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Serious Mental Illness Not a Barrier to Weight Loss


Patients with serious mental illness tend to be overweight; interventions are successful if they account for cognitive and psychiatric challenges.

Overweight and obese adults with serious mental illness who participate in a targeted behavioral weight loss intervention are able to significantly reduce weight, according to results of a study published online on March 21 in The New England Journal of Medicine.

Participants in the study, A Behavioral Weight-Loss Intervention in Persons with Serious Mental Illnesss, were recruited from 10 community psychiatric rehabilitation outpatient programs. Of the 291 adults who underwent randomization, 58.1% had schizophrenia or schizoaffective disorder, 22% had bipolar disorder, and 12% had major depression. Mean body mass index was 36.3 kg/m2 at baseline.

Participants assigned to the intervention arm attended group weight management and exercise sessions and individual weight management sessions. The interventions were modeled on lifestyle changes shown to be effective in the general population and adapted to account for psychiatric symptoms and cognitive impairment highly prevalent in this population. The control group received standard nutrition and physical activity information at baseline. 

The study period was 18 months and weight change was assessed at 6, 12, and 18 months. Weight loss in the intervention group increased steadily over the 18-month study period and differed significantly from the control group at each interval visit. At 18 months, the mean between group difference in weight was −3.2 kg (−7.0 lb; P =  .002); 37.8% of the participants in the intervention group lost at least 5% of their weight at baseline, while 22.7% of participants in the control group achieved this goal (P = .009).

Study authors note that more than 80% of people with serious mental illnesses are overweight or obese yet weight loss trials exclude this vulnerable population. Of those that have been conducted, few have been randomized and most are short-term.

The results, say the researchers, demonstrate that this group at high risk for obesity-related illness can make substantial lifestyle changes despite the cognitive and emotional challenges they face.

Access the full study, here: A Behavioral Weight-Loss Intervention in Persons with Serious Mental Illnesss.

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