Efficacy of behavioural interventions in managing atypical antipsychotic weight gain

Abstract

Atypical antipsychotic treatment is associated with weight gain and increased metabolic risk. This systematic literature review evaluates the current research on the effectiveness of behavioural interventions in treating and preventing atypical antipsychotic weight gain and reducing metabolic risk, describes characteristics of interventions implemented and discusses findings in the context of the RE-AIM framework. Sixteen studies were identified. When initiated at the start of treatment with an atypical antipsychotic agent, behavioural weight loss interventions decreased the amount of weight gain associated with atypical antipsychotic treatment. When behavioural interventions were initiated after the start of atypical antipsychotic treatment, these interventions were associated with weight loss. Mean weight losses across studies by treatment duration were 2.63 kg for 12- to 16-week interventions, 4.24 kg for 6-month interventions and 3.05 kg for 12- to 18-month interventions. Behavioural weight loss interventions were also found to improve insulin regulation and HbA1c. In addition to assessing efficacy, future studies should evaluate other components of the RE-AIM framework, including reach, adoption, implementation and maintenance. This information will be useful in determining what types of interventions are both effective and practical for delivery in health care or community mental health settings.

Lifestyle Interventions for Adults With Serious Mental Illness: A Systematic Literature Review

“…Three of the seven randomized controlled trials did not find statistically significant weight loss outcomes. Two were weight loss programs (10,27), and one was a fitness intervention (36). The other four randomized controlled trials—all weight loss programs—reported that their program participants achieved statistically significant weight loss when they were compared with their respective control groups.…”

“…This article seeks to address this question by systematically reviewing studies that report the health outcomes of lifestyle interventions evaluated in this population. Past reviews of the literature have focused mainly on weight management treatments among individuals with schizophrenia (8,9) or on the efficacy of behavioral interventions in managing weight gain associated with the use of second-generation antipsychotic medications (10). The review presented here builds on this previous work and provides a comprehensive literature review of interventions that not only focuses on weight but also examines exercise, health promotion, and self-management activities; expands the patient population to include other diagnostic categories (for example, bipolar disorder and schizoaffective disorder) represented in the population with serious mental illness (11); and assesses the inclusion of persons from racial and ethnic minority groups in these studies.…”

Weight Gain and its Correlates among Forensic Inpatients

“…Lifestyle changes are considered the first line of treatment to decrease cardiovascular risks in people with metabolic syndrome, 30 being more effective than pharmacological interventions. 3,8,15,20,[31][32][33][34][35][36][37][38][39][40] Forensic psychiatrists try to treat obesity on a case-by-case basis by imposing limits on junk food, 41 but systematic control over diet and behavioural contingencies is quite feasible in psychiatric hospitals. 33 A simple measure already taken in the study hospital is to reduce the regular diet to no more than 2400 kcal/day, and therapy for forensic inpatients with metabolic syndrome that supports dietary and activity changes is proposed.…”

Obesity and psychiatric disorders: Commonalities in dysregulated biological pathways and their implications for treatment

“…In a meta-analysis on randomised, controlled, cognitive-behavioural weight loss trials, Bonfioli et al (2012) concluded that in patients with psychosis, a weight loss of 0.98 points in BMI (corresponding to a loss of 3.12% of initial weight) was demonstrated from pooled data. Weight loss programs can also prevent weight gain associated with antipsychotic use and even promote weight loss (Chen et al, 2009, Gabriele et al, 2009, Menza et al, 2004, Vreeland et al, 2003. In a study by Zhang et al (2012), patients with psychotic spectrum disorders experienced a greater percent baseline weight loss at 12 months, and greater percent BMI loss at 9 and 12 months than people suffering from other psychiatric disorders and no psychiatric disorder.…”