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J Gen Intern Med. 2002 Jul;17(7):556-60.

Receipt of nutrition and exercise counseling among medical outpatients with psychiatric and substance use disorders.

Author information

  • 1Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, Conn 06516, USA. mayur.desai@yale.edu



Mentally ill persons represent a population that is potentially vulnerable to receiving a poorer quality of medical care. This study examines the relationship between mental disorders and the likelihood of receiving recommended nutrition and exercise counseling.


Cross-sectional study combining chart-review data and administrative database records.


One hundred forty-seven Veterans Affairs (VA) medical centers nationwide.


The sample included 90,240 patients with obesity and/or hypertension who had >/=3 medical outpatient visits in the previous year.


The outcomes of interest were chart-documented receipt of nutrition counseling and receipt of exercise counseling in the past 2 years. This chart information was merged with VA inpatient and outpatient administrative databases, which were used to identify persons with diagnosed mental disorders. Most patients received nutrition counseling (90.4%), exercise counseling (88.5%), and counseling for both (85.7%) in the past 2 years. The rates of counseling differed significantly but modestly by mental health status. The lowest rates were found among patients dually diagnosed with comorbid psychiatric and substance use disorders; however, the magnitude of the disparities was small, ranging from 2% to 4% across outcomes. These results were unchanged after controlling for demographics, health status, and facility characteristics using multivariable generalized estimating equation modeling.


Among patients engaged in active medical treatment, rates of nutrition and exercise counseling were high at VA medical centers, and the diagnosis of mental illness was not a substantial barrier to such counseling. More work is needed to determine whether these findings generalize to non-VA settings and to understand the potential role that integrated systems such as the VA can play in reducing disparities for vulnerable populations.

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