People with serious mental illnesses — such as schizophrenia, bipolar disorder and depression — can lose weight and keep it off through a modified lifestyle intervention program, according to a new study.
Over 80 percent of people with serious mental illnesses are overweight or obese, which contributes to them dying at three times the rate of the overall population, according to researchers. The leading causes of death are the same as for the rest of the population: Cardiovascular disease, diabetes and cancer.
Although antipsychotic medications can increase appetite and cause weight gain in these patients, it is not the only culprit.
Like the general population, sedentary lifestyle and poor diet also play a part. Lifestyle modifications such as diet and exercise should work for these patients, yet they are often left out of weight loss studies.
“People with serious mental illnesses are commonly excluded from studies to help them help themselves about their weight,” said Gail L. Daumit, M.D., of Johns Hopkins University, and the study’s lead author.
“We sought to dispel the perception that lifestyle programs don’t work in this population. There’s this really important need to find ways to help this population be healthier and lose weight. We brought a weight-loss program to them, tailored to the needs of people with serious mental illness. And we were successful.”
The researcher noted that many people with serious mental illnesses can’t afford or can’t get to physical activity programs like health clubs. Some also suffer from social phobia or have poor social interactions, and are simply afraid to work out in a public area, she said.
Daumit’s group attempted to solve these issues by bringing the gyms and nutritionists to places most of these patients frequent — psychiatric rehabilitation outpatient programs.
Under the trial name ACHIEVE (Achieving Healthy Lifestyles in Psychiatric Rehabilitation), the researchers recruited 291 overweight or obese patients with serious mental illness. About half, 144, were randomly placed in an intervention group, while 147 made up the control group. The intervention took place at 10 Baltimore area outpatient psychiatric rehabilitation day facilities that already offer vocational and skills training, case management and other services for people with mental illness not well enough to work full time.
While the control group received the usual care, which included nutrition and physical activity information, the intervention group got six months of intensive intervention consisting of exercise classes three times a week, along with individual or group weight loss classes once a week.
Both groups were followed for an additional year, during which the weight loss classes of the intervention group tapered down but the exercise classes remained constant.
At the 18-month point, the intervention group lost, on average, seven more pounds than the control group.
Nearly 38 percent of the intervention group lost 5 percent or more of their initial weight, as compared with 23 percent of the control group.
More than 18 percent of those in the intervention group lost more than 10 percent of their body weight after 18 months, compared with 7 percent in the control group.
Participants also lost more weight as the intervention went on. This suggests it took a while to make behavioral changes, but once these modifications took hold, the changes yielded positive results, Daumit said.
Of the people in the study, 50 percent had schizophrenia, 22 percent had bipolar disorder, and 12 percent major depression.
On average, each participant was on three psychotropic medications, with half on lithium or mood stabilizers, all known to cause weight gain. But no matter what they were on, they lost the weight, she said.
“We’re showing behavioral interventions work regardless of what they’re taking,” Daumit said.
Daumit thinks the weight-loss program could be adopted by other psychiatric rehabilitation facilities.
“This population is often stigmatized,” she said. “This study’s findings should help people think differently about people with serious mental illness. Our results provide clear evidence that this population can make healthy lifestyle changes and achieve weight loss.”
The study was published in the New England Journal of Medicine.