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Patients with Schizophrenia Can Lose Weight, Maintain Loss When Participating in Structured Weight Control Program

PISCATAWAY, NJ -- April 29, 2004 -- A new study shows obese adults taking atypical antipsychotic medications to treat severe mental illness such as schizophrenia were able to significantly decrease their weight and body mass index (BMI) while participating in a year-long structured weight management program.

This study is the first to provide long-term data showing that patients being treated for schizophrenia or schizoaffective disorder with atypical antipsychotics can benefit from a weight control program.

"Weight control has not been well studied in schizophrenia, and there is little information to guide clinical practice and help people being treated for serious and persistent mental illness control their weight," said Betty Vreeland, program manager of the University Behavioral HealthCare Center for Excellence in Psychiatry at the University of Medicine and Dentistry of New Jersey (UMDNJ) and clinical assistant professor at UMDNJ-Robert Wood Johnson Medical School and at the UMDNJ-School of Nursing.

"This study demonstrates that patients with schizophrenia can lose weight and maintain the loss over a one-year period, when the opportunity to participate in a structured weight control program is available," said Dr. Matthew Menza, study investigator and acting chairman of the Department of Psychiatry at UMDNJ-Robert Wood Johnson Medical School.

Patients with schizophrenia are, on average, significantly overweight. Consequently, they are at increased risk for a variety of obesity-related medical conditions such as diabetes and cardiovascular disease. A range of factors contributes to obesity in people with serious and persistent mental illness, including lifestyle factors such as poor diet and lack of exercise. In addition, some of the excess weight seen in people with schizophrenia is medication-induced.

"For those with severe and persistent mental illness, managing weight can be a challenge that sometimes results in medication non-adherence, potentially leading to psychiatric relapse and even hospitalization," Vreeland said. "This study suggests that programs like this can help people with psychiatric illnesses manage their weight, improve health outcomes and feel better about themselves. This finding should also lead to improved medication adherence."

The results of this study, which are published in the April issue of the Journal of Clinical Psychiatry, show that participants in the intervention group experienced a mean weight loss of 6.6 pounds (3 percent of body weight) compared to a mean gain of 7 pounds (3.5 percent of body weight) in the non- intervention group.

The weight loss was accompanied by significant improvements in other health outcomes such as hemoglobin A1C (the amount of glucose in the blood during the past 2 to 4 months), systolic and diastolic blood pressure, waist circumference, exercise and nutritional knowledge.

In addition to the weight loss, the study indicated that among those in the weight control program, there was a corresponding decrease in BMI 1.7 (5.1 percent) in the intervention group, in contrast to an increase of 2.6 (8.1 percent) in the nonintervention group. A BMI reduction of one point equates to a weight loss of about six or seven pounds, depending on the height of the individual.

In addition, patients were able to lose weight no matter what atypical antipsychotic they were receiving (olanzapine, clozapine, risperidone or quetiapine) with no significant differences between the drugs. The study was designed to detect differences between drugs.

For the study, 31 individuals with serious and persistent mental illness, who were participating in day treatment programs, enrolled in a 12-month, multi-modal, weight control program called Healthy Living. Twenty of the patients had schizophrenia and 11 had schizoaffective disorder. Sixteen others, who were also participating in the day treatment programs, declined to participate in the Healthy Living program and continued their care as usual. Twenty participants completed the program.

All patients had been treated with atypical antipsychotic medication for a minimum of three months and had a BMI of 26 or greater or a self-reported weight gain of five pounds or more within two months of beginning treatment with an atypical agent. The mean BMI at baseline in the treatment group was 34.3; in the nonintervention group the BMI was 32.2.

The protocol followed included nutrition counseling, exercise, and behavioral interventions designed to help adults with schizophrenia implement healthy changes. Behavioral strategies included self-monitoring of eating and physical activity, stress management, stimulus control, problem solving and social support.

The intervention lasted for 12 months and consisted of four phases: an assessment phase; an intensive 12-week control program with group meeting twice per week and one 15-minute individual session per week; a 12-week step- down, less intensive weight control program with a group meeting once per week and one 15-minute individual session per month, and six-month weight- maintenance extension with a group meeting once per week and one 15-minute individual session per month.

One of the two weekly group sessions in the intensive phase included teaching of basic nutrition principles. Subjects were encouraged to engage in light-to-moderate exercise (at least as intense as sustained walking) for a minimum of 20 minutes three to five times per week.

The investigator-initiated study was funded by Eli Lilly and Company.


SOURCE: University of Medicine and Dentistry of New Jersey

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