Lifestyle-Modification Program Helps People on Antipsychotics Improve Health

People with serious mental illness are at greater risk for obesity and the numerous health problems associated with obesity, such as diabetes. These risks are then compounded by metabolic side effects that antipsychotic drugs can cause.

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This significant vulnerability should make those with mental illness prime candidates for intensive weight-loss interventions, but as Carla Green, Ph.D., M.P.H., a senior investigator at the Kaiser Permanente Center for Health Research in Portland, Ore., pointed out in an interview with Psychiatric News, “We have so little data on how people with mental illnesses respond to weight-loss programs, because they are typically excluded from clinical studies.”

To remedy this, Green and her colleagues developed a comprehensive lifestyle intervention program known as STRIDE. In a study published September 15 in AJP in Advance, they demonstrated that STRIDE can help people taking antipsychotics lose weight and improve their glucose levels over the long term.

STRIDE seeks to promote healthy behaviors through weekly group sessions that teach participants important self-management skills, like creating activity logs, while also fostering social support and a sense of ownership. The program uses techniques and exercises to overcome cognitive barriers or other potential obstacles for people dealing with serious mental illness, while also educating the participants on how their mental and physical states were connected.

“This study filled an important gap in evidence by testing a lifestyle intervention that was adapted for delivery to individuals with serious mental illness,” said Christine Hunter, Ph.D., director of behavioral research at the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), which funded STRIDE. “Research to evaluate lifestyle approaches to reduce diabetes risk that are effective and tailored to the needs of high-risk populations is a priority for NIDDK.”

The study enrolled 200 adults who were taking antipsychotic medication and with a body mass index of at least 27. The volunteers were then randomly assigned to receive the STRIDE intervention for 12 months—split into a six-month intensive phase followed by a six-month maintenance phase—or a control group that received only usual care.

After six months, participants in the STRIDE intervention lost an average of nearly 10 pounds more than control group participants.

After the maintenance phase, intervention participants maintained, on average, a six-pound greater weight loss than the control group. Nearly half of the STRIDE participants lost at least 5 percent of their baseline body weight, with nearly one-fourth losing at least 10 percent. STRIDE participants also reduced their fasting blood glucose levels from around 106.3 to 100.4 mg/dL after 12 months, whereas blood glucose among the control group rose from 106.0 to 109.5 mg/dl.

This improved lifestyle showed some immediate benefits, as significantly fewer people in the STRIDE program reported nonpsychiatric medical hospitalizations than did controls during the study period—6.7 percent vs. 18.8 percent.

“We hope that demonstrating payoffs like fewer hospital visits will help convince organizations to fund these kinds of intervention programs,” Green said.

“It’s also a reason why we focused on antipsychotic use and not a particular disease,” she added. “This way we could make the intervention more broadly applicable and increase the chances of adoption.” She noted that STRIDE participants included people with schizophrenia, bipolar disorder, and posttraumatic stress disorder, and there were no discernable differences in how they responded to the intervention.

One outcome that did not differ between the STRIDE and control groups was the rate of psychiatric hospitalizations, which was around 15 percent in both groups. “One concern of our program was that the health education might destabilize the patients and they would stop taking their medication to prevent weight gain,” she said. “But we didn’t see any indication of that.”

Green noted that some areas of the program still could use some improvement, such as recruiting more men and minority patients—a common issue for such intervention programs—and minimizing the regaining of weight during the maintenance phase. However, this should not diminish the broad message that people with serious mental illness, given the right tools and support, can handle an intensive lifestyle program and lose weight just like anyone else. ■