title: Prevention of antipsychotic-induced weight gain with early behavioural intervention in first-episode psychosis: 2-year results of a randomized controlled trial A cognitive/behavioral group intervention for weight loss in patients treated with atypical antipsychotics Interventions to reduce weight gain in schizophrenia. Weight management program for treatment-emergent weight gain in olanzapine-treated patients with schizophrenia or schizoaffective disorder: A 12-week randomized controlled clinical trial. Effects of an Educational Intervention on Weight Gain in Patients Treated With Antipsychotics Physical health—a cluster randomized controlled lifestyle intervention among persons with a psychiatric disability and their staff Effects of behavioral therapy on weight loss in overweight and obese patients with schizophrenia or schizoaffective disorder. Outcomes of obese, clozapine-treated inpatients with schizophrenia placed on a six-month diet and physical activity program. Cognitive behavioural therapy for weight gain associated with antipsychotic drugs Attenuation of antipsychotic-induced weight gain with early behavioral intervention in drug-naive first-episode psychosis patients: A randomized controlled trial. A pilot study of a weight management program with food provision in schizophrenia The effects of an educational intervention on antipsychotic-induced weight gain. Nutritional intervention to prevent weight gain in patients commenced on olanzapine: a randomized controlled trial. The role of a fitness intervention on people with serious psychiatric disabilities.
abstract: While weight-management interventions are effective in attenuating antipsychotic-induced weight , there is no available evidence on their long-term effectiveness . This study sought to investigate the 2-year effects of an early behavioural intervention ( EBI ) design ed to prevent antipsychotic-induced weight gain in first-episode psychosis ( FEP ) patients . Sixty-one FEP patients were r and omized to receive either EBI or treatment-as-usual .  Intention-to-treat and observed-cases analysis showed that patients in the EBI group gained significantly less weight than those allocated to routine care at intervention completion ( 3-month follow-up ) with treatment effects maintained over 3months . Differences between groups were no longer significant by 12months . Weight-management interventions may need to be offered for longer periods to maintain preventative effects . Alternatively , booster sessions may need to be regularly delivered after intervention completion Obesity and diabetes have caused problems for individuals with schizophrenia long before atypical antipsychotic agents . The prevalence of obesity , insulin resistance , impaired glucose tolerance , type 2 diabetes mellitus , dyslipidemia , and the Metabolic Syndrome has increased in people with schizophrenia as compared to the general population . Risk reduction studies for persons with obesity , diabetes , and cardiovascular disease indicate that cognitive/behavioral interventions that promote motivation and provide strategies to overcome the barriers in adherence to diet and activity modification are effective interventions for weight management and risk reduction . In the l and mark multi-center r and omized-controlled trial study , the Diabetes Prevention Project ( DPP ) , a cognitive/behavioral intervention , was more successful in producing weight loss and preventing diabetes than the drugs metformin , troglitazone or placebo . This pilot study examined the effectiveness of a cognitive/behavioral group intervention , modified after the DPP program , in individuals with schizophrenia or schizoaffective disorder taking atypical antipsychotics in a large urban public mental health system . Outcome measures included body weight , body mass index , waist-hip ratios , and fasting glucose levels . Both groups demonstrated elevated fasting glucose levels and were obese with a mean BMI of 33 . The group that received the cognitive/behavioral group intervention  lost more weight than the treatment as usual group . The CB group participants lost an average of 5.4 lb or 2.9 % of body weight , and those in the control group lost 1.3 lb or 0.6 % body weight . The range of weight loss for the treatment group was from 1 to 20 lb . This pilot study has demonstrated that weight loss is possible with cognitive/behavioral interventions in a population with a psychotic disorder Background Weight gain is common for people with schizophrenia and this has serious implication s for health and well being . Objectives To determine the effects of both pharmacological ( excluding medication switching ) and non pharmacological strategies for reducing or preventing weight gain in people with schizophrenia . Search methods We search ed key data bases and the Cochrane Schizophrenia Group 's trials register ( April 2006 ) , reference sections within relevant papers , h and search ed key journals , and contacted the first author of each relevant study and other experts to collect further information . Selection criteria We included all clinical r and omised controlled trials comparing any pharmacological or non pharmacological intervention for weight gain  ( diet and exercise counselling ) with st and ard care or other treatments for people with schizophrenia or schizophrenia-like illnesses . Data collection and analysis We reliably selected , quality assessed and