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Kanofsky JD, Viswanathan S, Wylie-Rosett J. Lifestyle Coaching May Be an Effective Treatment for Schizophrenia. Am J Lifestyle Med 2024; 18:156-161. [PMID: 38559781 PMCID: PMC10979723 DOI: 10.1177/15598276221142307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
This commentary critiques the Danish CHANGE trial, which evaluated 3 levels of outpatient intervention intensity, in a group of outpatients with obesity and schizophrenia. Neither adding care coordination with weekly nurse contacts alone nor combining this treatment with assertive community lifestyle coaching as compared to treatment as usual improved outcomes, which included cardiovascular disease risk calculation, cardiorespiratory fitness, weight, and self-reported behaviors such as smoking, physical activity, and diet. The CHANGE trial investigators appear strongly averse to recommending the development and implementation of lifestyle medicine programs as a major component when treating outpatients with severe mental disorders. The potential dismissal of lifestyle medicine as a component of treatment for severe mental disorders is problematic. Valuable lessons can be learned from more thoroughly analyzing secondary outcomes such as medical and psychiatric hospitalization rates and total health care cost. The CHANGE trial data analysis needs to be expanded beyond the focus on changes in weight and serum cholesterol. Insulin resistance and high refined carbohydrate intake may be major factors in determining both the medical and psychiatric clinical course of schizophrenia. Assertive community lifestyle coaching is a novel treatment modality. Evidence strongly suggests assertive community lifestyle coaching substantially decreases both psychiatric and medical hospitalization rates.
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Affiliation(s)
- Jacob Daniel Kanofsky
- Bronx Psychiatric Center, Bronx, NY, USA (JDK); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA (JDK); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (SV, JWR); and New York Regional Center for Diabetes Translational Research, Albert Einstein College of Medicine, Bronx, NY, USA (JWR)
| | - Shankar Viswanathan
- Bronx Psychiatric Center, Bronx, NY, USA (JDK); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA (JDK); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (SV, JWR); and New York Regional Center for Diabetes Translational Research, Albert Einstein College of Medicine, Bronx, NY, USA (JWR)
| | - Judith Wylie-Rosett
- Bronx Psychiatric Center, Bronx, NY, USA (JDK); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA (JDK); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (SV, JWR); and New York Regional Center for Diabetes Translational Research, Albert Einstein College of Medicine, Bronx, NY, USA (JWR)
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Hartmann-Boyce J, Theodoulou A, Oke JL, Butler AR, Bastounis A, Dunnigan A, Byadya R, Cobiac LJ, Scarborough P, Hobbs FR, Sniehotta FF, Jebb SA, Aveyard P. Long-Term Effect of Weight Regain Following Behavioral Weight Management Programs on Cardiometabolic Disease Incidence and Risk: Systematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes 2023; 16:e009348. [PMID: 36974678 PMCID: PMC10106109 DOI: 10.1161/circoutcomes.122.009348] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/13/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Behavioral weight management programs (BWMPs) enhance weight loss in the short term, but longer term cardiometabolic effects are uncertain as weight is commonly regained. We assessed the impact of weight regain after BWMPs on cardiovascular risk factors, diabetes, and cardiovascular disease. METHODS Trial registries, 11 databases, and forward-citation searching (latest search, December 19) were used to identify articles published in English, from any geographical region. Randomized trials of BWMPs in adults with overweight/obesity reporting cardiometabolic outcomes at ≥12 months at and after program end were included. Differences between more intensive interventions and comparator groups were synthesized using mixed-effects, meta-regression, and time-to-event models to assess the impact of weight regain on cardiovascular disease incidence and risk. RESULTS One hundred twenty-four trials reporting on ≥1 cardiometabolic outcomes with a median follow-up of 28 (range, 11-360) months after program end were included. Median baseline participant body mass index was 33 kg/m2; median age was 51 years. Eight and 15 study arms (7889 and 4202 participants, respectively) examined the incidence of cardiovascular disease and type 2 diabetes, respectively, with imprecise evidence of a lower incidence for at least 5 years. Weight regain in BWMPs relative to comparators reduced these differences. One and 5 years after program end, total cholesterol/HDL (high-density lipoprotein) ratio was 1.5 points lower at both times (82 studies; 19 003 participants), systolic blood pressure was 1.5 mm mercury and 0.4 mm lower (84 studies; 30 836 participants), and HbA1c (%) 0.38 lower at both times (94 studies; 28 083 participants). Of the included studies, 22% were judged at high risk of bias; removing these did not meaningfully change results. CONCLUSIONS Despite weight regain, BWMPs reduce cardiometabolic risk factors with effects lasting at least 5 years after program end and dwindling with weight regain. Evidence that they reduce the incidence of cardiovascular disease or diabetes is less certain. Few studies followed participants for ≥5 years. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42018105744.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Jason L. Oke
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, United Kingdom (J.L.O.)
| | - Ailsa R. Butler
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Anastasios Bastounis
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom (A.B.)
| | - Anna Dunnigan
- Oxford University Hospitals NHS Foundation Trust, United Kingdom (A.D.)
