Barriers to Healthy Eating in Persons with Serious Mental Illness

Background and Purpose: Persons with serious mental illness (SMI) die 25 years earlier than people in the general population. Cardiovascular disease is the leading cause of death and higher rates of obesity, hypertension, diabetes mellitus, dyslipidemia and obesity in this population are contributing factors. A healthy diet can aid in the management and reduction of these risk factors and potentially extend lifespan. Currently, the diet of those with SMI is poor. Individuals tend to consume a diet high in calories, fat, fast food, and sugar-carbonated drinks and low in fiber, fruits, and vegetables. The objective of our study was to explore the understanding of healthy eating and the barriers to adopting a healthier diet in persons with SMI to facilitate the development of nutrition interventions. Methods: A qualitative study of health behaviors was conducted in individuals with SMI. Thirty-one study participants were recruited from a mental health center in Chicago, Illinois, and ranged in age from 31 to 62 years old. All participants were English speaking and lived in the community. In-depth semi-structured individual interviews were conducted in locations convenient to the participants. Interview questions focused on personal definitions of healthy eating, current eating behaviors, ideas about changing eating behaviors and barriers to healthier dietary habits. Each interview was audio taped and transcribed, then coded and interpreted by three independent investigators using the constant comparative method of analysis. Results: Participant definitions of healthy eating ranged in complexity. Those with the most basic level of understanding described a “balanced diet” containing a variety of foods while others specified that healthy diets limited sweets, sodas, fast food and/or junk food, used low fat cooking methods, and included more fruits and vegetables. Individuals varied in their ability to align eating behaviors with their knowledge of a healthy diet. Those able to adopt healthier eating habits changed their behavior in response to an increased perception of personal or proximal risk after experiencing an adverse health related event. Barriers to healthier eating were grouped as internal or external to the participant. Internal barriers were negative perceptions of healthy eating, poor taste and reduced satiation of healthier foods, resistance to changing familiar eating habits, emotional eating, and the prioritization of mental health over physical health. The external barriers included reduced availability and inconvenience of healthy foods, social pressures, and psychiatric medication side effects. Conclusions: Definitions of a healthy diet in persons with SMI were similar to those in the general population. Barriers to improved nutritional quality often reflected the poor socioeconomic status of those with SMI. Mental health interfered with making dietary changes through psychiatric medication side effects and prioritization of mental health above nutritional health. Developing nutrition interventions that address the identified barriers could aid in improving the diet of persons with SMI and subsequently reduce morbidity and mortality from co-morbid medical conditions.