extracted data from studies . As weight is a continuous outcome measurement , weighted mean differences ( WMD ) of the change from baseline were calculated . The primary outcome measure was weight loss . Main results Twenty-three r and omised controlled trials met the inclusion criteria for this review . Five trials assessed a cognitive/behavioural intervention and eighteen assessed a pharmacological adjunct . In terms of prevention , two cognitive/behavioural trials showed significant treatment effect ( mean weight change ) at end of treatment ( n=104 , 2 RCTs , WMD -3.38 kg CI -4.2 to -2.0 ) . Pharmacological adjunct treatments were significant with a modest prevention of weight gain ( n=274 , 6 RCTs , WMD - 1.16 kg CI -1.9 to -0.4 ) . In terms of treatments for weight loss , we found significantly greater weight reduction in the cognitive behavioural intervention group ( n=129 , 3 RCTs , WMD -1.69 kg CI -2.8 to -0.6 ) compared with st and ard care . Authors ' conclusions Modest weight loss can be achieved with selective pharmacological and non pharmacological interventions . However , interpretation is limited by the small number of studies , small sample size , short study duration and by variability of the interventions themselves , their intensity and duration . Future studies adequately powered , with longer treatment duration and rigorous methodology will be needed in further evaluating the efficacy and safety of weight loss interventions for moderating weight gain . At this stage , there is insufficient evidence to support the general use of pharmacological interventions for weight management in people with schizophrenia BACKGROUND The main objective was to assess the efficacy of a weight management program design ed for out patients taking olanzapine for schizophrenia or schizoaffective disorder and to compare these patients with a r and omized control group . The effects of the weight management program were also assessed with regard to safety and quality of life . METHOD Forty-eight patients were enrolled in a 12-week , r and omized , multicenter weight management study . Thirty-three patients were r and omly allocated to an intervention group in which they received olanzapine within a weight management program .  Fifteen patients were allocated to a control group in which they were given olanzapine treatment as usual out patients . Weight , body mass index ( BMI ) , and measurements of safety and quality of life were evaluated . The study was conducted from January 7 , 2003 , to September 16 , 2003 . RESULTS Thirty-six patients ( 75 % ) completed this study . We found significant differences in weight ( -3.94 + /- 3.63 kg vs. -1.48 + /- 1.88 kg , p = .006 ) and BMI ( -1.50 + /- 1.34 vs. -0.59 + /- 0.73 , p = .007 ) change from baseline to endpoint between the intervention and control groups , respectively . Significant differences in weight reduction were initially observed at week 8 ( p = .040 ) . No significant differences were found with regard to the safety outcomes . When the ratio of low-density lipoproteins to high-density lipoproteins was calculated , change from baseline was greater in the intervention group than the control group ( -0.19 vs. -0.04 ) , but the difference was not statistically significant ( p = .556 ) . After the completion of the weight management program , there was a trend toward statistical difference in the physical health score changes between the weight management and control groups ( 1.12 in the intervention group vs. -0.93 in the control group , p = .067 ) . CONCLUSION The weight management program was effective in terms of weight reduction in patients with schizophrenia or schizoaffective disorder taking olanzapine and was also found to be safe in terms of psychiatric symptoms , vital signs , and laboratory data . In addition , such a weight management program might improve quality of life in patients with schizophrenia or schizoaffective disorder with respect to their physical well-being Background : Increasing numbers of reports have raised concerns about significant increases in weight and adiposity over both short- and long-term treatment in patients treated with antipsychotics ( APs ) . The management of overweight and obesity in patients treated with APs has included pharmacological interventions , dietary suggestions , and behavioral strategies . Nevertheless , current evidence does not support the use of pharmacological management of this specific type of obesity , and only a limited number of studies have been published regarding prevention and treatment of weight gain with other strategies . Objective : The aim of this study was to evaluate the effectiveness of an educational intervention ( EI ) that combines low-calorie diet with increased physical activity to prevent and treat weight gain in patients treated with APs . Method : Data were from 53 subjects whose body mass index ( BMI ) had increased by more than 7 % after starting an AP therapy and who consented to participate in a 12-week educational intervention study aim ed at preventing further weight gain and , when possible , at inducing a weight loss . Weight and BMI were measured at baseline ( at each of the monthly follow-up visits ) and at study completion 12 weeks from entry in the study . Results : Twenty-six patients completed the 12-week program . Completers showed a significant mean body weight decrease of 3.15 kg , with a mean BMI reduction of 1.2 ( kg/m2 ) at the end of the 3-month period . Conclusions : Educational intervention can be an important tool for the management of weight increase in patients treated with APs . A larger prospect i ve and controlled study is now needed to confirm our findings The objective was to explore the impact on physical health of a lifestyle programme among persons with psychiatric disabilities , and their caregivers . Their satisfaction with the intervention was also assessed . Somatic comorbidity and an increased mortality related to the lifestyle among persons with psychiatric disabilities are well known . Few r and omized controlled trials have been aim ed specifically at lifestyle issues among persons with a psychiatric disability . This trial includes clients with psychiatric disabilities living in supported housing and their staff . Forty-one persons with a DSM-?V diagnosis of severe mental illness from psychiatric disability from 10 supported housing facilities and 41 of their caregivers participated in this 12-month study during 2005–2006 in Sweden . The supported housing facilities with residents and staff were r and omly assigned to either a health intervention programme or a control programme with an aesthetic content . The presence of metabolic syndrome and changes in the mean of physiological parameters such as Hba1c , P-glucose , P-insulin , lipids , blood pressure , physical working capacity , body mass index , Heart Score were investigated and participants ’ satisfaction assessed . There was a significant reduction in the mean of metabolic syndrome criteria in the intervention group compared with the control group at the follow-up . The participants expressed satisfaction with the programme . The results indicate that health interventions on lifestyle issues when involving carers are appreciated , feasible and could be successful in reducing some health-related risk factors among persons with psychiatric disabilities BACKGROUND Obesity is common in persons with schizophrenia . Besides its adverse health effects , obesity reduces quality of life and contributes to the social stigma of schizophrenia . METHOD This 14-week , multicenter , open-label , rater-blinded , r and omized study evaluated the effects of a group-based behavioral treatment ( BT ) for weight loss in overweight and obese stable patients with DSM-IV schizophrenia or schizoaffective disorder who had been switched from olanzapine to risperidone .  Participants were r and omly assigned to receive BT or usual clinical care ( UC ) . BT included 20 sessions during which patients were taught to reduce caloric intake . In UC , patients were encouraged to lose weight but received no special advice about weight reduction . The primary outcome measure was change in body weight . RESULTS Seventy-two patients were enrolled . The mean + /- SD weight loss at endpoint was significant in both groups ( p < .05 ) and numerically greater in patients receiving BT than in those receiving UC ( -2.0 + /- 3.79 and -1.1 + /- 3.11 kg , respectively ) . More patients in the BT group than in the UC group had lost > or = 5 % of their body weight at endpoint ( 26.5 % [ 9/34 ] and 10.8 % [ 4/37 ] , respectively ; p = .082 ) . A post hoc analysis of patients attending at least 1 BT session showed that significantly more patients in the BT than the UC group had lost > or = 5 % of their body weight at endpoint ( 32.1 % [ 9/28 ] vs. 10.8 % [ 4/37 ] , respectively , p = .038 ) and at week 14 ( complete population ; 40.9 % [ 9/22 ] and 14.3 % [ 4/28 ] , respectively , p = .027 ) . CONCLUSION BT may be an effective method for weight reduction in patients with chronic psychotic illness OBJECTIVE Patients with schizophrenia treated with clozapine  often gain weight . This study evaluated the effects of dietary control and physical activity among obese in patients with schizophrenia being treated with clozapine . METHODS Fifty-three clozapine-treated obese patients with schizophrenia in a veterans hospital in eastern Taiwan who had a body mass index greater than 27 ( weight divided by height in meters squared ) and who were taking clozapine  were r and omly assigned to a study group of 28 or a control group of 25 . The study group was placed on a diet that reduced calorie intake by 200 to 300 kcal per day ( to 1,300 to 1,500 kcal per day for women and to 1,600 to 1,800 kcal per day for men ) and a six-month regimen of regular physical activity in which participants used approximately 600 to 750 kcal per week ( level walking and walking on stairs for 60 minutes three days per week ) . Anthropometric , metabolic , and hormonal parameters were measured after three and six months by using anthropometry , an enzyme autoanalyzer , immunoassay , and enzyme-linked immunosorbent assay . RESULTS Compared with the control group , the study group showed a significant decrease in body weight , body mass index ( 5.4 % reduction ) , waist circumference ( 3.3 cm ) , and hip circumference ( 3.3 cm ) after three months and after six months . Triglyceride and insulin-like growth factor-binding protein-3 ( IGFBP-3 ) decreased significantly only after six months . CONCLUSIONS A program of dietary control and regular physical activity can significantly reduce body weight and improve metabolic profiles of insulin , triglyceride , and IGFBP-3 among obese in patients taking clozapine for the treatment of schizophrenia BACKGROUND Overweight and obesity are common concerns in