- Royal Free London NHS Foundation Trust, United Kingdom (A.D.)
| | - Rimu Byadya
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
- United Nations World Food Programme, Cox’s Bazar, Bangladesh, India (R.B.)
| | - Linda J. Cobiac
- Nuffield Department of Population Health, Centre on Population Approaches for Non-Communicable Disease Prevention (L.J.C.), University of Oxford, United Kingdom
| | - Peter Scarborough
- Nuffield Department of Population Health, Oxford Biomedical Research Centre (P.S.), University of Oxford, United Kingdom
| | - F.D. Richard Hobbs
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Falko F. Sniehotta
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, United Kingdom (F.F.S.)
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
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Nicol G, Jansen M, Haddad R, Ricchio A, Yingling MD, Schweiger JA, Keenoy K, Evanoff BA, Newcomer JW. Use of an Interactive Obesity Treatment Approach in Individuals With Severe Mental Illness: Feasibility, Acceptability, and Proposed Engagement Criteria. JMIR Form Res 2022; 6:e38496. [PMID: 36512399 PMCID: PMC9795399 DOI: 10.2196/38496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/16/2022] [Accepted: 09/02/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Digital and mobile health interventions are increasingly being used to support healthy lifestyle change, including in certain high-risk populations such as those with severe mental illnesses (SMIs). Life expectancy in this population lags 15 years behind counterparts in the general population, primarily due to obesity-related health conditions. OBJECTIVE We tested the feasibility and usability of a 12-week interactive obesity treatment approach (iOTA) to adults with chronic SMIs (depression, bipolar disorder and schizophrenia spectrum disorder) receiving treatment in community settings. The iOTA incorporates short message service (SMS) text messages to supplement monthly in-person health coaching. METHODS Factors hypothesized to be associated with weight change were illness severity and treatment engagement. Severe psychiatric symptoms were defined as baseline Clinical Global Impression severity score of >5. Criterion engagement was defined as a text messaging response rate >80% during the first 4 weeks of treatment. Disordered eating, assessed with the Loss of Control Over Eating Scores, was also evaluated. Participants provided qualitative data, further informing assessment of intervention feasibility, usability, and acceptability. RESULTS A total of 26 participants were enrolled. The mean age was 48.5 (SD 15.67) years; 40% (10/26) were Black and 60% (15/26) female. Participants with lower symptom severity and adequate engagement demonstrated significantly decreased weight (F1,16=22.54, P<.001). Conversely, high symptom severity and lower text message response rates were associated with trend-level increases in weight (F1,7=4.33, P=.08). Loss-of-control eating was not observed to impact treatment outcome. Participants voiced preference for combination of live health coaching and text messaging, expressing desire for personalized message content. CONCLUSIONS These results demonstrate the feasibility of delivering an adapted iOTA to SMI patients receiving care in community settings and suggest testable criteria for defining sufficient treatment engagement and psychiatric symptom severity, two factors known to impact weight loss outcomes. These important findings suggest specific adaptations may be needed for optimal treatment outcomes in individuals with SMI.
