Weight Loss in People with Serious Mental Illness

A new study showed that a weight-loss intervention can help overweight and obese people with serious mental illnesses—such as schizophrenia, bipolar disorder and major depression—lose significant weight and keep it off.

More than 80% of people with serious mental illnesses are overweight or obese — a major factor that helps lead to a death rate 3 times that of the overall population. Factors that contribute to obesity include unhealthy eating habits and lack of physical activity. Medications to help control mental illness symptoms can increase appetite and encourage weight gain. Adding to these challenges, people with serious mental illnesses may have impairments in memory and mental processes that make it more difficult for them to learn and adopt new weight loss behaviors such as counting calories.

To address the problem, researchers led by Dr. Gail L. Daumit at Johns Hopkins University tested the effectiveness of an 18-month behavioral weight-loss program tailored for adults with serious mental illnesses. The study was funded by NIH’s National Institute of Mental Health (NIMH). Results appeared online on March 21, 2013, in the New England Journal of Medicine.

The researchers studied 291overweight or obese adults who attended community outpatient psychiatric rehabilitation programs. The participants' average age was 45 years. Half were men, and 38% were black. All were taking an average of 3 psychotropic medications, many known to cause weight gain. About 60% of the participants had schizophrenia or a schizoaffective disorder, 22% had bipolar disorder and 12% had major depression.

The researchers chose these community programs as the setting because the facilities usually have commercial kitchens and spaces that can be used for group exercise. The programs typically provide breakfast and lunch, and participants often attend several times a week. Staff was advised on providing healthier options to all participants, such as serving water with lemon or unsweetened iced tea instead of lemonade.

The researchers randomly assigned participants to an intervention or control group. Those in the intervention group took part in weight management and group exercise sessions. To address deficits in memory and learning, information was divided into small units and skills repeated. Goals included avoiding sugar-sweetened beverages and junk food, eating 5 servings of fruits and vegetables daily, choosing smaller portions, and participating in at least 30 minutes of moderate-intensity aerobic exercise daily. The control group received standard nutrition and physical activity information at the beginning of the program.

The researchers found that patients in the intervention group lost an average of 4 pounds after 6 months and 7.5 pounds after 18 months. In comparison, those in the control group lost an average of only 0.6 pounds after 6 months and 0.5 pounds after 18 months.

At 18 months, 38% of the participants in the intervention group had lost 5% or more of their starting weight, compared to 23% of those in the control group. This weight loss, although modest, has been shown to have beneficial health effects, such as lowered blood pressure and prevention of type 2 diabetes.

These findings demonstrate that overweight and obese adults with serious mental illness can adopt healthy habits while in an outpatient psychiatric rehabilitation program.

“We’re showing that serious mentally ill patients can make successful, sustained changes with proper interventions,” Daumit says. The researchers now hope to expand the program.