Health promotion lifestyle interventions for weight management in psychosis: a systematic review and meta-analysis of randomised controlled trials
Open accessAbstract
BACKGROUND: Psychiatric patients have more physical health problems and much shorter life expectancies compared to the general population, due primarily to premature cardiovascular disease. A multi-causal model which includes a higher prevalence of risk factors has provided a valid explanation. It takes into consideration not only risks such as gender, age, and family history that are inherently non-modifiable, but also those such as obesity, smoking, diabetes, hypertension, and dyslipidemia that are modifiable through behavioural changes and improved care. Thus, it is crucial to focus on factors that increase cardiovascular risk. Obesity in particular has been associated with both the lifestyle habits and the side effects of antipsychotic medications. The present systematic review and meta-analysis aims at collecting and updating available evidence on the efficacy of non-pharmacological health promotion programmes for psychotic patients in randomised clinical trials. METHODS: We systematically reviewed the randomised controlled trials from 1990 onward, in which psychoeducational and/or cognitive-behavioural interventions aimed at weight loss or prevention of weight gain in patients with psychosis had been compared to treatment as usual. We carried out a meta-analysis and pooled the results of the studies with Body Mass Index as primary outcome. RESULTS: The results of the meta-analysis show an effect toward the experimental group. At the end of the intervention phase there is a -0.98 kg/m(2) reduction in the mean Body Mass Index of psychotic subjects. Notably, prevention studies with individual psychoeducational programmes that include diet and/or physical activity seem to have the highest impact. CONCLUSIONS: When compared with treatment as usual in psychotic patients, preventive and individual lifestyle interventions that include diet and physical activity generally prove to be effective in reducing weight. Physical screening and monitoring programmes are well accepted by patients and can be implemented in a variety of settings. A weight loss of 0.98 points in the Body Mass Index corresponds to a loss of 3.12% of the initial weight. This percentage is below the 5% to 10% weight loss deemed sufficient to improve weight-related complications such as hypertension, type II diabetes, and dyslipidemia. However, it is reported that outcomes associated with metabolic risk factors may have greater health implications than weight changes alone. Therefore, in addition to weight reduction, the assessment of metabolic parameters to monitor other independent risk factors should also be integrated into physical health promotion and management in people with mental disorders.
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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 Bonfioli et al. 2012
In Results (‘Results for all interventions’; page unavailable), the paper says its test failed to suggest substantial heterogeneity in effects. Its ‘Heterogeneity of studies’ section describes differences in samples and interventions, but says the analysis did not detect statistically significant heterogeneity. Those differences do not establish the claimed large differences between effects. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredModerate 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 Bonfioli et al. 2012
The Discussion reports that lifestyle interventions reduced BMI by 0.98 kg/m², corresponding to 3.12% of initial weight—not 0.94 kg/m² or 3.12 kg. The Results describe participants taking antipsychotics, but the studies included normal-weight and overweight participants as well as obese participants. The paper reports reducing weight, not counteracting weight loss. Page numbers are not available in our copy. (LLM, conf=0.90)
Experimental — accuracy not yet measuredTwo meta-analyses indicated that weight management programs could impede weight gain during antipsychotic treatment and could also be effective for weight loss.
“Two meta-analyses (Bonfioli et al. 2012, Caemmerer et al. 2012) indicated that weight management programs could impede weight gain during antipsychotic treatment and could also be effective for weight loss.”
From Excess early mortality in schizophrenia. (2014) · cites this paper as Bonfioli et al. 2012
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Cited by
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Excess early mortality in schizophrenia.
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A systematic review and meta-analysis of exercise interventions in schizophrenia patients
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- Authors
- Bonfioli, E., Berti, L., Goss, C., Muraro, F., & Burti, L.
- Affiliations
- University of Verona (IT)
- Corresponding author
- Bonfioli, Elena
- ORCID
- Bonfioli, Elena
- Venue
- BMC Psychiatry
- Published
- 2012-07-12
- Volume
- 12
- Issue
- 1
- Pages
- 78-78
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC3549787
- OpenAlex
- W2160364963
- Cited by
- 154
- References
- 5
- Citations by year
- 2026: 7 · 2025: 3 · 2024: 5 · 2023: 9 · 2022: 12 · 2021: 15 · 2020: 14 · 2019: 11 · 2018: 17 · 2017: 10 · 2016: 16 · 2015: 10 · 2014: 13 · 2013: 10 · 2012: 2
- FWCI
- 1.51
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Università degli Studi di Verona
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Keywords
- psychosis, weight management, health promotion, lifestyle intervention, psychoeducation, cognitive-behavioural intervention, body mass index, weight gain prevention, obesity, cardiovascular risk, antipsychotic adverse effects, physical activity, diet, metabolic risk factors, mental illness
- MeSH terms
- Health Promotion, Humans, Obesity, Patient Education as Topic, Psychotic Disorders, Cognitive Behavioral Therapy, Body Mass Index, Randomized Controlled Trials as Topic, Risk Reduction Behavior, Weight Reduction Programs
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