individuals with severe mental disorders . In particular , antipsychotic drugs ( AP ) frequently induce weight gain . This phenomenon lacks current management and no previous controlled studies seem to use cognitive therapy to modify eating and weight-related cognitions . Moreover , none of these studies considered binge eating or eating and weight-related cognitions as possible outcomes . AIM The main aim of this study is to assess the effectivity of cognitive and behavioural treatment ( CBT ) on eating and weight-related cognitions , binge eating symptomatology and weight loss in patients who reported weight gain during AP treatment . METHOD A r and omized controlled study ( 12-week CBT vs. Brief Nutritional Education ) was carried out on 61 patients treated with an antipsychotic drug who reported weight gain following treatment .  Binge eating symptomatology , eating and weight-related cognitions , as well as weight and body mass index were assessed before treatment , at 12 weeks and at 24 weeks . RESULTS The CBT group showed some improvement with respect to binge eating symptomatology and weight-related cognitions , whereas the control group did not . Weight loss occurred more progressively and was greater in the CBT group at 24 weeks . CONCLUSION The proposed CBT treatment is particularly interesting for patients suffering from weight gain associated with antipsychotic treatment BACKGROUND The purpose of this study was to compare an early behavioral intervention ( EBI ) with nonstructured st and ard physical care ( routine care intervention [ RCI ] ) in preventing antipsychotic-induced weight gain in drug-naive first-episode psychosis patients . METHOD Sixty-one patients with a DSM-IV-diagnosed psychotic disorder were first r and omly assigned to 3 different antipsychotic treatments ( risperidone [ N = 23 ] , olanzapine [ N = 18 ] , and haloperidol [ N = 21 ] ) and subsequently r and omly assigned to the intervention condition ( EBI , N = 35 ) or RCI ( N = 27 ) . EBI was specifically design ed to teach strategies to enhance control over factors associated with antipsychotic-induced weight gain and consisted of 8 flexible intervention modules that incorporated behavioral interventions , nutrition , and exercise . In the RCI group , patients were informed about potential weight gain and advised to increase their exercise and limit food intake . Body weight and body mass index were measured at baseline and then weekly for 3 months . In addition to change in weight and body mass index , a third outcome measure was the proportion of patients who had gained more than 7 % of their body weight at 3 months . Participating patients were referred between August 2002 and September 2004 . RESULTS All 61 participants completed the study . Patients in the EBI group gained significantly less weight ( mean = 4.1 kg , SD = 4.0 ) than those allocated to the RCI group ( mean = 6.9 kg , SD = 4.5 ) ( p < .01 ) during the 3-month follow-up period . Similar findings were obtained when both groups were compared on treatment-induced change in body mass index , which was significantly less in the EBI group than in the RCI group ( 1.40 vs. 2.39 kg/m2 ) ( p < .01 ) . Accordingly , significantly fewer patients in the EBI group ( N = 11 ; 39.3 % ) than in the RCI group ( N = 26 ; 78.8 % ) ( p < .002 ) increased their baseline weight by more than 7 % , the cutoff for clinical ly meaningful weight gain . CONCLUSIONS EBI was effective in attenuating antipsychotic-induced weight gain in a drug-naive first-episode psychosis cohort . Patients displayed good adherence to this type of preventive intervention Obesity is a serious medical problem that disproportionately affects people with severe mental illness . Behavioral strategies aim ed at lifestyle modification have proven effective for weight loss in general population but have not been studied adequately among persons with schizophrenia . We have conducted a r and omized controlled pilot trial of an established weight loss program , modified for this specific population , and supplemented with a novel food replacement program , as well as practical , community based teaching of shopping and preparing healthy food . The program not only arrested weight gain , and produced meaningful weight loss , but also weight loss continued 6 months after the intervention is completed . Cognitive impairment had no bearing to the extent a participant benefited from the program . As a conclusion , well design ed simple behavioral programs can produce lasting weight loss for patients with schizophrenia and comorbid obesity , improve metabolic indices , and possibly decrease significant medical risks associated with obesity PURPOSE To assess the effect of an educational intervention on antipsychotic-induced weight gain among patients with schizophrenia . DESIGN AND METHODS Quasi-experimental . Seventy patients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder entered this 6-month study condicted in the United States . All participants began receiving olanzapine treatment when they entered the study . The patients were then r and omly assigned to an intervention group or a st and ard care group . Over the next 4-months , the intervention group participated in weekly psychoeducation classes focused on nutrition , exercise , and living a healthy lifestyle . Patients were followed for an additional 2 months to assess weight change . FINDINGS A statistically significant