A Randomized, Controlled Multisite Study of Behavioral Interventions for Veterans with Mental Illness and Antipsychotic Medication-Associated Obesity
- First Online:
- 310 Downloads
Weight gain and other metabolic sequelae of antipsychotic medications can lead to medication non-adherence, reduced quality of life, increased costs, and premature mortality. Of the approaches to address this, behavioral interventions are less invasive, cost less, and can result in sustained long-term benefits.
We investigated behavioral weight management interventions for veterans with mental illness across four medical centers within the Veterans Affairs (VA) Healthcare System.
We conducted a 12-month, multi-site extension of our previous randomized, controlled study, comparing treatment and control groups.
Veterans (and some non-veteran women) diagnosed with mental illness, overweight (defined as having a BMI over 25), and required ongoing antipsychotic therapy.
One group received “Lifestyle Balance” (LB; modified from the Diabetes Prevention Program) consisting of classes and individual nutritional counseling with a dietitian. A second group received less intensive “Usual Care” (UC) consisting of weight monitoring and provision of self-help.
Participants completed anthropometric and nutrition assessments weekly for 8 weeks, then monthly. Psychiatric, behavioral, and physical assessments were conducted at baseline and months 2, 6, and 12. Metabolic and lipid laboratory tests were performed quarterly.
Participants in both groups lost weight. LB participants had a greater decrease in average waist circumference [F(1,1244) = 11.9, p < 0.001] and percent body fat [F(1,1121) = 4.3, p = 0.038]. Controlling for gender yielded statistically significant changes between groups in BMI [F(1,1246) = 13.9, p < 0.001]. Waist circumference and percent body fat decreased for LB women [F(1,1243) = 22.5, p < 0.001 and F(1,1221) = 4.8, p = 0.029, respectively]. The majority of LB participants kept food and activity journals (92%), and average daily calorie intake decreased from 2055 to 1650 during the study (p < 0.001).
Behavioral interventions specifically designed for individuals with mental illness can be effective for weight loss and improve dietary behaviors. “Lifestyle Balance” integrates well with VA healthcare’s patient-centered “Whole Health” approach.
ClinicalTrials.gov identifier NCT01052714.
Key Wordsantipsychotic weight management obesity behavioral intervention mental health
- 8.US Department of Health and Human Services: Agency for Healthcare Research and Quality. National Statistics on Mental Health Hospitalizations: Schizophrenia and other psychotic disorders. Healthcare Cost and Utilization Project (H-CUPnet). http://hcupnet.ahrq.gov/HCUPnet.jsp. Accessed June 29, 2016.
- 28.Overall JE, Gorham DR. The brief psychiatric rating scale (BPRS): Recent developments in ascertainment and scaling. Psychopharmacol Bull. 1988;24(1):97–99.Google Scholar
- 29.Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised. Rockville, MD: US Dept. of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch, Division of Extramural Research Programs. 1976.Google Scholar
- 31.Beck A, Steer R. Beck Anxiety Inventory Manual. San Antonio, TX: Psychological Corp.; 1993.Google Scholar
- 38.First M, Spitzer R, Gibbon M, Williams J. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I). New York, NY: Biometric Research Department; 1997.Google Scholar
- 39.Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486–2497.Google Scholar
- 40.Balady GJ, Chaitman B, Driscoll D, et al. American College of Sports Medicine Position Stand and American Heart Association. Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Med Sci Sports Exerc. 1998;30(6):1009–1018.Google Scholar
- 44.Wenzel A, Brown GK, Karlin BE. Cognitive Behavioral Therapy for Depression in Veterans and Military Servicemembers: Therapist Manual. Washington, DC: US Department of Veterans Affairs; 2011.Google Scholar
- 46.Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. New York, NY: Guilford Press; 2012.Google Scholar
- 47.US Department of Agriculture. USDA Supertracker “Food-A-Pedia”. USDA Supertracker. https://www.supertracker.usda.gov/foodapedia.aspx. Accessed October 26, 2016.
- 50.Goodrich DE, Klingaman EA, Verchinina L, et al. Sex differences in weight loss among veterans with serious mental illness: observational study of a national weight management program. Womens Health Issues. 2016.Google Scholar
- 51.Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129(25 Suppl 2):S102–138.CrossRefPubMedGoogle Scholar
- 52.Vazin R, McGinty EE, Dickerson F, et al. Perceptions of strategies for successful weight loss in persons with serious mental illness participating in a behavioral weight loss intervention: a qualitative study. Psychiatr Rehabil J. 2016;39(2):137–46.Google Scholar