Journal of General Internal Medicine

, Volume 32, Supplement 1, pp 32–39 | Cite as

A Randomized, Controlled Multisite Study of Behavioral Interventions for Veterans with Mental Illness and Antipsychotic Medication-Associated Obesity

  • Zachary D. Erickson
  • Crystal L. Kwan
  • Hollie A. Gelberg
  • Irina Y. Arnold
  • Valery Chamberlin
  • Jennifer A. Rosen
  • Chandresh Shah
  • Charles T. Nguyen
  • Gerhard Hellemann
  • Dixie R. Aragaki
  • Charles F. Kunkel
  • Melissa M. Lewis
  • Neena Sachinvala
  • Patrick A. Sonza
  • Joseph M. Pierre
  • Donna Ames
Original Research



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.

Main Measures

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.

Key Results

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. identifier NCT01052714.

Key Words

antipsychotic weight management obesity behavioral intervention mental health 



The authors wish to thank Drs. Binyamin Amrami, Hyung Kim, Frederick Martin, Christopher Reist, and Heidi Weinreich as well as Matthew Baker, Luzviminda Cristobal, RN, Michael King, Jr., Eugene Beau LaPorte, Jr., Shirley Mena, RN, Hilary Meyer, Deborah Peters, RN, and Jillian Tessier for providing clinical oversight, collaboration, and research assistance. We are also thankful to the staff and Veterans of the Mental Health Clinics, MHICM programs, and PRRCs at the VA Greater Los Angeles and Long Beach Healthcare Systems for their support of this program.

This work was supported by VA Merit Review Project D7358-R from the United States (US) Department of Veterans Affairs Rehabilitation Research and Development Service, which had no input as to study design, execution, analysis, or reporting. The contents do not represent the views of the US Department of Veterans Affairs or the United States Government.

Posters presented preliminary results of this study at the Annual Meeting for the California Dietetic Association in Ontario, CA, in 2012 and at the California Academy of Nutrition and Dietetics Annual Conference in Riverside, CA, in 2016.

Compliance with Ethical Standards

Conflict of Interest

Dr. Charles Nguyen owns stock in Orexigen Therapeutics, Inc., has received research grants from Forest Laboratory, Inc., and is a consultant and part of the Speakers Bureaus for Eisai Co., Ltd., and Otsuka America Pharmaceutical, Inc. All other authors declare no conflicts of interest.

Supplementary material

11606_2016_3960_MOESM1_ESM.docx (18 kb)
ESM 1 (DOCX 17 kb)
11606_2016_3960_MOESM2_ESM.docx (16 kb)
ESM 2 (DOCX 16 kb)


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Copyright information

© Society of General Internal Medicine 2016

Authors and Affiliations

  • Zachary D. Erickson
    • 1
  • Crystal L. Kwan
    • 1
  • Hollie A. Gelberg
    • 1
  • Irina Y. Arnold
    • 1
  • Valery Chamberlin
    • 2
    • 3
  • Jennifer A. Rosen
    • 4
    • 5
    • 6
  • Chandresh Shah
    • 2
  • Charles T. Nguyen
    • 7
  • Gerhard Hellemann
    • 8
  • Dixie R. Aragaki
    • 3
    • 9
  • Charles F. Kunkel
    • 3
    • 9
  • Melissa M. Lewis
    • 2
  • Neena Sachinvala
    • 2
    • 3
  • Patrick A. Sonza
    • 2
  • Joseph M. Pierre
    • 2
    • 3
  • Donna Ames
    • 2
    • 3
  1. 1.Research Service at VA Greater Los Angeles Healthcare SystemLos AngelesUSA
  2. 2.Mental Health Service at VA Greater Los Angeles Healthcare SystemLos AngelesUSA
  3. 3.David Geffen School of Medicine at University of California-Los AngelesLos AngelesUSA
  4. 4.Department of Pharmacy at VA Northern California Healthcare SystemMartinezUSA
  5. 5.University of the Pacific School of PharmacyStocktonUSA
  6. 6.University of Southern California School of PharmacyLos AngelesUSA
  7. 7.Department of Mental Health at VA Medical CenterLong BeachUSA
  8. 8.Semel Institute for Neuroscience & Human Behavior at University of California-Los AngelesLos AngelesUSA
  9. 9.Physical Medicine and Rehabilitation Service at VA Greater Los Angeles Healthcare SystemLos AngelesUSA

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