental illness (SMI).
- Participants receiving CoachToFit (CTF) had nearly twice the odds of achieving clinically meaningful weight loss (≥5%) compared to usual care at 6 months.
- The intervention leveraged remote monitoring tools and smartphone applications, optimizing engagement in a population with high obesity prevalence.
- The study underscores the potential scalability of paraprofessional-delivered, telehealth-facilitated lifestyle interventions in mental health care settings.
Background
Serious mental illness (SMI), including diagnoses such as schizophrenia, bipolar disorder, and major depressive disorder, affects a significant subset of the veteran population. Veterans with SMI disproportionately experience obesity and associated cardiometabolic comorbidities compared to both the general veteran and civilian populations. This excess burden contributes to shortened life expectancy and diminished quality of life. Traditional weight loss programs often underperform in this group due to psychiatric symptomatology, medication side effects, and barriers to care access, creating an urgent need for tailored intervention approaches.
Emerging evidence supports integrating behavioral weight management with mental health services using digital health solutions and peer support. However, robust randomized trial data examining efficacy and implementation in veterans remain limited. The recent trial by Chinman et al. (2025) addresses this gap by evaluating CoachToFit (CTF), a remotely delivered program combining peer specialist engagement, fitness tracking technology, and a health education app, adapted for veterans with SMI.
Key Content
Study Design and Population
Chinman et al. conducted a randomized clinical trial from 2020 to 2025 at the Pittsburgh Veterans Affairs healthcare system. The study enrolled 256 veterans with SMI diagnoses (major depressive disorder 77.7%, bipolar disorder, schizophrenia), BMI ≥30 kg/m², excluding those with recent psychiatric hospitalization or bariatric surgery history. Participants were randomized to either the CoachToFit intervention or usual care, with outcomes assessed over 6 months.
Intervention Components
The CoachToFit (CTF) program featured multiple synergistic elements:
- Weekly telephone coaching from Veteran Health Administration peer specialists familiar with SMI challenges.
- Provision of Bluetooth-enabled scales and fitness trackers enabling real-time remote monitoring of weight and physical activity.
- A smartphone application delivering tailored health education content and facilitating self-monitoring of steps, exercise goals, and weight changes.
Engagement with peer specialists aimed to enhance motivation, adherence, and address psychosocial barriers.
Primary Outcomes
The investigators measured weight (kg), BMI change, and cardiorespiratory fitness via 6-minute walk distance. At 6 months:
- The CTF group lost a mean (SD) of -3.2 (6.2) kg vs. -1.6 (4.9) kg in usual care (p=0.05), with an adjusted mean difference of -1.62 kg (95% CI: -3.38 to 0.14; P=0.07), indicating a trend toward greater weight loss.
- BMI reduction paralleled weight change: adjusted mean difference of -0.56 (95% CI: -1.15 to 0.03; P=0.06).
- Cardiorespiratory fitness improvements, measured by meters walked in 6 minutes, did not differ significantly (adjusted mean difference 3.53 m; 95% CI, -12.87 to 19.92; P=0.67).
- Clinically meaningful weight loss (≥5%) was achieved by 36.6% in CTF vs. 22.4% in usual care, representing a 1.93-fold greater likelihood (adjusted 95% CI, 0.96-3.91; P=0.07).
- Notably, ≥7% weight loss was observed in 22.6% of CTF participants vs. 8.2% in controls, a statistically significant 3.9-fold greater likelihood (95% CI, 1.45-10.36; P=0.007).
Comparison with Prior Evidence
Earlier studies have documented challenges addressing obesity in people with SMI, with meta-analyses revealing modest weight reductions from lifestyle interventions often limited by engagement and psychiatric severity. Peer support and technology-assisted interventions are increasingly recognized as promising strategies. Chinman et al.’s trial adds rigor by randomizing a real-world veteran sample and incorporating telemonitoring, confirming feasibility and encouraging efficacy signals.
Methodological Strengths and Limitations
Strengths include the randomized design, integration within VA healthcare infrastructure, and use of objective measures (Bluetooth scales, fitness trackers). Limitations noted are the nonsignificant P values for continuous weight change likely due to sample size and variability, the predominance of major depressive disorder limiting generalizability across all SMI diagnoses, and short duration of follow-up preventing assessment of weight maintenance.
Expert Commentary
This trial exemplifies a patient-centered approach critical for veterans with complex SMI and obesity. The judicious use of peer specialists leverages lived experience to enhance trust and adherence, addressing an important psychosocial domain often neglected in standard programs.
The use of remote digital tools aligns with growing telehealth adoption accelerated by the COVID-19 pandemic and facilitates sustained monitoring and feedback. However, the modest absolute weight difference highlights that such programs are components of multi-modal care rather than standalone solutions. Efforts should refine strategies to boost physical activity and incorporate adjunct pharmacotherapies.
Clinicians should recognize that achieving ≥5% to 7% weight loss is associated with meaningful cardiometabolic improvements, thus even modest weight loss differences have clinical relevance. Importantly, the tailored approach acknowledges and mitigates barriers related to psychiatric disability.
Guidelines for managing obesity in mental illness are evolving, with increasing endorsement of integrated behavioral-health interventions supported by digital technologies and peer engagement. Future research should focus on long-term sustainability, cost-effectiveness, and adaptation to diverse psychiatric diagnoses.
Conclusion
The 2025 randomized trial by Chinman et al. presents compelling evidence that a tailored, peer-supported, technology-enabled weight loss program can facilitate clinically meaningful weight reduction in veterans with serious mental illness. Although statistical significance for continuous weight change was not definitive, the increased likelihood of achieving ≥7% weight loss is both statistically and clinically significant. This intervention model offers a scalable framework for addressing the high obesity burden in a vulnerable population, integrating mental health expertise, peer support, and remote monitoring. Future studies should explore long-term outcomes, optimize engagement strategies, and expand applicability across psychiatric subgroups to enhance cardiometabolic health in people with SMI.
References
- Chinman M, Wang T, Dodge JR, et al. Tailored Weight Loss Programs for Adults With Serious Mental Illness: A Randomized Clinical Trial. JAMA Psychiatry. 2025 Dec 17. doi:10.1001/jamapsychiatry.2025.3828. PMID: 41405896; PMCID: PMC12712835.
- Daumit GL, Dickerson FB, Wang N-Y, et al. A behavioral weight-loss intervention in persons with serious mental illness. N Engl J Med. 2013;368(17):1594-1602. doi:10.1056/NEJMoa1214530
- Alvarez-Jimenez M, Parker AG, Hetrick SE, et al. Interventions for weight gain in people with psychosis: a systematic review and meta-analysis of randomized controlled trials. Br J Psychiatry. 2008;193(1):7-14. doi:10.1192/bjp.bp.107.039055
- Naslund JA, Aschbrenner KA, Marsch LA, Bartels SJ. The future of mental health care: peer-to-peer support and social media. Epidemiol Psychiatr Sci. 2016;25(2):113-122. doi:10.1017/S2045796015001067
- Naslund JA, Whiteman KL, McHugo GJ, et al. Peer-led interventions to improve physical health among people with serious mental illness: A systematic review. Psychiatr Rehabil J. 2020;43(4):345-355. doi:10.1037/prj0000391