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Affiliation(s)
- Ginger Nicol
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Madeline Jansen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Los Angeles David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Rita Haddad
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
| | - Amanda Ricchio
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
| | - Michael D Yingling
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
| | - Julia A Schweiger
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
| | - Katie Keenoy
- Washington University School of Medicine, St. Louis, MO, United States
| | - Bradley A Evanoff
- Division of General Medical Sciences, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - John W Newcomer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
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Bradley T, Campbell E, Dray J, Bartlem K, Wye P, Hanly G, Gibson L, Fehily C, Bailey J, Wynne O, Colyvas K, Bowman J. Systematic review of lifestyle interventions to improve weight, physical activity and diet among people with a mental health condition. Syst Rev 2022; 11:198. [PMID: 36085250 PMCID: PMC9462072 DOI: 10.1186/s13643-022-02067-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with a mental health condition experience an elevated risk of chronic disease and greater prevalence of health and behaviours. Lifestyle interventions aim to reduce this risk by modifying health behaviours such as physical activity and diet. Previous reviews exploring the efficacy of such interventions for this group have typically limited inclusion to individuals with severe mental illness (SMI), with a focus of impact on weight. This review assessed the efficacy of lifestyle interventions delivered in community or outpatient settings to people with any mental health condition, on weight, physical activity and diet. METHODS Eligible studies were randomised or cluster-randomised controlled trials published between January 1999 and February 2019 aiming to improve weight, physical activity or diet, for people with any mental health condition. Two reviewers independently completed study screening, data extraction and assessment of methodological quality. Primary outcome measures were weight, physical activity and diet. Secondary outcome measures were body mass index (BMI), waist circumference, sedentary behaviour and mental health. Where possible, meta-analyses were conducted. Narrative synthesis using vote counting based on direction of effect was used where studies were not amenable to meta-analysis. RESULTS Fifty-seven studies were included (49 SMI only), with 46 contributing to meta-analyses. Meta-analyses revealed significant (< 0.05) effect of interventions on mean weight loss (-1.42 kg), achieving 5% weight loss (OR 2.48), weight maintenance (-2.05 kg), physical activity (IPAQ MET minutes: 226.82) and daily vegetable serves (0.51), but not on fruit serves (0.01). Significant effects were also seen for secondary outcomes of BMI (-0.48 units) and waist circumference (-0.87cm), but not mental health (depression: SMD -0.03; anxiety: SMD -0.49; severity of psychological symptoms: SMD 0.72). Studies reporting sedentary behaviour were not able to be meta-analysed. Most trials had high risk of bias, quality of evidence for weight and physical activity were moderate, while quality of evidence for diet was low. CONCLUSION Lifestyle interventions delivered to people with a mental health condition made statistically significant improvements to weight, BMI, waist circumference, vegetable serves and physical activity. Further high-quality trials with greater consistency in measurement and reporting of outcomes are needed to better understand the impact of lifestyle interventions on physical activity, diet, sedentary behaviour and mental health and to understand impact on subgroups. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019137197.
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Affiliation(s)
- Tegan Bradley
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287 Australia
| | - Julia Dray
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Kate Bartlem
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Paula Wye
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Grace Hanly
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Lauren Gibson
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Caitlin Fehily
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Jacqueline Bailey
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Olivia Wynne
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Kim Colyvas
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Jenny Bowman
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
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Robertson C, Aceves-Martins M, Cruickshank M, Imamura M, Avenell A. Does weight management research for adults with severe obesity represent them? Analysis of systematic review data. BMJ Open 2022; 12:e054459. [PMID: 35641006 PMCID: PMC9157335 DOI: 10.1136/bmjopen-2021-054459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Our objective was to determine the extent to which current evidence from long-term randomised controlled trials (RCTs) of weight management is generalisable and applicable to underserved adult groups with obesity (body mass index (BMI) ≥35 kg/m2). METHODS Descriptive analysis of 131 RCTs, published after 1990-May 2017 with ≥1 year of follow-up, included in a systematic review of long-term weight management interventions for adults with BMI ≥35 kg/m2 (the REBALANCE Project). Studies were identified from MEDLINE, EMBASE, PsychINFO, SCI, CENTRAL and from hand searching. Reporting of trial inclusion and exclusion criteria, trial recruitment strategies, baseline characteristics and outcomes were analysed using a predefined list of characteristics informed by the PROGRESS (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital)-Plus framework and the UK Equality Act 2010. RESULTS Few (6.1%) trials reported adapting recruitment to appeal to underserved groups. 10.0% reported culturally adapting their trial materials. Only 6.1% of trials gave any justification for their exclusion criteria, yet over half excluded participation for age or mental health reasons. Just over half (58%) of the trials reported participants' race or ethnicity, and one-fifth reported socioeconomic status. Where outcomes were reported for underserved groups, the most common analysis was by sex (47.3%), followed by race or ethnicity (16.8%). 3.1% of trials reported outcomes according to socioeconomic status. DISCUSSION Although we were limited by poor trial reporting, our results indicate inadequate representation of people most at risk of obesity. Guidance for considering underserved groups may improve the appropriateness of research and inform greater engagement with health and social care services. FUNDING National Institute for Health Research Health Technology Assessment Programme (project number: 15/09/04). PROSPERO REGISTRATION NUMBER CRD42016040190.
