Lifestyle Interventions for Weight Management in People With Serious Mental Illness: A Systematic Review With Meta-Analysis, Trial Sequential Analysis, and Meta-Regression Analysis Exploring the Mediators and Moderators of Treatment Effects
Abstract
Background: Serious mental illness (SMI) reduces life expectancy, primarily due to somatic comorbidity linked to obesity. Meta-analyses have found beneficial effects of lifestyle interventions in people with SMI and recommended their implementation to manage obesity. Objective: The objective of this systematic review was to assess the benefits and harms of individualized lifestyle interventions for weight in people diagnosed with SMI and to explore potential mediators and moderators of the effect. Methods: The protocol was registered at PROSPERO (CRD42016049093). Randomized clinical trials (RCTs) assessing the effect of individualized lifestyle interventions on weight management in people with SMI were included. Primary outcomes were differences in endpoint body mass index (BMI) and the proportion achieving clinically relevant weight loss (≥5%). Secondary outcomes included quality of life, cardiometabolic risk factors, and adverse effects. Results: We included 41 RCTs (n = 4,267). All trials were at high risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. The experimental interventions reduced the mean difference in BMI by –0.63 kg/m2 (95% confidence interval [CI] = –1.02 to –0.23; p = 0.002; I2 = 70.7%) compared to the control groups. At postintervention follow-up (17 RCTs), the effect size remained similar but was no longer significant (BMI = –0.63 kg/m2; 95% CI = –1.30 to 0.04; p = 0.07; I2 = 48.8%). The risk ratio for losing ≥5% of baseline weight was 1.51 (95% CI = 1.07–2.13; p = 0.02) compared to the control groups. GRADE showed very low or low quality of evidence. Conclusion: There is a statistically significant, but clinically insignificant, mean effect of individualized lifestyle interventions for weight reduction in people with SMI.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The magnitude of weight reduction is similar to the magnitude of weight lost from lifestyle interventions and by adding topiramate or metformin to current antipsychotic medication.
“On the other hand, the magnitude is similar to the magnitude of weight lost from lifestyle interventions (79, 80) and by adding topiramate or metformin to current antipsychotic medication, all being recommended in clinical guidelines (81).”
From Reversibility of Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis (2021) · cites this paper as [79]
Cites
The Health Belief Model: a decade later.
Janz, N. K., & Becker, M. H. (1984) · Health Education Quarterly · doi:10.1177/109019818401100101 · Cited by 8,437 · see citing works
Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes
The Look AHEAD Research Group (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1212914 · Cited by 2,908 · see citing works
Random-effects model for meta-analysis of clinical trials: An update
DerSimonian, R., & Kacker, R. (2007) · Contemporary Clinical Trials · doi:10.1016/j.cct.2006.04.004 · Cited by 2,374 · see citing works
Plea for routinely presenting prediction intervals in meta-analysis.
IntHout, J., Ioannidis, J. P. A., Rovers, M. M., & Goeman, J. J. (2016) · BMJ Open · doi:10.1136/bmjopen-2015-010247 · Cited by 2,264 · see citing works
Puhan, M. A., Schunemann, H. J., Murad, M. H., Li, T., Brignardello-Petersen, R., Singh, J. A., Kessels, A. G., Guyatt, G. H., & for the GRADE Working Group (2014) · BMJ · doi:10.1136/bmj.g5630 · Cited by 1,812 · see citing works
Vancampfort, D., Stubbs, B., Mitchell, A. J., De Hert, M., Wampers, M., Ward, P. B., Rosenbaum, S., & Correll, C. U. (2015) · World Psychiatry · doi:10.1002/wps.20252 · Cited by 1,271 · see citing works
Self-citationLiu, N. H., Daumit, G. L., Dua, T., Aquila, R., Charlson, F., Cuijpers, P., Druss, B., Dudek, K., Freeman, M., Fujii, C., et al. (2017) · World Psychiatry · doi:10.1002/wps.20384 · Cited by 865 · see citing works
Self-citationVancampfort, D., Correll, C. U., Galling, B., Probst, M., De Hert, M., Ward, P. B., Rosenbaum, S., Gaughran, F., Lally, J., & Stubbs, B. (2016) · World Psychiatry · doi:10.1002/wps.20309 · Cited by 659 · see citing works
