A 6-month randomized controlled trial to test the efficacy of a lifestyle intervention for weight gain management in schizophrenia

Cecília Attux, Larissa C Martini, Hélio Elkis, Sérgio Tamai, Andréa Freirias, Maria das Graças Miquelutti Camargo, Mário Dinis Mateus, Jair de Jesus Mari, André F Reis, Rodrigo A Bressan, Cecília Attux, Larissa C Martini, Hélio Elkis, Sérgio Tamai, Andréa Freirias, Maria das Graças Miquelutti Camargo, Mário Dinis Mateus, Jair de Jesus Mari, André F Reis, Rodrigo A Bressan

Abstract

Background: Patients with schizophrenia have lower longevity than the general population as a consequence of a combination of risk factors connected to the disease, lifestyle and the use of medications, which are related to weight gain.

Methods: A multicentric, randomized, controlled-trial was conducted to test the efficacy of a 12-week group Lifestyle Wellness Program (LWP). The program consists of a one-hour weekly session to discuss topics like dietary choices, lifestyle, physical activity and self-esteem with patients and their relatives. Patients were randomized into two groups: standard care (SC) and standard care plus intervention (LWP). Primary outcome was defined as the weight and body mass index (BMI).

Results: 160 patients participated in the study (81 in the intervention group and 79 in the SC group). On an intent to treat analysis, after three months the patients in the intervention group presented a decrease of 0.48 kg (CI 95% -0.65 to 1.13) while the standard care group showed an increase of 0.48 kg (CI 95% 0.13 to 0.83; p=0.055). At six-month follow-up, there was a significant weight decrease of -1.15 kg, (CI 95% -2.11 to 0.19) in the intervention group compared to a weight increase in the standard care group (+0.5 kg, CI 95% -0.42-1.42, p=0.017).

Conclusion: In conclusion, this was a multicentric randomized clinical trial with a lifestyle intervention for individuals with schizophrenia, where the intervention group maintained weight and presented a tendency to decrease weight after 6 months. It is reasonable to suppose that lifestyle interventions may be important long-term strategies to avoid the tendency of these individuals to increase weight.

Trial registration: ClinicalTrials.gov NCT01368406.

Figures

Figure 1
Figure 1
CONSORT diagram: participation in the study.

