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Overweight and obese individuals with serious mental illness who participated in a behavioral intervention were able to significantly reduce their weight, a randomized trial showed.
Weight loss increased progressively throughout the 18-month study period, with individuals in the intervention group losing 7 pounds more than those in the control group, according to Gail Daumit, MD, MHS, of Johns Hopkins University, and colleagues.
By the end of the study, patients in the intervention group were more likely than those in the control group to have lost at least 5% of their initial weight (37.8% versus 22.7%, P=0.009), the researchers reported online in the New England Journal of Medicine.
The rate of obesity is nearly doubled in patients with serious mental illness compared with the general population, stemming from physical inactivity, unhealthy diets, and the use of psychotropic medications, according Daumit and colleagues.
Yet their findings -- reported simultaneously at the American Heart Association's Epidemiology and Prevention/Nutrition, Physical Activity, and Metabolism meeting in New Orleans -- "show that overweight and obese adults with serious mental illness can make substantial lifestyle changes despite the myriad challenges they face."
"Given the epidemic of obesity and weight-related disease among persons with serious mental illness, our findings support implementation of targeted behavioral weight-loss interventions in this high-risk population."
Maintaining a healthy weight among patients with serious mental illness often has been considered a lost cause because many psychotropic medications induce weight gain, according to Michael Jensen, MD, of the Mayo Clinic in Rochester, Minn.
But with this study, "our psychiatric care providers can no longer say we can't possibly prevent weight gain or we can't achieve weight loss," Jensen said in an interview. "It takes a lot of work, it takes a lot of input, but you can prevent weight gain and you can even achieve a modicum of weight loss."
Patients with serious mental illness are often excluded from weight-loss trials because of concerns about their ability to adhere to treatments and participate in groups.
But the ACHIEVE trial evaluated the effectiveness of a behavioral weight-loss intervention in 291 adults with schizophrenia or schizoaffective disorder (58.1%), bipolar disorder (22%), major depression (12%), or other psychiatric disorders (7.9%) who were receiving treatment at one of 10 community psychiatric rehabilitation outpatient programs in central Maryland.
The average age of the patients was 45.3 and the average body mass index at baseline was 36.3 kg/m2. Average weight was 226 pounds. The patients were taking a mean of 3.1 psychotropic medications.
The intervention included both group and individual weight-management sessions that focused on lifestyle modification while addressing deficits in memory and executive function, as well as group exercise sessions.
Health classes not focused on weight were offered quarterly to patients in the control group.
The researchers made efforts to improve access to healthy meal options at the facilities for patients in both groups.
In the control group, average weight loss was 0.6 pounds at 6 months, and that remained relatively unchanged at the 18-month visit (0.5 pounds lost).
In contrast, weight loss increased throughout the study period in the intervention group, from an average of 4 pounds at 6 months to 7.5 pounds at 18 months. Weight loss was significantly greater in the intervention group than in the control group at each time point (P<0.05 for all).
"This extent of weight loss, albeit modest, has been shown to have beneficial effects, such as a reduced risk of cardiovascular disease among persons with an initially elevated risk," the authors noted.
At 18 months, the percentage of patients who maintained or lost weight was higher in the intervention group (63.9% versus 49.2%, P=0.02).
The findings were consistent after adjustment for the number of psychotropic medications used.
There were no differences between the groups in adverse events. Those included five deaths and 14 cardiovascular events, none of which was considered even probably related to the study.
The authors acknowledged some limitations of the study, including a decline in participation in the intervention sessions and rehabilitation programs over time. In addition, the study was not designed or powered to determine the effects of weight loss on cardiovascular risk factors or to influence medication use.
Jensen noted that the intensity and cost of the intervention could limit its application in the real world.
"Future studies will have to focus on [whether we can] achieve a comparable outcome with a less expensive, less intensive treatment," he said.
Weight loss increased progressively throughout the 18-month study period, with individuals in the intervention group losing 7 pounds more than those in the control group, according to Gail Daumit, MD, MHS, of Johns Hopkins University, and colleagues.
By the end of the study, patients in the intervention group were more likely than those in the control group to have lost at least 5% of their initial weight (37.8% versus 22.7%, P=0.009), the researchers reported online in the New England Journal of Medicine.
The rate of obesity is nearly doubled in patients with serious mental illness compared with the general population, stemming from physical inactivity, unhealthy diets, and the use of psychotropic medications, according Daumit and colleagues.
Yet their findings -- reported simultaneously at the American Heart Association's Epidemiology and Prevention/Nutrition, Physical Activity, and Metabolism meeting in New Orleans -- "show that overweight and obese adults with serious mental illness can make substantial lifestyle changes despite the myriad challenges they face."
"Given the epidemic of obesity and weight-related disease among persons with serious mental illness, our findings support implementation of targeted behavioral weight-loss interventions in this high-risk population."
Maintaining a healthy weight among patients with serious mental illness often has been considered a lost cause because many psychotropic medications induce weight gain, according to Michael Jensen, MD, of the Mayo Clinic in Rochester, Minn.
But with this study, "our psychiatric care providers can no longer say we can't possibly prevent weight gain or we can't achieve weight loss," Jensen said in an interview. "It takes a lot of work, it takes a lot of input, but you can prevent weight gain and you can even achieve a modicum of weight loss."
Patients with serious mental illness are often excluded from weight-loss trials because of concerns about their ability to adhere to treatments and participate in groups.
But the ACHIEVE trial evaluated the effectiveness of a behavioral weight-loss intervention in 291 adults with schizophrenia or schizoaffective disorder (58.1%), bipolar disorder (22%), major depression (12%), or other psychiatric disorders (7.9%) who were receiving treatment at one of 10 community psychiatric rehabilitation outpatient programs in central Maryland.
The average age of the patients was 45.3 and the average body mass index at baseline was 36.3 kg/m2. Average weight was 226 pounds. The patients were taking a mean of 3.1 psychotropic medications.
The intervention included both group and individual weight-management sessions that focused on lifestyle modification while addressing deficits in memory and executive function, as well as group exercise sessions.
Health classes not focused on weight were offered quarterly to patients in the control group.
The researchers made efforts to improve access to healthy meal options at the facilities for patients in both groups.
In the control group, average weight loss was 0.6 pounds at 6 months, and that remained relatively unchanged at the 18-month visit (0.5 pounds lost).
In contrast, weight loss increased throughout the study period in the intervention group, from an average of 4 pounds at 6 months to 7.5 pounds at 18 months. Weight loss was significantly greater in the intervention group than in the control group at each time point (P<0.05 for all).
"This extent of weight loss, albeit modest, has been shown to have beneficial effects, such as a reduced risk of cardiovascular disease among persons with an initially elevated risk," the authors noted.
At 18 months, the percentage of patients who maintained or lost weight was higher in the intervention group (63.9% versus 49.2%, P=0.02).
The findings were consistent after adjustment for the number of psychotropic medications used.
There were no differences between the groups in adverse events. Those included five deaths and 14 cardiovascular events, none of which was considered even probably related to the study.
The authors acknowledged some limitations of the study, including a decline in participation in the intervention sessions and rehabilitation programs over time. In addition, the study was not designed or powered to determine the effects of weight loss on cardiovascular risk factors or to influence medication use.
Jensen noted that the intensity and cost of the intervention could limit its application in the real world.
"Future studies will have to focus on [whether we can] achieve a comparable outcome with a less expensive, less intensive treatment," he said.
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