Behavioral Program Helps Long Term Weight Maintenance in Patients with Severe Mental Illness: Presented at ECNP
October 25, 2005

A weight management programme that used behavioral techniques was successful to achieve and maintain clinically significant weight loss for as long as 4 years in a group of 93 patients with serious mental illness, mostly schizophrenia and bipolar disorder.

Findings reported here on October 24th at the 18th European College of Neuropsychopharmacology (ECNP) Congress show that a well motivated, self referred cohort of patients with severe mental illness involved in a 4-year program undergoing treatment with atypical antipsychotics can achieve and maintain significant weight gain.

Researchers led by John Pendlebury, MSc, RMN, Community Psychiatric Nurse, Bolton, Salford and Trafford Mental Health Trust, Manchester, United Kingdom, evaluated the outcomes of their weight management clinic, started in 2001, which accepted self-referred patients only. The clinic was staffed by a community mental health nurse and an occupational therapist.

The program runs in an 8-week rotational topic cycle with weekly 1-hour group sessions. Sessions were divided into three parts: weighing, group discussion, and educational topics sessions. Self-monitoring skills formed an important part of the program. There was no limit on sessions that could be attended. A gap of clinic visits of more than 3 months was determined to represent the start of a new treatment course.

Results show that mean body mass index (BMI) decreased from more than 32 kg/m2 at baseline in 93 participants to 31 kg/m2 in the 60 participants who continued on the program at week 12, to less than 30 kg/m2 in the 30 participants who continued in the program at 1 year, and 28 kg/m2 at 2 years in 14 participants. Two patients were followed up for 4 years and had a mean BMI of 26 kg/m2.

Similarly, mean weight was 90 kg at baseline, 86 kg at week 12 (n = 69), 85 kg at 1 year (n = 41), and 78 kg at 2 years (n = 16).

At the end of the first year, 66% of 41 participants had lost at least 5% of their body weight and 34% of 41 had lost at least 10%.

Of the 16 patients in the study for 2 years, 85% had lost 5% of their body weight, and 81% had lost more than 10%; 19% had a BMI below 25 kg/m2.

Both the mean weight and the mean BMI decreased steadily over the time that participants were in the program, with similar decreases in men and women. Weight gain was observed in 4% of participants.

Over the 4 years since the start of the program, 93 patients attended at least 4 weeks of sessions. Some attended more than once, so the researchers reviewed the results of 103 weight management courses lasting from 4 weeks to 4 years.

They could not identify any strong predictors of successful weight loss, and there was no observable difference in weight loss and maintenance among the various atypical antipsychotic therapies.

Patients treated with antipsychotics lost more weight than patients on other psychotropic drugs but only in the first 8 weeks of treatment. Similarly, patients with schizophrenia lost more weight than patients with affective disorders during this time period.