References

    1. Allison DB, Fontaine KR, Heo M, Mentore JL, Cappelleri JC, Chandler LP. The distribution of body mass index among individuals with and without schizophrenia. J Clin Psychiatry. 1999;60:215–220. doi: 10.4088/JCP.v60n0402.
    1. Brown S, Birtwistle J, Roe L, Thompson C. The unhealthy lifestyle of people with schizophrenia. Psychol Med. 1999;29:697–701. doi: 10.1017/S0033291798008186.
    1. Allison DB, Mackell JA, McDonnell DD. The impact of weight gain on quality of life among persons with schizophrenia. Psychiatr Serv. 2003;54:565–567. doi: 10.1176/appi.ps.54.4.565.
    1. Casey DE, Hansen TE. In: Medical Illness and Schizophrenia. 2. Meyer JM, Nasrallah HA, editor. Washington DC: American Psychiatric Publishing Inc; 2009. Excessive mortality and morbidity associated with schizophrenia; pp. 17–36.
    1. Saha S, Chant D, McGrath J. A systematic review of mortality in schizophreniais the differential mortality gap worsening over time? Arch Gen Psychiatry. 2007;64:1123–1131. doi: 10.1001/archpsyc.64.10.1123.
    1. Brown S, Kim M, Mitchell C, Inskip H. Twenty-five year mortality of a community cohort with schizophrenia. Br J Psychiatry. 2010;196:116–121. doi: 10.1192/bjp.bp.109.067512.
    1. Weiden PJ, Mackell JA, McDonnell DD. Obesity as a risk factor for antipsychotic noncompliance. Schizophr Res. 2004;66:51–57. doi: 10.1016/S0920-9964(02)00498-X.
    1. Weiden PJ, Mackell JA, McDonnel DD. Obesity as a risk factor for antipsychotic noncompliance. Schizophr Res. 1872;2003:1–7.
    1. Bushe C, Haddad P, Peveler R, Pendlebury J. The role of lifestyle interventions and weight management in schizophrenia. J Psychopharmacol. 2005;19:28–35. doi: 10.1177/0269881105058682.
    1. Faulkner G, Cohn T, Remington G. Interventions to reduce weight gain in schizophrenia. The Cochrane Library. 2009;04:Art. No. CD005148. doi: 10.1002/14651858.CD005148.pub1.
    1. Tuomilehto J. Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343–1350. doi: 10.1056/NEJM200105033441801.
    1. Eriksson MK, Franks PW, Eliasson M. A 3-year randomized trial of lifestyle intervention for cardiovascular risk reduction in the primary caresetting. The Swedish Björknäs Study. PLoS ONE. 2009;4:e5195. doi: 10.1371/journal.pone.0005195.
    1. Damião R, Sartorelli DS, Hirai A, Bevilacqua MR, Salvo VL, Ferreira SR. Impact of a lifestyle intervention program on metabolic, anthropometrical and dietary profile of Japanese-Brazilians with and without metabolic syndrome. Arq Bras Endocrinol Metab. 2011;55:134–145. doi: 10.1590/S0004-27302011000200006.
    1. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2011;34(1):S11–S61.
    1. Attux C, Martini LC, Reis AF, Bressan RA. Intervenções não farmacológicas para manejo do ganho de peso em pacientes com esquizofrenia em uso de antipsicóticos. Arq Bras Endocrinol Metabol. 2009;53:391–398.
    1. Álvarez-Jiménez M, Hetrick SE, González-Blanch C, Gleeson JF, McGorry PD. Non-pharmacological management of antipsychotic-induced weight gain: systematic review and meta-analysis of randomized controlled trials. Br J Psychiatr. 2008;193:101–107. doi: 10.1192/bjp.bp.107.042853.
    1. Attux C, Martini LC, Araujo CM, Roma AM, Mullan EM. Non-pharmacological management of weight gain: a national, multicentric study for schizophrenia and severe mental disorders In: XIV Biennial Winter Workshop on Schizophrenia and Bipolar Disorders, 2008, Montreux. Schizophr Res Amsterdam. 2008;98:52. Elsevier.
    1. Attux C, Martini LC, Araujo CM, Roma AM, Reis AF, Bressan RA. The effectiveness of a non-pharmacological intervention for weight gain management in severe mental disorders: results from a national multicentric study. Rev Bras Psiq. 2011;33:117–121.
    1. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition. (SCID-I/P) New York: Biometrics Research, New YorkState Psychiatric Institute, November 2002. Schizophr Bull. 1987;13:261–276. doi: 10.1093/schbul/13.2.261.
    1. Kay SR, Flszbein A, Opfer LA. The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia. Schizophr Bull. 1987;13:261–276. doi: 10.1093/schbul/13.2.261.
