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Mental illness

Mental illness should not be a barrier for weight intervention

Patients who emrolled in a behaviour management programme made substantial lifestyle changes to improve their health

Patients with serious mental illness can make healthy behavioural changes and achieve significant weight loss in intervention programmes, according to a study published in the New England journal of Medicine. The amounts of weight loss were comparable other weight loss programmes with that specifically excluded people with serious mental illnesses, said the study’s researchers from John Hopkins University.

"This population is often stigmatised," said study leader Dr Gail L Daumit, an associate professor of general internal medicine at the Johns Hopkins University School of Medicine. "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."

Results of the new research, which the researchers believe is the first large study of its kind to involve people with schizophrenia, bipolar disorder or major depression, suggest that a population some consider to be unable to engage in a behaviour management programme can make substantial lifestyle changes to improve their health. People with serious mental illness often are overweight or obese and have mortality rates two to three times higher than that of the general population, primarily from obesity-related conditions. Many are sedentary and take several psychotropic medications, which include weight gain as a side effect.

The study did not investigate the effects of bariatric surgery on patients with mental illness.

The ACHIEVE (Randomized Trial of Achieving Healthy Lifestyles in Psychiatric Rehabilitation) trial enrolled 291 overweight or obese patients with serious mental illness. One hundred and forty four were randomly placed in an intervention group, with 147 assigned to a control group. The intervention took place at ten Baltimore area outpatient psychiatric rehabilitation day facilities that already offered vocational and skills training, case management and other services for people with mental illness not well enough to work full time.

The researchers added a schedule of regular group and individual weight-management sessions, three-weekly exercise classes and a weekly weigh-in for the first six months of the trial. The sessions and weigh-ins continued, though less frequently, for the following year, though the exercise class schedule remained the same.

Of 291 participants who underwent randomisation, 58.1% had schizophrenia or a schizoaffective disorder, 22.0% had bipolar disorder, and 12.0% had major depression. Many with serious mental illness, particularly schizophrenia, have impairments in memory and executive function, as well as residual psychiatric symptoms that impede learning and adoption of new behaviours.

At baseline, the patients’ mean BMI was 36.3, and the mean weight was 102.7kg (225.9lb). Data on weight at 18 months were obtained from 279 participants.

Weight loss in the intervention group increased progressively over the 18-month study period and differed significantly from the control group at each follow-up visit. At 18 months, the mean between-group difference in weight (change in intervention group minus change in control group) was −3.2kg (−7.0lb, p=0.002); 37.8% of the participants in the intervention group lost 5% or more of their initial weight, as compared with 22.7% of those in the control group (p=0.009). There were no significant between-group differences in adverse events.

The participants took three psychotropic medications on average; the medications, often required for long-term symptom control, are known to cause weight gain in part by stimulating appetites and increased eating.

"We sought to dispel the perception that lifestyle programs don't work in this population," said Daumit. "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."

Instead of asking participants to keep detailed food logs and counting every calorie they consume – a practice common to other weight-loss programs – the trial focused on relatively simple messages and goals. Patients were encouraged to avoid junk food and sugary beverages, monitor portion sizes and include more fruits and vegetables in their diet. They had regular exercise at the rehabilitation facilities as part of the study, and were encouraged to exercise for 30 minutes on other days.

The study concluded: “Given the epidemic of obesity and weight-related disease among persons with serious mental illness, our findings support implementation of targeted behavioural weight-loss interventions in this high-risk population.”

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