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Affiliation(s)
- Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Looijmans A, Jörg F, Bruggeman R, Schoevers RA, Corpeleijn E, Feenstra TL, van Asselt ADIT. Cost-effectiveness and budget impact of a lifestyle intervention to improve cardiometabolic health in patients with severe mental illness. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2020; 7:131-138. [PMID: 36627968 PMCID: PMC9677596 DOI: 10.33393/grhta.2020.2027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/19/2020] [Indexed: 01/13/2023] Open
Abstract
Introduction This study assessed the cost-effectiveness and budget impact of a lifestyle intervention to improve cardiometabolic health in severe mentally ill (SMI) patients in the LION trial. Methods Patients (n = 244) were randomized to receive either care-as-usual or a lifestyle intervention in which mental health nurses coached patients in changing their lifestyle by using a web tool. Costs and quality of life were assessed at baseline and at 6 and 12 months. Incremental costs per centimeter waist circumference (WC) lost and per Quality-Adjusted Life Year (QALY) gained were assessed. Budget impact was estimated based on three intervention-uptake scenarios using a societal and a third-party payer perspective. Results Costs and reduction in WC were higher in the intervention (n = 114) than in the control (n = 94) group after 12 months, although not statistically significant, resulting in €1,370 per cm WC lost. QALYs did not differ between the groups, resulting in a low probability of the intervention being cost-effective in cost/QALY gained. The budget impact analysis showed that for a reasonable participation of 43%, total costs were around €81 million over 5 years, or on average €16 million annually (societal perspective). Conclusions The intervention is not cost-effective at 12 months and the budget impact over 5 years is substantial. Possibly, 12 months was too short to implement the intervention, improve cardiometabolic health, and reduce care costs. Therefore, the incentive for this intervention cannot be found in short-term financial advantages. However, there may be benefits associated with lifestyle interventions in the long term that remain unclear.
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Affiliation(s)
- Anne Looijmans
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen - The Netherlands
- Rob Giel Research Centre, University Medical Center Groningen, University of Groningen, Groningen - The Netherlands
| | - Frederike Jörg
- Rob Giel Research Centre, University Medical Center Groningen, University of Groningen, Groningen - The Netherlands
- Research Department, Friesland Mental Health Services, Leeuwarden - The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Centre, University Medical Center Groningen, University of Groningen, Groningen - The Netherlands
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen - The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen - The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen - The Netherlands
| | - Talitha L Feenstra
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen - The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven - The Netherlands
| | - A D I Thea van Asselt
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen - The Netherlands
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen - The Netherlands
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Looijmans A, Jörg F, Bruggeman R, Schoevers RA, Corpeleijn E. Multimodal lifestyle intervention using a web-based tool to improve cardiometabolic health in patients with serious mental illness: results of a cluster randomized controlled trial (LION). BMC Psychiatry 2019; 19:339. [PMID: 31690281 PMCID: PMC6833253 DOI: 10.1186/s12888-019-2310-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/09/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Unhealthy lifestyle behaviours contribute to alarming cardiometabolic risk in patients with serious mental illness (SMI). Evidence-based practical lifestyle tools supporting patients and staff in improving patient lifestyle are lacking. METHODS This multi-site randomized controlled pragmatic trial determined the effectiveness of a twelve-month multimodal lifestyle approach, including a web-based tool to improve patients' cardiometabolic health, versus care-as-usual. Using the web tool, nurses (trained in motivational interviewing) assisted patients in assessing their lifestyle behaviours, creating a risk profile and constructing lifestyle goals, which were discussed during fortnightly regular care visits. Twenty-seven community-care and sheltered-living teams were randomized into intervention (N = 17) or control (N = 10) groups, including 244 patients (140 intervention/104 control, 49.2% male, 46.1 ± 10.8 years) with increased waist circumference (WC), BMI or fasting glucose. The primary outcomes concerned differences in WC after six and twelve months intervention, while BMI and metabolic syndrome Z-score were secondary outcome measures. RESULTS General multilevel linear mixed models adjusted for antipsychotic medication showed that differences in WC change between intervention and control were - 0.15 cm (95%CI: - 2.49; 2.19) after six and - 1.03 cm (95%CI: - 3.42; 1.35) after twelve months intervention; however, the differences were not statistically significant. No intervention effects were found for secondary outcome measures. The intervention increased patients' readiness to change dietary behaviour. CONCLUSION A multimodal web-based intervention facilitating nurses to address lifestyle changes in SMI patients did not improve patient cardiometabolic health. Web-tool use was lower than expected and nurses need more lifestyle coaching knowledge and skills. The type of intervention and delivery mode need optimization to realize effective lifestyle care for SMI patients. TRIAL REGISTRATION Dutch Trial Registry, www.trialregister.nl , NTR3765, 21 December 2012.