    1. Ghiringhello MT, Vieira JGH, Tachibana TT, Ferrer C, Maciel RMB, Amioka PHC. Distribution of HOMA-IR in Brazilian Subjects with Different Body Mass Indexes. Arq. 2006;50:573–574. doi: 10.1590/S0004-27302006000300025.
    1. Bressan RA, Chaves AC, Shirakawa I, Mari JJ. Validity study of the Brazilian version of the Calgary Depression Scale for Schizophrenia. Schizophr Res. 1998;32:31–39. doi: 10.1016/S0920-9964(98)00029-2.
    1. Haro JM, Kamath SA, Ochoa S, Novick D, Rele K, Fargas A, Rodriguez MJ, Rele R, Orta J, Kharbeng A, Araya S, Gervin M, Alonso J, Mavreas V, Lavrentzou E, Liontos N, Gregor K, Jones PB. The Clinical Global Impression–Schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia. Acta Psychiatr Scand. 2003;107:16–23. doi: 10.1034/j.1600-0447.107.s416.5.x.
    1. Jones SH, Thornicroft G, Coffey M, Dunn G. A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF) Br J Psychiatry. 1995;166:654–659. doi: 10.1192/bjp.166.5.654.
    1. Martini LC, Attux C, Bressan RA, Mari JJ. Cultural adaptation, reliability and validity of the Brazilian version Independent Living Skills Survey (ILSS-BR/P) in schizophrenia. Rev Psiquiatr Clin. 2012;39:12–18. doi: 10.1590/S0101-60832012000100003.
    1. Fleck MPA, Fachel O, Louzada S, Xavier M, Chachamovich E, Vieira G. Desenvolvimento da versão em português do instrumento de avaliação de qualidade de vida da organização mundial da saúde (WHOQOL-100) Rev Bras Psiquiatr. 1999;21:19–28. doi: 10.1590/S1516-44461999000100006.
    1. Dini GM, Quaresma MR, Ferreira LM. Adaptação Cultural e Validação da Versão Brasileira da Escala de Auto Estima de Rosemberg. Rev Soc Bras Cir Plast. 2004;19:41–52.
    1. Roe L, Strong C, Whiteside C, Neil A, Mant D. Dietary intervention in primary care: validity of the DINE method for Diet Assessment. Fam Pract. 1994;11:375–381. doi: 10.1093/fampra/11.4.375.
    1. Carmo JT, Pueyo AA. A adaptação ao português do Fagerström test for nicotine dependence (FTND) para avaliar a dependência e tolerância à nicotina em fumantes brasileiros. Rev Bras Med. 2002;59:73–80.
    1. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International Physical Activity Questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–1395. doi: 10.1249/01.MSS.0000078924.61453.FB.
    1. Kwon JS, Choi JS, Bahk WM, Kim CY, Kim CH, Shin YC. Weight management program for treatment-emergent weight gain in olanzapine-treated patients with schizophrenia or schizoaffective disorder: a 12-week randomized controlled clinical trial. J Clin Psychiatry. 2006;67:547–553. doi: 10.4088/JCP.v67n0405.
    1. Wu RR, Zhao JP, Jin H, Shao P, Fang MS, Guo XF. Lifestyle intervention and metformin for treatment of antipsychotic-induced weight gain: a randomized controlled trial. JAMA. 2008;299:185–193. doi: 10.1001/jama.2007.56-b.
    1. Porsdal V, Beal C, Kleivenes OK, Martinsen EW, Lindström E, Nilsson H, Svanborg P. The Scandinavian Solutions for Wellness study – a two-arm observational study on the effectiveness of lifestyle intervention on subjective well-being and weight among persons with psychiatric disorders. BMC Psychiatry. 2010;10:42. doi: 10.1186/1471-244X-10-42.
    1. McKibbin CL, Patterson TL, Norman G, Patrick K, Jin H, Roesch S. A lifestyle intervention for older schizophrenia patients with diabetes mellitus: A randomized controlled trial. Schizophr Res. 2006;86:36–44. doi: 10.1016/j.schres.2006.05.010.
    1. Wu MK, Wang CK, Bai YM, Huang CY, Lee SD. Outcomes of obese, clozapine-treated inpatients with schizophrenia placed on a six-month diet and physical activity program. Psychiatr Serv. 2007;58:544–550. doi: 10.1176/appi.ps.58.4.544.
    1. LeBlanc ES, O’Connor E, Whitlock EP, Patnode CD, Kapka T. Effectiveness of primary care–relevant treatments for obesity in adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155:434–447.
    1. Institute of Medicine. Weighing the options: criteria for evaluating weight management programs. Washington DC: National Academy Press; 1995.
    1. Littrell KH, Hilligoss NM, Kirshner CD, Petty RG, Johnson CG. The effects of an educational intervention on antipsychotic-induced weight gain. J Nurs Scholarsh. 2003;35:237–241. doi: 10.1111/j.1547-5069.2003.00237.x.

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