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Cited by 182Schizophrenia research and treatmentEating Disorders and BehaviorsPharmacology and Obesity Treatment

Acute and maintenance effects of non-pharmacologic interventions for antipsychotic associated weight gain and metabolic abnormalities: a meta-analytic comparison of randomized controlled trials.

Open access
Caemmerer, Jacqueline, Correll, Christoph U., Maayan, Lawrence·2012·Schizophrenia Research
DOI 10.1016/j.schres.2012.03.017PMC PMC10416544
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Abstract

Objective To evaluate the efficacy of non-pharmacological interventions for antipsychotic-associated weight gain.Methods Systematic literature search and meta-analysis of randomized controlled trials comparing behavioral interventions with control groups to ameliorate antipsychotic-associated weight gain.Results Across 17 studies (n=810, mean age: 38.8 years, 52.7% male, 40.8% White, 85.6% with schizophrenia-spectrum disorders), non-pharmacological interventions led to a significant reduction in weight (-3.12 kg; CI: -4.03, -2.21, p<0.0001) and body mass index (BMI) (-0.94 kg/m²; CI: -1.45, -0.43, p=0.0003) compared with control groups. Intervention benefits extended to all secondary outcomes, except for high density-lipoprotein-cholesterol and systolic blood pressure. Compared to controls, intervention patients experienced significant decreases in waist circumference (WMD=-3.58 cm, CI: -5.51, -1.66, p=0.03), percent body fat (WMD=-2.82%, CI: -5.35, -0.30, p=0.03), glucose (WMD=-5.79 mg/dL, CI: -9.73, -1.86, p=0.004), insulin (WMD=-4.93 uIU/mL, CI: -7.64, -2.23, p=0.0004), total cholesterol (WMD=-20.98 mg/dL, CI: -33.78, -8.19; p=0.001), low density-lipoprotein-cholesterol (WMD=-22.06 mg/dL, CI: -37.80, -6.32, p=0.006) and triglycerides (WMD=-61.68 mg/dL, CI: -92.77, -30.59, p=0.0001), and less weight gain >7% (29.7% vs. 61.3%; RR=-0.52, CI: -0.35, -0.78, p=0.002; number-needed-to-treat=4). Up to 12 months after the intervention ended (mean=3.6 months), benefits endured regarding weight (WMD=-3.48 kg, CI: -6.37, -0.58, p=0.02), but not BMI (p=0.40). Subgroup analyses showed superiority of non-pharmacological interventions irrespective of treatment duration, individual or group, cognitive behavioral or nutritional interventions, or prevention versus intervention trials. However, weight and BMI were significantly improved only in outpatient trials (p<0.0001), but not in inpatient or mixed samples (p=0.09-0.96).Conclusion Behavioral interventions effectively prevented and reduced antipsychotic-associated weight gain and cardiometabolic perturbations, at least in outpatients agreeing to participate in trials aimed at improving physical health. Effective treatments ranged from nutritional interventions to cognitive behavioral therapy.

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Crossref · 10.1016/j.schres.2012.03.017

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  • Moderate evidence suggests that it is possible to counteract weight loss or to prevent weight increases of 3.12 kg on average (or 0.94 kg/m2 measured as BMI) in obese mentally ill people undergoing antipsychotic treatment.

    “Moderate evidence suggests that it is possible to counteract weight loss or to prevent weight increases of 3.12 kg on average (or 0.94 kg/m 2 measured as BMI) in obese mentally ill people undergoing antipsychotic treatment.”

    From Excess early mortality in schizophrenia. (2014) · cites this paper as Caemmerer et al. 2012

    The Results (Co-primary Outcomes; page not provided) report 3.12 kg less weight and 0.94 kg/m² less BMI with non-pharmacological interventions than with controls. The paper describes preventing or reducing weight gain, not “counteracting weight loss.” The claim also limits the finding to obese people, whereas the pooled groups’ mean BMIs were below the obesity threshold and the Discussion says significant benefits were found only in outpatient trials. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Exercise has demonstrated benefits for people with mental illness, including symptom reduction, improved cardiovascular risk profile, and improved physical capacity.

    “In addition to pharmacological and psychological interventions, exercise has demonstrated bene fi ts for people with mental illness including symptom reduction, improvedcardiovascularriskpro fi le and improved physical capacity.”

    From A call to action: Exercise as treatment for patients with mental illness (2015) · cites this paper as Caemmerer et al. 2012

    The Results and Discussion (page not provided) report improvements in several cardiometabolic risk factors from non-pharmacological interventions, some of which included exercise. They do not establish benefits from exercise alone or report reductions in psychiatric symptoms or improvements in physical capacity. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Exercise may reduce cardiometabolic symptoms in patients with mental illness.

    “Evidence suggests exercise may reduce cardiometabolic symptoms in patients with mental illness (Caemmerer et al. 2012)”

    From A call to action: Exercise as treatment for patients with mental illness (2015) · cites this paper as Caemmerer et al. 2012

    The Discussion reports that pooled non-pharmacologic interventions reduced several cardiometabolic risk factors, including glucose, cholesterol, and triglycerides. It also says the interventions included exercise, but exercise was not assessed separately for those outcomes. The Abstract conclusion limits the finding to antipsychotic-associated problems, at least among outpatients who agreed to participate, rather than patients with mental illness generally. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Large differences exist between the effects achieved in the studies.

    “Note that large differences exist between the effects achieved in the studies (Bonfioli et al. 2012, Caemmerer et al. 2012).”

    From Excess early mortality in schizophrenia. (2014) · cites this paper as Caemmerer et al. 2012

  • AE is known to be preventative of cardiovascular, metabolic and respiratory dysfunction.

    “Moreover, AE is known to be preventative of cardiovascular, metabolic and respiratory dysfunction, which suggests that the inclusion of an AE intervention may be useful in stemming the risk of psychiatric patients developing these severe conditions (Caemmerer et al., 2012; Vancampfort et al., 2014).”

    From Aerobic Exercise as a Tool to Improve Hippocampal Plasticity and Function in Humans: Practical Implications for Mental Health Treatment (2016) · cites this paper as Caemmerer et al., 2012

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Authors
Caemmerer, J., Correll, C. U., & Maayan, L.
Affiliations
  • Nathan Kline Institute for Psychiatric Research (US)
  • Albert Einstein College of Medicine (US)
ORCID
Venue
Schizophrenia Research
Publisher
Elsevier BV
Published
2012-09
Volume
140
Issue
1-3
Pages
159-168
ISSN
0920-9964 (ISSN-L)
DOI
10.1016/j.schres.2012.03.017
PMC
PMC10416544
OpenAlex
W1968434622
Cited by
182
References
50
Citations by year
2026: 1 · 2025: 9 · 2024: 9 · 2023: 10 · 2022: 7 · 2021: 14 · 2020: 14 · 2019: 18 · 2018: 14 · 2017: 18 · 2016: 17 · 2015: 14 · 2014: 20 · 2013: 15 · 2012: 2
FWCI
11.59
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Schizophrenia Research (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (MH090590, P30MH090590)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
Keywords
non-pharmacological treatment
MeSH terms
Adult, Behavior Therapy, Female, Humans, Male, Metabolic Diseases, Schizophrenia, Antipsychotic Agents, Weight Gain, Databases, Factual, Treatment Outcome

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