Major mental illness no hurdle for weight loss

JOHNS HOPKINS (US) — People with serious mental illness often are overweight or obese, but behavioral management programs can help them lose significant weight, new research shows.

Simple nutrition messages, counseling, and regular exercise classes can lead to weight loss for schizophrenia, bipolar disorder, or major depression patients—similar to that achieved in studies that exclude people with mental illnesses, the researchers say.


People with serious mental illness have mortality rates two to three times higher than that of the general population, primarily from obesity-related conditions. Many are sedentary and take several psychotropic medications, which include weight gain as a side effect.

“We sought to dispel the perception that lifestyle programs don’t work in this population,” says study leader Gail L. Daumit, an associate professor of general internal medicine at the Johns Hopkins University School of Medicine.

“There’s this really important need to find ways to help this population be healthier and lose weight. We brought a weight-loss program to them, tailored to the needs of people with serious mental illness. And we were successful.”

The ‘intervention’

Known as ACHIEVE (Randomized Trial of Achieving Healthy Lifestyles in Psychiatric Rehabilitation), the study enrolled 291 overweight or obese patients with serious mental illness. Some 144 were randomly placed in an intervention group, while 147 made up the control group.

The intervention took place at 10 Baltimore area outpatient psychiatric rehabilitation day facilities that already offered vocational and skills training, case management and other services for people with mental illness not well enough to work full time.

The researchers added a schedule of regular group and individual weight-management sessions, thrice-weekly exercise classes, and a weekly weigh-in for the first six months of the trial. The sessions and weigh-ins continued, though less frequently, for the following year, though the exercise class schedule remained the same.

Long-term success

At the 18-month point, on average, the intervention group lost seven more pounds than the control group. Nearly 38 percent of the intervention group lost 5 percent or more of their initial weight, as compared with 23 percent of the control group. More than 18 percent of those in the intervention arm of the study lost more than 10 percent of their body weight after 18 months, compared with 7 percent in the control group.

Participants lost more weight as the intervention went on. This suggests it took a while to make behavioral change, but once these modifications took hold, the changes yielded positive results, Daumit says.

Of the people in the study, 50 percent had schizophrenia, 22 percent had bipolar disorder and 12 percent major depression. Many with serious mental illness, particularly schizophrenia, have impairments in memory and executive function, as well as residual psychiatric symptoms that impede learning and adoption of new behaviors.

What the study suggested, Daumit says, is that tailored programs can overcome these impediments.

The average number of psychotropic medications study participants took was three; the medications, often required for long-term symptom control, are known to cause weight gain in part by stimulating appetites and increased eating.

Instead of asking participants to keep detailed food logs and counting every calorie they consume—a practice common to other weight-loss programs—Daumit’s program instead focused on relatively simple messages and goals, she says.

They were encouraged to avoid junk food and sugary beverages, monitor portion sizes and include more fruits and vegetables in their diet. They had regular exercise at the rehabilitation facilities as part of the study, and were encouraged to exercise 30 minutes on other days, too.

Daumit says she thinks the weight-loss program could be adopted by other psychiatric rehabilitation facilities.

“This population is often stigmatized,” she says. “This study’s findings should help people think differently about people with serious mental illness. Our results provide clear evidence that this population can make healthy lifestyle changes and achieve weight loss.”

The National Institutes of Health’s National Institute of Mental Health funded the study, which was published in the New England Journal of Medicine.

Source: Johns Hopkins University