Posted by Phillipa on April 28, 2013, at 19:52:00
Medscape Medical News > Psychiatry
Novel Weight-Loss Program Effective in Severely Mentally Ill
Apr 24, 2013
A custom intervention aimed at obese patients with severe mental illness is effective in helping this often stigmatized population achieve significant weight loss and engage in healthy lifestyles, new research shows.
An 18-month randomized controlled trial conducted by investigators at Johns Hopkins University in Baltimore, Maryland, showed that on average, a greater proportion of patients in the intervention group lost 5% or more of their initial body weight compared with those in the control group.
"This population is often stigmatized. This study's findings should help people think differently about [those] with serious mental illness. Our results provide clear evidence that this population can make healthy lifestyle changes and achieve weight loss," study investigator Gail L. Daumit, MD, MHS, said in a release.
The findings are published in the April 25 issue of the New England Journal of Medicine.
According to investigators, overweight and obesity are epidemic among individuals with serious mental illness such as schizophrenia, bipolar disorder, and major depression. Yet, weight-loss trials "systematically exclude this vulnerable population."
They also point out that mortality rates among patients with severe mental illness are between 2 and more than 3 times higher than those in the general population and that the primary cause of death is cardiovascular disease.
The investigators note that because psychiatric symptoms and cognitive impairment are highly prevalent in these patients, any lifestyle interventions need to be customized to meet the special needs of this population.
The multicenter study included 291 overweight or obese patients aged 18 years or older with serious mental illness who were randomly assigned to an intervention group (n = 144) or a control group (n = 147).
Study participants attended 1 of 10 outpatient psychiatric rehabilitation day facilities that routinely offered vocational and skills training, case management, and other services for those with mental illness who were not well enough to work full-time.
Of the total cohort, 58.1% had schizophrenia or a schizoaffective disorder, 22% had bipolar disorder, and 12.0% had major depression.
At baseline, the mean body mass index (BMI) was 36.3 and the mean weight was 225.9 lbs.
No Calorie Counting
Participants in the intervention group received tailored group and individual weight-management sessions and thrice-weekly group exercise sessions. The control group received standard nutrition and physical-activity information at baseline. Health classes were offered quarterly with information unrelated to weight.
Instead of keeping food logs and counting calories, as is commonly done in most weight-loss programs, the intervention group was encouraged to avoid junk food and sugary beverages, to monitor portion sizes, and to increase consumption of fruits and vegetables. In addition, those in the intervention group were encouraged to be physically active between exercise classes.
Weight change was assessed at 6, 12, and 18 months.
At 18 months, weight data were available on 279 participants. The investigators found that at this time point, 38% of those in the intervention group had lost 5% or more of their initial weight vs 23% of the control group. Further, more than 18% of those in the intervention arm of the study lost more than 10% of their body weight at 18 months compared with 7% in the control group.
Participants in the intervention group lost more weight as time went on, said Dr. Daumit, and she suggests that behavioral change can take time but that once it takes hold, it can yield positive results.
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"There's this really important need to find ways to help this population be healthier and lose weight. We brought a weight-loss program to them, tailored to the needs of people with serious mental illness, and we were successful," she said.
According to the investigators, these results warrant the "implementation of targeted behavioral weight-loss interventions in this high-risk population."
The investigators add that an important feature of the trial was the setting of psychiatric rehabilitation programs. They acknowledge that although not all patients with serious mental illness attend such clinics, many are affiliated with outpatient clinics, which "therefore could serve as a hub for this or similar lifestyle interventions."
The study was funded by the National Institute of Mental Health. The authors report not relevant financial relationships.
N Engl J Med. 2013;368:1594-1602. Full article