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Meta-Analysis
. 2012 Jul 12:12:78.
doi: 10.1186/1471-244X-12-78.

Health promotion lifestyle interventions for weight management in psychosis: a systematic review and meta-analysis of randomised controlled trials

Elena Bonfioli  1 , Loretta Berti, Claudia Goss, Francesca Muraro, Lorenzo Burti
Affiliations
Meta-Analysis

Health promotion lifestyle interventions for weight management in psychosis: a systematic review and meta-analysis of randomised controlled trials

Elena Bonfioli et al. BMC Psychiatry. .

Abstract

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 randomised clinical trials.

Methods: We systematically reviewed the randomised controlled trials from 1990 onward, in which psychoeducational and/or cognitive-behavioural interventions aimed at weight loss or prevention of weight gain in patients with psychosis had been compared to treatment as usual. We carried out a meta-analysis and pooled the results of the studies with Body Mass Index as primary outcome.

Results: The results of the meta-analysis show an effect toward the experimental group. At the end of the intervention phase there is a -0.98 kg/m(2) reduction in the mean Body Mass Index of psychotic subjects. 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. Physical screening and monitoring programmes are well accepted by patients and can be implemented in a variety of settings. A weight loss of 0.98 points in the Body Mass Index corresponds to a loss of 3.12% of the initial 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 implications than weight changes alone. Therefore, in addition to weight reduction, the assessment of metabolic parameters to monitor other independent risk factors should also be integrated into physical health promotion and management in people with mental disorders.

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Figures

Figure 1
Figure 1
Stages of systematic review and meta-analysis.
Figure 2
Figure 2
Risk of bias graph.
Figure 3
Figure 3
Efficacy of lifestyle interventions (Experimental) vs. treatment as usual (Control) for weight management in psychosis.
See this image and copyright information in PMC

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References

    1. Fleischacker WW, Cetkovich-Bakmas M, De Hert M, Hennekens CH, Lambert M, Leucht S, Maj M, McIntyre M, Naber D, Newcomer JW, Olfson M, Osby U, Sartorius N, Lieberman JA. Comorbid somatic illnesses in patients with severe mental disorders: clinical, policy and research challenges. J Clin Psychiatry. 2008;64(4):514–519. - PubMed
    1. De Hert M, Correll C, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, Detraux J, Gautam S, Möller H, Ndetei DM, Newcomer JW, Uwakwe R, Leucht S. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry. 2011;10:52–77. - PMC - PubMed
    1. Heald A. Physical health in schizophrenia: a challenge for antipsychotic therapy. Eur Psychiatry. 2010;25(Suppl 2):S6–S11. - PubMed
    1. Allison DB, Newcomer JW, Dunn AL, Blumenthal JA, Fabricatore AN, Daumit GL, Cope MB, Riley WT, Vreeland B, Hibbeln JR, Alpert JE. Obesity among those with mental disorders. A National Institute of Mental Health meeting report. Am J Prev Med. 2009;36(4):341–350. - PubMed
    1. Van Gaal LF. Long-term health considerations in schizophrenia: metabolic effects and the role of abdominal adiposity. Eur Neuropsychopharmacol. 2006;16:S142–S148. - PubMed

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