Health promotion lifestyle interventions for weight management in psychosis: a systematic review and meta-analysis of randomised controlled trials

Abstract

BackgroundPsychiatric patients have more physical health problems and much shorter life expectancies compared to the general population, due primarily to premature cardiovascular disease. A multi-causal model which includes a higher prevalence of risk factors has provided a valid explanation. It takes into consideration not only risks such as gender, age, and family history that are inherently non-modifiable, but also those such as obesity, smoking, diabetes, hypertension, and dyslipidemia that are modifiable through behavioural changes and improved care. Thus, it is crucial to focus on factors that increase cardiovascular risk. Obesity in particular has been associated with both the lifestyle habits and the side effects of antipsychotic medications. The present systematic review and meta-analysis aims at collecting and updating available evidence on the efficacy of non-pharmacological health promotion programmes for psychotic patients in randomised clinical trials.MethodsWe systematically reviewed the randomised controlled trials from 1990 onward, in which psychoeducational and/or cognitive-behavioural interventions aimed at weight loss or prevention of weight gain in patients with psychosis had been compared to treatment as usual. We carried out a meta-analysis and pooled the results of the studies with Body Mass Index as primary outcome.ResultsThe results of the meta-analysis show an effect toward the experimental group. At the end of the intervention phase there is a −0.98 kg/m2 reduction in the mean Body Mass Index of psychotic subjects. Notably, prevention studies with individual psychoeducational programmes that include diet and/or physical activity seem to have the highest impact.ConclusionsWhen 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. A weight loss of 0.98 points in the Body Mass Index corresponds to a loss of 3.12% of the initial weight. This percentage is below the 5% to 10% weight loss deemed sufficient to improve weight-related complications such as hypertension, type II diabetes, and dyslipidemia. However, 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.

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.…”

An Intervention with Physical Activity and Lifestyle Counseling Improves Health-Related Quality of Life and Shows Small Improvements in Metabolic Risks in Persons with Psychosis

“…The most important result was the improvement of HRQoL demonstrated by the EQ-VAS within the intervention group. Previous research has shown that interventions based on group activities are efficient (Green et al, 2014, Bonfioli, et al, 2012, Verhaeghe et al, 2011, Happel et al, 2012, and that QoL is shown to be one of the variables most affected by interventions (Happel et al, 2012). Our intervention attempted to take a multifaceted grasp of lifestyle, here defined as physical activities, and education in lifestyle and nutrition.…”

“…Previous studies (Pearsall et al, 2014, Bonfioli et al, 2012, Happell et al, 2012, Papanastasiou, 2012, Lowe and Lubos, 2008 have demonstrated a great variety of lifestyle interventions for persons with psychosis. In the absence of convincing research findings, there is no consensus or "golden standard" of lifestyle interventions.…”

“…Study design, content of interventions, and measured outcomes vary greatly (Pearsall et al, 2014, Bonfioli et al, 2012. Likewise, they have included participants with different psychiatric diagnoses, for instance, persons with psychosis (Bonfioli et al, 2012), schizophrenia (Papanastasiou, 2012), mental Illness (Happell et al, 2012), or serious mental illness (Lowe and Lubos, 2008), which may hamper the possibility to compare results between studies (Fernández-San-Martín et al, 2014). Lowe and Lubos (2008) have called for more research with standardized outcome measures to determine and compare the effectiveness of educational and exercise intervention, with usual treatment.…”

Stakeholders' views about nutrition education

“…The effects of such medicines for many people is secondary to inherited cardiovascular risk (Phutane et al, 2011;Chang and Lu, 2012) and the impact of an unhealthy lifestyle (Benseñor et al, 2012) suggesting that the delivery of nutritional behaviour change interventions could have a positive impact on health. Systematic reviews of lifestyle interventions have shown some promising outcomes in people with serious mental health problems (Caemmerer et al, 2012;Bonfioli et al, 2012).…”