BACKGROUND: Weight gain and other metabolic sequelae of antipsychotic medications can lead to medication non-adherence, reduced quality of life, increased costs, and premature mortality. Of the approaches to address this, behavioral interventions are less invasive, cost less, and can result in sustained long-term benefits.
OBJECTIVE: We investigated behavioral weight management interventions for veterans with mental illness across four medical centers within the Veterans Affairs (VA) Healthcare System.
DESIGN: We conducted a 12-month, multi-site extension of our previous randomized, controlled study, comparing treatment and control groups.
PARTICIPANTS: Veterans (and some non-veteran women) diagnosed with mental illness, overweight (defined as having a BMI over 25), and required ongoing antipsychotic therapy.
INTERVENTIONS: One group received "Lifestyle Balance" (LB; modified from the Diabetes Prevention Program) consisting of classes and individual nutritional counseling with a dietitian. A second group received less intensive "Usual Care" (UC) consisting of weight monitoring and provision of self-help.
MAIN MEASURES: Participants completed anthropometric and nutrition assessments weekly for 8 weeks, then monthly. Psychiatric, behavioral, and physical assessments were conducted at baseline and months 2, 6, and 12. Metabolic and lipid laboratory tests were performed quarterly.
KEY RESULTS: Participants in both groups lost weight. LB participants had a greater decrease in average waist circumference [F(1,1244)?=?11.9, p?0.001] and percent body fat [F(1,1121)?=?4.3, p?=?0.038]. Controlling for gender yielded statistically significant changes between groups in BMI [F(1,1246)?=?13.9, p?0.001]. Waist circumference and percent body fat decreased for LB women [F(1,1243)?=?22.5, p?0.001 and F(1,1221)?=?4.8, p?=?0.029, respectively]. The majority of LB participants kept food and activity journals (92%), and average daily calorie intake decreased from 2055 to 1650 during the study (p?0.001).
CONCLUSIONS: Behavioral interventions specifically designed for individuals with mental illness can be effective for weight loss and improve dietary behaviors. "Lifestyle Balance" integrates well with VA healthcare's patient-centered "Whole Health" approach. ClinicalTrials.gov identifier NCT01052714.
Most antipsychotic drugs, olanzapine and clozapine in particular, are associated with hyperglycemia, dyslipidemia and weight gain. Aripiprazole, ziprasidone, asenapine, iloperidone, and lurasidone purportedly have less metabolic adverse effects, but they're more expensive. This study demonstrates that behavioral intervention is a feasible and effective alternative to switching, or probably an adjunct for patients when metabolic AEs persist despite switching.
It is good to know that patients treated with antipsychotic medications can lose weight when in a program that has that intent. It is not surprising that this is the case, however, given other work to date.
This is another paper showing evidence about behavioral interventions through positive behavioral support and health education and promotion on handling obesity and mental health issues. These kinds of studies fill identified gaps, thus making established health targets and goals achievable. Moreover, these kinds of studies articulate future scenarios in terms of alternatives for change thereby bringing a huge public health transformation.
Veterans may be more used to regular behaviors than civilians; this may lead to the inability to generalize the results to them.