Behavioral treatment of obesity in patients taking antipsychotic medications.

OBJECTIVE Antipsychotic medications are associated with weight gain and metabolic dysregulation, yet little is known about the management of obesity among individuals with severe and persistent mental illness. Thus we sought to evaluate the potential utility of a behavioral weight control program for this population. METHOD Outpatients receiving psychiatric care at a university medical center who had a body mass index (BMI; weight in kg/[height in m](2)) >or= 30 and were currently taking antipsychotic medication participated in a 12-week group behavioral weight control program. A medical chart review was conducted for each participant's body weight over the 10 months prior to beginning the program. A multiple baseline design was used to determine the impact of the intervention on BMI through 12-month posttreatment follow-up. We also assessed self-reported eating behavior, physical activity, and health-related quality of life. Data were collected from October 2000 to July 2003. RESULTS Among 35 patients who began the program, 29 (83%) completed treatment, with mean (+/- SD) weight loss of 5.04 (+/- 7.52) pounds (p = .001) and improvements in eating, activity, and quality of life. At 3-month posttreatment follow-up (N = 27; 77%), total mean weight loss was 7.14 (+/- 11.47) pounds (p = .003). Results of a longitudinal model based on general estimating equations indicated that, relative to the pretreatment period, BMI decreased significantly during treatment and remained stable through 12-month posttreatment follow-up. CONCLUSION Behavioral weight control is a promising approach to the treatment of obesity among outpatients taking antipsychotic medications, but longer and more robust interventions are needed.

[1]  S. Minsky,et al.  Managing atypical antipsychotic-associated weight gain: 12-month data on a multimodal weight control program. , 2004, The Journal of clinical psychiatry.

[2]  L. Epstein,et al.  Do children lose and maintain weight easier than adults: a comparison of child and parent weight changes from six months to ten years. , 1995, Obesity research.

[3]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[4]  C. McHorney,et al.  The MOS 36‐Item Short‐Form Health Survey (SF‐36): II. Psychometric and Clinical Tests of Validity in Measuring Physical and Mental Health Constructs , 1993, Medical care.

[5]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[6]  J. Newcomer,et al.  Atypical Antipsychotics and Metabolic Dysregulation: Evaluating the Risk/Benefit Equation and Improving the Standard of Care , 2004, Journal of clinical psychopharmacology.

[7]  P. O'Neil,et al.  Development and validation of the Eating Behavior Inventory , 1979 .

[8]  D. Taylor,et al.  Atypical antipsychotics and weightgain — a systematic review , 2000, Acta psychiatrica Scandinavica.

[9]  M. Heo,et al.  Antipsychotic-induced weight gain: a comprehensive research synthesis. , 1999, The American journal of psychiatry.

[10]  R. Paffenbarger,et al.  Physical activity as an index of heart attack risk in college alumni. , 1978, American journal of epidemiology.

[11]  R. Buchanan,et al.  A program for treating olanzapine-related weight gain. , 2001, Psychiatric services.

[12]  L. Epstein,et al.  Ten-year follow-up of behavioral, family-based treatment for obese children. , 1990, JAMA.