Weight Loss and Lifestyle Interventions for Patients Taking Antipsychotics

Summary and Comment |
October 3, 2014

Weight Loss and Lifestyle Interventions for Patients Taking Antipsychotics

  1. Joel Yager, MD

An array of behavioral approaches benefits a wide range of psychiatric patients.

  1. Joel Yager, MD

Atypical antipsychotic medications increase risks for weight gain, insulin resistance, and diabetes. A randomized, controlled trial conducted in an intensive outpatient psychiatric rehabilitation program, and shorter-term studies have demonstrated the value of programs addressing eating, weight management, and exercise. In the current 12-month study, researchers randomized 200 overweight patients taking antipsychotics to a group intervention or usual care. Patients were recruited from an integrated healthcare system and two community mental health centers.

The intervention consisted of 6 months of weekly group meetings focusing on individualized dietary and behavioral self-management, moderate calorie restriction, and physical activity, followed by six monthly meetings emphasizing weight maintenance and motivational enhancement. Patients (mean body-mass index, 38.3; mean age, 47) were predominantly low income (45% received disability income) and female (72%). Diagnoses were predominantly bipolar disorder/affective psychoses (69%) or schizophrenia spectrum (29%). Almost all patients (91%) received atypical antipsychotics; 75% of medications were known to cause weight gain, 64% severely so. Attendance during the first 6 months averaged 60%.

Intervention recipients lost a mean of 4.4 kg more than controls (who gained a mean of 0.5 kg) at 6 months and 2.6 kg more at 12 months. Mean fasting glucose levels by 12 months fell in the intervention group (baseline, 106.3 mg/dL; 1 year, 100.4 mg/dL) and rose in controls (106.0 mg/dL to 109.5 mg/dL). During the year, 6.7% of intervention patients versus 18.8% of controls required medical hospitalization.

Comment

This 12-month, freestanding intervention improved weight and overall health in a diverse population taking weight-inducing antipsychotics. Alterations to the program might engage and retain more patients, and even-longer interventions might better sustain health benefits. Actively empowering patients in their own recovery and wellness clearly yields multiple benefits. Clinicians should consider prescribing these programs routinely.

Editor Disclosures at Time of Publication

  • Disclosures for Joel Yager, MD at time of publication Grant /Research support AHRQ Editorial boards Bulletin of the Menninger Clinic; Eating Disorders: Journal of Treatment and Prevention; Eating Disorders Review (Editor-in-Chief); International Journal of Eating Disorders; UpToDate; FOCUS: The Journal of Lifelong Learning in Psychiatry Leadership positions in professional societies American Psychiatric Association (Chair, Council of Quality Care)

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