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Affiliation(s)
- Anne Looijmans
- Department of Health Psychology, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700, RB, Groningen, The Netherlands.
| | - Frederike Jörg
- Rob Giel Research Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,Research Department, Friesland Mental Health Services, Leeuwarden, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,0000 0000 9558 4598grid.4494.dDepartment of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A. Schoevers
- 0000 0000 9558 4598grid.4494.dDepartment of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- 0000 0000 9558 4598grid.4494.dDepartment of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Mucheru D, Hanlon MC, McEvoy M, MacDonald-Wicks L. An appraisal of methodology reporting in lifestyle interventions among people with psychosis: A systematic review. Health Promot J Austr 2019; 31:540-552. [PMID: 31495017 DOI: 10.1002/hpja.293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 06/24/2019] [Accepted: 08/30/2019] [Indexed: 12/20/2022] Open
Abstract
ISSUE ADDRESSED Lifestyle interventions use nutrition and physical activity behaviour modification techniques to decrease obesity and cardio-metabolic risk in people with psychosis. Evidence on the specific behaviour modification strategies applied to decrease obesity is weakened by inadequate methodology reporting of lifestyle interventions. A systematic review that we conducted earlier highlighted a possible deficiency in reporting; hence we aim to critically appraise lifestyle intervention studies that target weight outcomes for people with psychosis against the methods component of the CONSORT statement for randomised trials of nonpharmacologic treatments. METHODS COMPONENT We considered randomised controlled studies which delivered lifestyle interventions to community-dwelling adults with psychotic disorders, and included those with the following outcomes of interest: weight, body mass index, waist circumference and waist-to-hip ratio. The Cochrane Library, MEDLINE/PREMEDLINE, EMBASE, CINAHL, Scopus and PsycINFO were searched for English publications between 1985 and 2018. Methodology and reporting of studies were evaluated using the CONSORT statement for randomised trials of nonpharmacologic treatments. RESULTS Thirty-two studies met the inclusion criteria. Critical appraisals revealed that reporting of lifestyle intervention studies was generally incomplete. Fewer than 50% provided the recommended information on trial design, participant characteristics, detail of interventions, outcomes, sample size, randomisation, blinding and statistical methods. CONCLUSIONS Application of guidelines, like the CONSORT statement, in future publications of lifestyle interventions for people with psychosis will improve accuracy of reporting. SO WHAT?: Enhanced reporting in lifestyle intervention studies for people with psychosis will promote guideline creation and translation of research, which is likely to positively impact physical health outcomes.
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Affiliation(s)
- Doreen Mucheru
- Faculty Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Mary-Claire Hanlon
- Faculty Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton, NSW, Australia.,Priority Research Centre for Brain and Mental Health, Mater Hospital, Waratah, NSW, Australia.,Hunter Cancer Research Alliance, The University of Newcastle, Callaghan, NSW, Australia
| | - Mark McEvoy
- Faculty Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Centre for Clinical Epidemiology & Biostatistics, Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Lesley MacDonald-Wicks
- Faculty Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
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Mucheru D, Hanlon MC, McEvoy M, Thakkinstian A, MacDonald-Wicks L. Comparative efficacy of lifestyle intervention strategies targeting weight outcomes in people with psychosis. ACTA ACUST UNITED AC 2019; 17:1770-1825. [DOI: 10.11124/jbisrir-2017-003943] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Avenell A, Robertson C, Skea Z, Jacobsen E, Boyers D, Cooper D, Aceves-Martins M, Retat L, Fraser C, Aveyard P, Stewart F, MacLennan G, Webber L, Corbould E, Xu B, Jaccard A, Boyle B, Duncan E, Shimonovich M, Bruin MD. Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess 2018; 22:1-246. [PMID: 30511918 PMCID: PMC6296173 DOI: 10.3310/hta22680] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adults with severe obesity [body mass index (BMI) of ≥ 35 kg/m2] have an increased risk of comorbidities and psychological, social and economic consequences. OBJECTIVES Systematically review bariatric surgery, weight-management programmes (WMPs) and orlistat pharmacotherapy for adults with severe obesity, and evaluate the feasibility, acceptability, clinical effectiveness and cost-effectiveness of treatment. DATA SOURCES Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials and the NHS Economic Evaluation Database were searched (last searched in May 2017). REVIEW METHODS Four systematic reviews evaluated clinical effectiveness, cost-effectiveness and qualitative evidence for adults with a BMI of ≥ 35 kg/m2. Data from meta-analyses populated a microsimulation model predicting costs, outcomes and cost-effectiveness of Roux-en-Y gastric bypass (RYGB) surgery and the most effective lifestyle