Weight loss possible for mentally ill patients

By Laura Cowen, medwireNews Reporter

The STRIDE lifestyle intervention helps individuals taking antipsychotics to lose weight and improve their fasting glucose levels, study findings indicate.

Patients randomly assigned to the STRIDE intervention (n=104) were nearly four times more likely to achieve a clinically significant 5% loss of baseline bodyweight by 6 months and twice as likely to have normal blood glucose levels at 12 months compared with those assigned to normal care (n=96), report Carla Green (Kaiser Permanente Northwest, Portland, Oregon, USA) and colleagues.

Green et al explain that STRIDE is based on the PREMIER lifestyle intervention and the DASH (Dietary Approaches to Stop Hypertension) diet, and is designed to reduce weight and obesity-related risk through dietary changes, moderate calorie restriction and increased physical activity.

The intervention was tailored to people with serious mental illness by including a mental health counsellor as well as a nutritionist, and by adding sessions addressing the effects of psychiatric medications on weight, planning for psychiatric symptom exacerbation, improving sleep, eating healthily on a budget and stress management.

As reported in The American Journal of Psychiatry, patients assigned to the STRIDE intervention, which included weekly group sessions for 6 months followed by monthly maintenance sessions for 6 months, lost 4.4 kg more than those assigned to usual care after 6 months and 2.6 kg more over a 12-month period.

Forty percent of intervention participants achieved at least 5% of baseline weight loss by 6 months, compared with 17% of control participants, a statistically significant difference. However, the effect was no longer significant after 12 months, with rates at 47% and 36%, respectively.

Patients in the intervention group also experienced greater improvements in fasting blood glucose levels at 12 months than those in the control group. Specifically, the average level fell from106.3 mg/dL at baseline to 100.4 mg/dL at 12 months in the intervention group, whereas it increased from 106.0 mg/dL to 109.5 mg/dL in the control group.

In addition, the researchers found that during the 12-month study period, there were significantly fewer medical hospitalisations in the intervention group than in the control group, at 6.7% versus 18.8%.

“If these results are replicated, reduced hospital costs could be an added benefit of offering these interventions”, they remark.

Green and co-authors add that “[i]ncreasing the length of the intervention and the number of sessions attended holds potential to support additional weight loss and glucose control and to address other cardiometabolic risk factors.”

They conclude: “Increasing the reach of the intervention is an important step in advancing research on health interventions for people with serious mental illnesses.”

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