Mental health and weight loss in men: an exploratory mixed methods study of the Game of Stones trial

Abstract

Objective: Weight management interventions can affect mental health. Mental health can affect engagement with weight loss interventions or services. This study explored mental health and wellbeing outcomes, retention and participant experiences of mental health within the Game of Stones trial. Methods: Mixed methods process evaluation within a 3-group randomised controlled trial: behavioural text messages with financial incentives, texts alone, and waiting list control, for 585 men with obesity. Secondary outcomes analysed descriptively included: Warwick-Edinburgh Mental Wellbeing Scale, Weight Self-Stigma Questionnaire, EQ-5D-5L, EQ-5D-5L anxiety and depression subscale, Patient Health Questionniare-4, and retention. Three categories of participants were compared: ever diagnosed with a mental health condition (n=146; 25.0%), latent mental health condition (n=142; 24.3%) no mental health condition (n=295; 50.6%). Semi-structured interviews (n=54) were conducted after 12 months and analysed using Framework method. Results: A higher proportion of men who self-reported ever having a mental health condition had a disability, multiple long-term conditions, were under financial strain and were single compared to those with those with a latent mental health condition and no mental health condition. Improvements from baseline were shown for weight stigma, wellbeing and PHQ-4 at 12 months for men in intervention groups with a mental health condition and latent mental health condition. EQ-5D-5L Visual Analogue Scale scores improved across all mental health categories and trial groups, but EQ-5D-5L and EQ-5D-5L-AD scores were inconsistent. Retention at 12 months was 76.0% (mental health condition), 70.4% (latent mental health condition) and 72.5% (no mental health condition). The qualitative evidence indicated that stress, anxiety and depression were experienced in different ways by men during the programme. Mental health difficulties were unique to the individual, could be episodic, recurrent, cyclical or ongoing and were a barrier to behaviour change for some but not for others. Conclusion: The trial was able to engage and retain men regardless of mental health category. Behavioural text messages with or without incentives helped some men lose weight, but not others. Observed heterogeneity for mental health and wellbeing measures is problematic for weight management trials with men.