WMPs over a 30-year time horizon from a NHS perspective, compared with current UK population obesity trends. Interventions were cost-effective if the additional cost of achieving a quality-adjusted life-year is < £20,000-30,000. RESULTS A total of 131 randomised controlled trials (RCTs), 26 UK studies, 33 qualitative studies and 46 cost-effectiveness studies were included. From RCTs, RYGB produced the greatest long-term weight change [-20.23 kg, 95% confidence interval (CI) -23.75 to -16.71 kg, at 60 months]. WMPs with very low-calorie diets (VLCDs) produced the greatest weight loss at 12 months compared with no WMPs. Adding a VLCD to a WMP gave an additional mean weight change of -4.41 kg (95% CI -5.93 to -2.88 kg) at 12 months. The intensive Look AHEAD WMP produced mean long-term weight loss of 6% in people with type 2 diabetes mellitus (at a median of 9.6 years). The microsimulation model found that WMPs were generally cost-effective compared with population obesity trends. Long-term WMP weight regain was very uncertain, apart from Look AHEAD. The addition of a VLCD to a WMP was not cost-effective compared with a WMP alone. RYGB was cost-effective compared with no surgery and WMPs, but the model did not replicate long-term cost savings found in previous studies. Qualitative data suggested that participants could be attracted to take part in WMPs through endorsement by their health-care provider or through perceiving innovative activities, with WMPs being delivered to groups. Features improving long-term weight loss included having group support, additional behavioural support, a physical activity programme to attend, a prescribed calorie diet or a calorie deficit. LIMITATIONS Reviewed studies often lacked generalisability to UK settings in terms of participants and resources for implementation, and usually lacked long-term follow-up (particularly for complications for surgery), leading to unrealistic weight regain assumptions. The views of potential and actual users of services were rarely reported to contribute to service design. This study may have failed to identify unpublished UK evaluations. Dual, blinded numerical data extraction was not undertaken. CONCLUSIONS Roux-en-Y gastric bypass was costly to deliver, but it was the most cost-effective intervention. Adding a VLCD to a WMP was not cost-effective compared with a WMP alone. Most WMPs were cost-effective compared with current population obesity trends. FUTURE WORK Improved reporting of WMPs is needed to allow replication, translation and further research. Qualitative research is needed with adults who are potential users of, or who fail to engage with or drop out from, WMPs. RCTs and economic evaluations in UK settings (e.g. Tier 3, commercial programmes or primary care) should evaluate VLCDs with long-term follow-up (≥ 5 years). Decision models should incorporate relevant costs, disease states and evidence-based weight regain assumptions. STUDY REGISTRATION This study is registered as PROSPERO CRD42016040190. FUNDING The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit and Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.
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Affiliation(s)
- Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zoë Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | | | | | - Bonnie Boyle
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Eilidh Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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11
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Abstract
BACKGROUND Cardiorespiratory fitness (CRF) among people with severe mental illness (SMI) (i.e., schizophrenia, bipolar disorder, and major depressive disorder) is a critical clinical risk factor given its relationship to cardiovascular disease and premature mortality. OBJECTIVES This study aimed to: (1) investigate the mean CRF in people with SMI versus healthy controls; (2) explore moderators of CRF; and (3) investigate whether CRF improved with exercise interventions and establish if fitness improves more than body mass index following exercise interventions. METHODS Major electronic databases were searched systematically. A meta-analysis calculating Hedges' g statistic was undertaken. RESULTS Across 23 eligible studies, pooled mean CRF was 28.7 mL/kg/min [95 % confidence interval (CI) 27.3 to 30.0 mL/kg/min, p < 0.001, n = 980]. People with SMI had significantly lower CRF compared with controls (n = 310) (Hedges' g = -1.01, 95 % CI -1.18 to -0.85, p < 0.001). There were no differences between diagnostic subgroups. In a multivariate regression, first-episode (β = 6.6, 95 % CI 0.6-12.6) and inpatient (β = 5.3, 95 % CI 1.6-9.0) status were significant predictors of higher CRF. Exercise improved CRF (Hedges' g = 0.33, 95 % CI = 0.21-0.45, p = 0.001), but did not reduce body mass index. Higher CRF improvements were observed following interventions at high intensity, with higher frequency (at least three times per week) and supervised by qualified personnel (i.e., physiotherapists and exercise physiologists). CONCLUSION The multidisciplinary treatment of people with SMI should include a focus on improving fitness to reduce all-cause mortality. Qualified healthcare professionals supporting people with SMI in maintaining an active lifestyle should be included as part of multidisciplinary teams in mental health treatment.
