Adults with severe mental illness need tailor made help to lose weightBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1925 (Published 26 March 2013) Cite this as: BMJ 2013;346:f1925
Adults with severe mental illness have a particularly high prevalence of obesity and a high risk of cardiovascular disease and death as a result. They are usually excluded from trials testing lifestyle approaches to weight loss, so US researchers designed a new trial excluding everyone else and embedded it into existing community rehabilitation programmes. Their intervention included all the traditional elements, such as regular lifestyle counselling and exercise, calorie goals, feedback, and incentives. But content and delivery were specially adapted for people with severe and ongoing psychiatric problems, who often have cognitive deficits and multiple social barriers to a healthy lifestyle.
Obese or overweight adults assigned to the intervention lost 3.2 kg more over 18 months than controls given brief lifestyle advice and health sessions unrelated to weight (95% CI −5.1 to −1.2). They lost weight slowly but steadily during the trial, despite falling attendances at scheduled sessions, and without the usual rapid weight loss and rebound weight gain seen in other populations.
Overweight and obese adults with severe mental illness have specific challenges, including drug treatments that increase appetite, say the authors. Weight control is clearly possible with targeted help, delivered sympathetically to people attending community rehabilitation programmes. Most of the 291 participants in this trial had schizophrenia, schizoaffective disorder, bipolar disorder, or major depression. They had a mean body mass index of 36.3 when recruited.
Cite this as: BMJ 2013;346:f1925