Reaching for a Healthier Lifestyle: A Photovoice Investigation of Barriers to Healthy Living in People with Serious Mental Illness

What Is the Purpose of this Study?

• • To investigate social and structural factors that affect weight loss in partnership with community co-researchers enrolled in a group lifestyle program for overweight/obese people with serious mental illness (SMI) living in supportive housing settings.

What is the Problem?

• • People with mental illness in the United States are almost twice as likely to be obese compared with those without a mental illness.

• • Lifestyle factors, such as poor dietary choices and physical inactivity, are often cited as causes of obesity in this population, which limits the response to the obesity epidemic primarily to behavioral change interventions.

• • In response, this project is grounded in a human rights framework to ensure that the people most affected by the problem are included in understanding and addressing the problem.

What Are the Findings?

• • Co-researchers selected 33 photos reflecting two overarching themes: 1) structural barriers, such as poor quality food, transportation costs, limited Supplemental Nutrition Access Program (SNAP) benefits, limits of food pantries, easy availability of tobacco and alcohol products, and limited places for exercise, and 2) strategies for overcoming structural barriers, such as healthy eating on a budget.

• • Co-researchers highlighted structural barriers that were a cause or consequence of food insecurity and situations that threaten the right to healthy food and opportunities for a healthy life.

• • Co-researchers reported examples of knowledge and skills they learned through participation in the project that were used to overcome structural barriers to healthy eating and physical activity, and likely contributed to weight loss.

Who Should Care Most?

• • Health practitioners who care for people with SMI who are obese, to better understand the multilevel challenges to healthy eating and physical activity.

• • Researchers developing interventions to support health in people with SMI, to recognize the importance of addressing the social determinants of health in new interventions.

• • Policymakers, to understand the impact of cuts to programs such as the SNAP and Social Security, and how these cuts disproportionally affect the health of people with disabilities.

Recommendations for Action

• • Provide opportunities for populations affected by complex health problems to offer real-life insights to inform intervention development and help to address hidden and important barriers to achieving a healthy life in the community.

• • Continue to support creative community-based participatory research approaches, such as Photovoice, to provide opportunity for deeper dialogue and engagement with marginalized populations.

• • Advocate for structural and policy level changes to increase the availability of healthy food options in low-income neighborhoods, improve income supports, maintain and increase food subsidies, and incorporate changes to the built environment to support physical activity, to ensure the right to food and the right to health for people with psychiatric disabilities.