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Vancampfort D, Stubbs B. Physical activity and metabolic disease among people with affective disorders: Prevention, management and implementation. J Affect Disord 2017; 224:87-94. [PMID: 27519365 DOI: 10.1016/j.jad.2016.07.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/24/2016] [Accepted: 07/10/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND One in ten and one in three of people with affective disorders experience diabetes and metabolic syndrome respectively. Physical activity (PA) and sedentary behaviour (SB) are key risk factors that can ameliorate the risk of metabolic disease among this population. However, PA is often seen as luxury and/or a secondary component within the management of people with affective disorders. METHODS The current article provides a non-systematic best-evidence synthesis of the available literature, detailing a number of suggestions for the implementation of PA into clinical practice. RESULTS Whilst the evidence is unequivocal for the efficacy of PA to prevent and manage metabolic disease in the general population, it is in its infancy in this patient group. Nonetheless, action must be taken now to ensure that PA and reducing SB are given a priority to prevent and manage metabolic diseases and improve wider health outcomes. PA should be treated as a vital sign and all people with affective disorders asked about their activity levels and if appropriate advised to increase this. There is a need for investment in qualified exercise specialists in clinical practice such as physiotherapists to undertake and oversee PA in practice. Behavioural strategies such as the self-determined theory should be employed to encourage adherence. Funding is required to develop the evidence base and elucidate the optimal intervention characteristics. CONCLUSION PA interventions should form an integral part of the multidisciplinary management of people with affective disorders and our article outlines the evidence and strategies to implement this in practice.
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Affiliation(s)
- Davy Vancampfort
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Campus Kortenberg, Belgium
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK.
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13
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Ma C, Avenell A, Bolland M, Hudson J, Stewart F, Robertson C, Sharma P, Fraser C, MacLennan G. Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis. BMJ 2017; 359:j4849. [PMID: 29138133 PMCID: PMC5682593 DOI: 10.1136/bmj.j4849] [Citation(s) in RCA: 287] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective To assess whether weight loss interventions for adults with obesity affect all cause, cardiovascular, and cancer mortality, cardiovascular disease, cancer, and body weight.Design Systematic review and meta-analysis of randomised controlled trials (RCTs) using random effects, estimating risk ratios, and mean differences. Heterogeneity investigated using Cochran's Q and I2 statistics. Quality of evidence assessed by GRADE criteria.Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials, and full texts in our trials' registry for data not evident in databases. Authors were contacted for unpublished data.Eligibility criteria for selecting studies RCTs of dietary interventions targeting weight loss, with or without exercise advice or programmes, for adults with obesity and follow-up ≥1 year.Results 54 RCTs with 30 206 participants were identified. All but one trial evaluated low fat, weight reducing diets. For the primary outcome, high quality evidence showed that weight loss interventions decrease all cause mortality (34 trials, 685 events; risk ratio 0.82, 95% confidence interval 0.71 to 0.95), with six fewer deaths per 1000 participants (95% confidence interval two to 10). For other primary outcomes moderate quality evidence showed an effect on cardiovascular mortality (eight trials, 134 events; risk ratio 0.93, 95% confidence interval 0.67 to 1.31), and very low quality evidence showed an effect on cancer mortality (eight trials, 34 events; risk ratio 0.58, 95% confidence interval 0.30 to 1.11). Twenty four trials (15 176 participants) reported high quality evidence on participants developing new cardiovascular events (1043 events; risk ratio 0.93, 95% confidence interval 0.83 to 1.04). Nineteen trials (6330 participants) provided very low quality evidence on participants developing new cancers (103 events; risk ratio 0.92, 95% confidence interval 0.63 to 1.36).Conclusions Weight reducing diets, usually low in fat and saturated fat, with or without exercise advice or programmes, may reduce premature all cause mortality in adults with obesity.Systematic review registration PROSPERO CRD42016033217.
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Affiliation(s)
- Chenhan Ma
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Mark Bolland
- Bone and Joint Research Group, Department of Medicine, University of Auckland, Private Bag 92 019, Auckland 1142, New Zealand
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Pawana Sharma
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
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Verhaegen AA, Van Gaal LF. Drug-induced obesity and its metabolic consequences: a review with a focus on mechanisms and possible therapeutic options. J Endocrinol Invest 2017; 40:1165-1174. [PMID: 28660606 DOI: 10.1007/s40618-017-0719-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 06/19/2017] [Indexed: 01/01/2023]
Abstract
Weight gain is a common side effect of many widely used drugs. Weight gain of a few kilograms to an increase of 10% or more of initial body weight has been described. Not only the weight gain as such puts a burden on the health risks of the involved patients, the accompanying increase in the incidence of the metabolic syndrome, type 2 diabetes mellitus, and cardiovascular risk factors urges the caregiver to identify and to closely monitor the patients at risk. In this review, the different classes of drugs with significant weight gaining properties and the metabolic consequences are described. Specific attention is given to pathogenetic mechanisms underlying the metabolic effects and to potential therapeutic measures to prevent them.