Self-citationA Behavioral Weight-Loss Intervention in Persons with Serious Mental Illness
Daumit, G. L., Dickerson, F. B., Wang, N.-Y., Dalcin, A., Jerome, G. J., Anderson, C. A. M., Young, D. R., Frick, K. D., Yu, A., Gennusa, J. V., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1214530 · Cited by 523 · see citing works
Exercise therapy improves mental and physical health in schizophrenia: a randomised controlled trial
Scheewe, T. W., Backx, F. J. G., Takken, T., Jörg, F., van Strater, A. C. P., Kroes, A. G., Kahn, R. S., & Cahn, W. (2013) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12029 · Cited by 246 · see citing works
Methodological Recommendations for Trials of Psychological Interventions
Guidi, J., Brakemeier, E.-L., Bockting, C. L. H., Cosci, F., Cuijpers, P., Jarrett, R. B., Linden, M., Marks, I., Peretti, C. S., Rafanelli, C., et al. (2018) · Psychotherapy and Psychosomatics · doi:10.1159/000490574 · Cited by 205 · see citing works
Caemmerer, J., Correll, C. U., & Maayan, L. (2012) · Schizophrenia Research · doi:10.1016/j.schres.2012.03.017 · Cited by 182 · see citing works
Bruins, J., Jörg, F., Bruggeman, R., Slooff, C., Corpeleijn, E., & Pijnenborg, M. (2014) · PLoS ONE · doi:10.1371/journal.pone.0112276 · Cited by 129 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Cardiovascular disease in patients with severe mental illness
Nielsen, R. E., Banner, J., & Jensen, S. E. (2021) · Nature Reviews Cardiology · doi:10.1038/s41569-020-00463-7 · Cited by 389 · see citing works
Whicher, C. A., Price, H. C., Phiri, P., Rathod, S., Barnard‐Kelly, K., Ngianga, K., Thorne, K., Asher, C., Peveler, R. C., McCarthy, J., et al. (2021) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.14334 · Cited by 77 · see citing works
Reversibility of Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis
Speyer, H., Westergaard, C., Albert, N., Karlsen, M., Stürup, A. E., Nordentoft, M., & Krogh, J. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.577919 · Cited by 44 · see citing works
Self-citationWalburg, F. S., van Meijel, B., Hoekstra, T., Kol, J., Pape, L. M., de Joode, J. W., van Tulder, M., & Adriaanse, M. (2023) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2023.1566 · Cited by 27 · see citing works
Korman, N., Fox, H., Skinner, T., Dodd, C., Suetani, S., Chapman, J., Parker, S., Dark, F., Collins, C., Rosenbaum, S., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00319 · Cited by 27 · see citing works
Psychosocial therapies in severe mental illness: update on evidence and recommendations
Gühne, U., Weinmann, S., Riedel-Heller, S. G., & Becker, T. (2020) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000618 · Cited by 19 · see citing works
Behavioral Interventions to Reduce Cardiovascular Risk Among People with Severe Mental Disorder
Baker, A. L., Forbes, E., Pohlman, S., & McCarter, K. (2022) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-072720-012042 · Cited by 9 · see citing works
- Authors
- Speyer, H., Jakobsen, A. S., Westergaard, C., Nørgaard, H. C. B., Pisinger, C., Krogh, J., Hjorthøj, C., Nordentoft, M., Gluud, C., Correll, C. U., & Jørgensen, K. B.
- Affiliations
- Copenhagen University Hospital (DK)
- Aarhus University Hospital (DK)
- Glostrup Hospital (DK)
- Northwell Health (US)
- ORCID
- Venue
- Psychotherapy and Psychosomatics
- Publisher
- S. Karger AG
- Published
- 2019
- Volume
- 88
- Issue
- 6
- Pages
- 350-362
- ISSN
- 0033-3190 (ISSN-L)
- 1423-0348
- OpenAlex
- W2972525214
- Cited by
- 116
- References
- 13
- Citations by year
- 2026: 13 · 2025: 23 · 2024: 20 · 2023: 19 · 2022: 18 · 2021: 10 · 2020: 11 · 2019: 2
- FWCI
- 1.66
- Type
- journal article
- Language
- en
- Update notices
- erratum (2019-09-13)
- Open access
- closed
- Locations
- Psychotherapy and Psychosomatics (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Scopus (Elsevier) (submittedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Keywords
- severe mental illness, lifestyle intervention, weight management, obesity, body mass index, weight loss, cardiometabolic risk factors, quality of life, personalized interventions
- MeSH terms
- Mental Disorders, Humans, Life Style, Obesity, Quality of Life, Regression Analysis, Antipsychotic Agents, Weight Gain, Randomized Controlled Trials as Topic, Risk Reduction Behavior
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
