Erickson ZD, Kwan CL, Gelberg HA, et al. A Randomized, Controlled Multisite Study of Behavioral Interventions for Veterans with Mental Illness and Antipsychotic Medication-Associated Obesity. J Gen Intern Med. 2017 Mar 7. doi: 10.1007/s11606-016-3960-3.
Discipline Area Score
Nurse 6 / 7
Physician 5 / 7

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?

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. identifier NCT01052714.

Comments from MORE raters

Nurse rater

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.

Nurse rater

Nice study.

Physician rater

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.

Physician rater

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.

Physician rater

Veterans may be more used to regular behaviors than civilians; this may lead to the inability to generalize the results to them.