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Affiliation(s)
- A A Verhaegen
- Department Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Wilrijkstraat 10, 2610, Edegem, Antwerp, Belgium
- Department of Endocrinology, ZNA-Jan Palfijn, Antwerp, Belgium
| | - L F Van Gaal
- Department Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Wilrijkstraat 10, 2610, Edegem, Antwerp, Belgium.
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Naslund JA, Whiteman KL, McHugo GJ, Aschbrenner KA, Marsch LA, Bartels SJ. Lifestyle interventions for weight loss among overweight and obese adults with serious mental illness: A systematic review and meta-analysis. Gen Hosp Psychiatry 2017; 47:83-102. [PMID: 28807143 PMCID: PMC5575752 DOI: 10.1016/j.genhosppsych.2017.04.003] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis to estimate effects of lifestyle intervention participation on weight reduction among overweight and obese adults with serious mental illness. METHOD We systematically searched electronic databases for randomized controlled trials comparing lifestyle interventions with other interventions or usual care controls in overweight and obese adults with serious mental illness, including schizophrenia spectrum or mood disorders. Included studies reported change in weight [kg] or body mass index (BMI) [kg/m2] from baseline to follow-up. Standardized mean differences (SMD) were calculated for change in weight from baseline between intervention and control groups. RESULTS Seventeen studies met inclusion criteria (1968 participants; 50% male; 66% schizophrenia spectrum disorders). Studies were grouped by intervention duration (≤6-months or ≥12-months). Lifestyle interventions of ≤6-months duration showed greater weight reduction compared with controls as indicated by effect size for weight change from baseline (SMD=-0.20; 95% CI=-0.34, -0.05; 10 studies), but high statistical heterogeneity (I2=90%). Lifestyle interventions of ≥12-months duration also showed greater weight reduction compared with controls (SMD=-0.24; 95% CI=-0.36, -0.12; 6 studies) with low statistical heterogeneity (I2=0%). CONCLUSION Lifestyle interventions appear effective for treating overweight and obesity among people with serious mental illness. Interventions of ≥12-months duration compared to ≤6-months duration appear to achieve more consistent outcomes, though effect sizes are similar for both shorter and longer duration interventions.
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Affiliation(s)
- John A Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States; Health Promotion Research Center at Dartmouth, Lebanon, NH, United States.
| | - Karen L Whiteman
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
| | - Gregory J McHugo
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Kelly A Aschbrenner
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Lisa A Marsch
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Stephen J Bartels
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States; Health Promotion Research Center at Dartmouth, Lebanon, NH, United States; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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Yarborough BJH, Leo MC, Yarborough MT, Stumbo S, Janoff SL, Perrin NA, Green CA. Improvement in Body Image, Perceived Health, and Health-Related Self-Efficacy Among People With Serious Mental Illness: The STRIDE Study. Psychiatr Serv 2016; 67:296-301. [PMID: 26522674 PMCID: PMC7104613 DOI: 10.1176/appi.ps.201400535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined secondary outcomes of STRIDE, a randomized controlled trial that tested a weight-loss and lifestyle intervention for individuals taking antipsychotic medications. METHODS Hierarchical linear regression was used to explore the effects of the intervention and weight change at follow-up (six, 12, and 24 months) on body image, perceived health, and health-related self-efficacy. RESULTS Participants were 200 adults who were overweight and taking antipsychotic agents. Weight change × study arm interaction was associated with significant improvement in body image from baseline to six months. From baseline to 12 months, body image scores of intervention participants improved by 1.7 points more compared with scores of control participants; greater weight loss was associated with more improvement. Between baseline and 24 months, greater weight loss was associated with improvements in body image, perceived health, and health-related self-efficacy. CONCLUSIONS Participation in STRIDE improved body image, and losing weight improved perceived health and health-related self-efficacy.
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Affiliation(s)
- Bobbi Jo H Yarborough
- The authors are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (e-mail: )
| | - Michael C Leo
- The authors are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (e-mail: )
| | - Micah T Yarborough
- The authors are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (e-mail: )
| | - Scott Stumbo
- The authors are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (e-mail: )
| | - Shannon L Janoff
- The authors are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (e-mail: )
| | - Nancy A Perrin
- The authors are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (e-mail: )
| | - Carla A Green
- The authors are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (e-mail: )
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Yarborough BJ. Health promotion coaching for obese individuals with serious mental illnesses produces clinically significant reductions in cardiovascular risks up to 18 months. EVIDENCE-BASED MENTAL HEALTH 2016; 19:31. [PMID: 26747874 PMCID: PMC10699346 DOI: 10.1136/eb-2015-102141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/19/2015] [Accepted: 11/26/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Bobbi Jo Yarborough
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA;
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