difference in weight change between the two groups was observed post-treatment and at endpoint . At endpoint , the mean weight change of the intervention group was -.06 pounds , while the mean weight change in the st and ard care group was 9.57 pounds . In both groups , men gained significantly more weight than did women . CONCLUSIONS The results indicate that a structured educational intervention might have a positive effect on antipsychotic-induced weight gain among patients with schizophrenia OBJECTIVE Olanzapine is the most commonly prescribed atypical antipsychotic medication in Australia . Research reports an average weight gain of between 4.5 and 7 kg in the 3 months following its commencement . Trying to minimize this weight gain in a population with an already high prevalence of obesity , mortality and morbidity is of clinical and social importance . This r and omized controlled trial investigated the impact of individual nutrition education provided by a dietitian on weight gain in the 3 and 6 months following the commencement of olanzapine . METHOD Fifty-one individuals ( 29 females , 22 males ) who had started on olanzapine in the previous 3 months ( mean length of 27 days + /- 20 ) were recruited through Peninsula Health Psychiatric Services and were r and omly assigned to either the intervention ( n = 29 ) or the control group ( n = 22 ) . Individuals in the intervention group received six 1 hour nutrition education sessions over a 3-month period . Weight , waist circumference , body mass index ( BMI ) and qualitative measures of exercise levels , quality of life , health and body image were collected at baseline at 3 and 6 months . RESULTS After 3 months , the control group had gained significantly more weight than the treatment group ( 6.0 kg vs 2.0 kg , p < or = 0.002 ) . Weight gain of more than 7 % of initial weight occurred in 64 % of the control group compared to 13 % of the treatment group . The control group 's BMI increased significantly more than the treatment group 's ( 2 kg/m(2)vs 0.7 kg/m(2 ) , p < or = 0.03 ) . The treatment group reported significantly greater improvements in moderate exercise levels , quality of life , health and body image compared to the controls . At 6 months , the control group continued to show significantly more weight gain since baseline than the treatment group ( 9.9 kg vs 2.0 kg , p < or = 0.013 ) and consequently had significantly greater increases in BMI ( 3.2 kg/m(2)vs 0.8 kg/m(2 ) , p < or = 0.017 ) . CONCLUSION Individual nutritional intervention provided by a dietitian is highly successful at preventing olanzapine-induced weight gain The purpose of this study was to determine the effects a health education and exercise program would have in limiting weight gain and in improving fitness and psychological parameters in adults with mood or psychotic disorders . Thirty volunteers were r and omly assigned to the healthy lifestyle group ( HL ) or a control group . The HL group engaged in exercise for 12 weeks . Pre- and post-exercise testing was conducted to assess body fat , lipid profile , and cardiovascular fitness . Educational seminars were held weekly . The intervention group evidence d greater weight loss than the control group , although not statistically significant . Significant differences were observed in ratings of general health ( p < .05 ) and empowerment ( p < .01 ) . Trends suggest that exercise interventions may encourage weight loss , particularly if barriers to full participation can be addressed . Additionally , such interventions may contribute to " perceived " well-being even among those with sub clinical participation
target: Results The results of the meta- analysis show an effect toward the experimental group .
  Notably , prevention studies with individual psychoeducational programmes that include diet and /or physical activity seem to have the highest impact .
  Conclusions When compared with treatment as usual in psychotic patients , preventive and individual lifestyle interventions that include diet and physical activity generally prove to be effective in reducing weight .
  This percentage is below the 5 % to 10 % weight loss deemed sufficient to improve weight-related complications such as hypertension , type II diabetes , and dyslipidemia .
  However , it is reported that outcomes associated with metabolic risk factors may have greater health implication s than weight changes alone .
background: Background Psychiatric patients have more physical health problems and much shorter life expectancies compared to the general population , due primarily to premature cardiovascular disease .
  A multi-causal model which includes a higher prevalence of risk factors has provided a valid explanation .
  It takes into consideration not only risks such as gender , age , and family history that are inherently non-modifiable , but also those such as obesity , smoking , diabetes , hypertension , and dyslipidemia that are modifiable through behavioural changes and improved care .
  Thus , it is crucial to focus on factors that increase cardiovascular risk .
  Obesity in particular has been associated with both the lifestyle habits and the side effects of antipsychotic medications .
  The present systematic review and meta- analysis aims at collecting and updating available evidence on the efficacy of non-pharmacological health promotion programmes for psychotic patients in r and omised clinical trials .