Weight gain is one of the side effects that people who take antipsychotic drugs complain of the most. Obesity is common in this population and this can often lead to cardiovascular problems and a far shorter life expectancy than the rest of the population.
As a result, there is a great deal of interest in behavioural changes that can be recommended for people with psychosis, to help them reduce their weight or prevent weight gain in the first place. The question is: Can diet and physical activity help reduce the complications of obesity such as hypertension, type II diabetes and dyslipidemia? A weight loss of 5-10% in this population is the target set by the WHO and other US health organisations.
A new systematic review and meta-analysis has recently been published in the BMC Psychiatry Journal by a research team from the University of Verona. The authors reviewed randomised controlled trials (RCTs) published from Jan 1990-Dec 2011 that looked at psychoeducational and/or cognitive-behavioural interventions aimed at weight loss or prevention of weight gain in patients with psychosis compared to treatment as usual.￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼ They found 17 RCTs and included 13 in their analysis.
Here’s what they found:
- Overall, diet and physical activity interventions reduced weight in psychotic patients by −0.98 BMI points (95% CI -1.31 kg/m2 to −0.65 kg/m2)
- This level of weight loss corresponds to a loss of 3.12%, which is below the 5-10% target
- Prevention studies with individual psychoeducational programmes including diet and/or physical activity seemed to have the highest impact
The authors concluded:
When compared with treatment as usual in psychotic patients, preventive and individual lifestyle interventions that include diet and physical activity generally prove to be effective in reducing weight. Physical screening and monitoring programmes are well accepted by patients and can be implemented in a variety of settings.
It is reported that outcomes associated with metabolic risk factors may have greater health implications than weight changes alone. Therefore, in addition to weight reduction, the assessment of metabolic parameters to monitor other independent risk factors should also be integrated into physical health promotion and management in people with mental disorders.
The overall quality of the trials included in the review is not that high. The size of the trials is relatively small, none of them describe random allocation and only 3 describe the random sequence generation. None are double blind and only 3 are single-blind trials. Seven of the included trials include all participants in the final analysis or provide an intention to treat analysis. The authors provide detailed data on the quality of the trials in a risk of bias table.
Bonfioli, E. Berti, L. Goss, C. Muraro, F. Burti, L. Health promotion lifestyle interventions for weight management in psychosis: a systematic review and meta-analysis of randomised controlled trials (PDF). BMC Psychiatry 2012, 12:78 doi:10.1186/1471-244X-12-78.