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The Effects of Lifestyle Interventions on (Long-Term) Weight Management, Cardiometabolic Risk and Depressive Symptoms in People with Psychotic Disorders: A Meta-Analysis
Open accessAbstract
AIMS: The aim of this study was to estimate the effects of lifestyle interventions on bodyweight and other cardiometabolic risk factors in people with psychotic disorders. Additionally, the long-term effects on body weight and the effects on depressive symptoms were examined. MATERIAL AND METHODS: We searched four databases for randomized controlled trials (RCTs) that compared lifestyle interventions to control conditions in patients with psychotic disorders. Lifestyle interventions were aimed at weight loss or weight gain prevention, and the study outcomes included bodyweight or metabolic parameters. RESULTS: The search resulted in 25 RCTs -only 4 were considered high quality- showing an overall effect of lifestyle interventions on bodyweight (effect size (ES) = -0.63, p<0.0001). Lifestyle interventions were effective in both weight loss (ES = -0.52, p<0.0001) and weight-gain-prevention (ES = -0.84, p = 0.0002). There were significant long-term effects, two to six months post-intervention, for both weight-gain-prevention interventions (ES = -0.85, p = 0.0002) and weight loss studies (ES = -0.46, p = 0.02). Up to ten studies reported on cardiometabolic risk factors and showed that lifestyle interventions led to significant improvements in waist circumference, triglycerides, fasting glucose and insulin. No significant effects were found for blood pressure and cholesterol levels. Four studies reported on depressive symptoms and showed a significant effect (ES = -0.95, p = 0.05). CONCLUSION: Lifestyle interventions are effective in treating and preventing obesity, and in reducing cardiometabolic risk factors. However, the quality of the studies leaves much to be desired.
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“Interventions with long-term follow-up are also warranted, since there are no reasons to believe that changes in metabolic risk factors occur faster in patients with severe mental disorders than the general population 18 .”
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“Weight reduction is the most used outcome [46][47][48][49][50][51][52][53][54][55] and the evidence is reported to be favourable 17 , although long-term trials are missing 18 .”
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“ISMI are more likely to have obesity (Manu et al., 2015), and die prematurely because of metabolic complications (Almeida et al., 2014), and PA appears to be an effective strategy to manage them (Bruins et al., 2014; Chalfoun et al., 2015; Firth et al., 2015).”
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“Several studies have demonstrated that participating in behavioural lifestyle interventions often lead weight loss [55].”
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“A recently published meta-analysis has showed that lifestyle interventions have impacted the reduction and prevention of obesity and on decreasing cardio-metabolic risk factors except blood pressure and cholesterol levels (Bruins et al., 2014).”
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“Concerning that, and due to the role of healthy diet on weight lost, insulin resistance, dyslipidemia, and hypertension (Bonfioli, Berti, Goss, Muraro, & Burti, 2012; Bruins et al., 2014; Wu, Wang, Bai, Huang, & Lee, 2007), traditional dietary patterns with proven benefits on health may be recommended for people with…”
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“The authors however noted that the quality of studies was poor with only 4 of the 25 RCTs included judged to be high quality [10].”
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“Uncontrolled hyperglycaemia can however still progress to type 2 diabetes, therefore, it is important that this risk is mitigated through lifestyle intervention [64].”
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“…al., 2013; Naslund et al., 2016; Olker et al., 2016; Richards et al., 2016; Verhaeghe et al., 2013), significant reductions in waist circumference (Bruins et al., 2014; Caemmerer et al., 2012; Fernández-San-Martín et al., 2014, Gill et al., 2016), reductions in blood pressure (Bauer et al., 2016;…”
BackgroundResultMucheru, D., Ashby, S., Hanlon, M., McEvoy, M., & MacDonald‐Wicks, L. K. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-05629-0 · Cited by 13
Exercise as a novel treatment option to address cardiometabolic dysfunction associated with PTSD
Rosenbaum, S., Tiedemann, A., Berle, D., Ward, P. B., & Steel, Z. (2015) · Metabolism · doi:10.1016/j.metabol.2015.01.016 · Cited by 12
İnce, S. Ç., & Günüşen, N. P. (2021) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12745 · Cited by 12
Faden, J., Serdenes, R., & Citrome, L. (2022) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2022.2060742 · Cited by 12
“treatment as usual, with little difference between specific interventions [95,96].”
BackgroundKoning, E., Grigolon, R. B., Breda, V., Gomes, F. A., Zucatti, K. P., Teixeira, P. P., Colpani, V., Gerchman, F., & Brietzke, E. M. (2023) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2023.111445 · Cited by 15
Wang, S., Xu, W., Gao, L., Tan, W., Zheng, H., Hou, C., & Jia, F. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1104841 · Cited by 12
Vincenzi, B., Greene, M. C., ULLOA, M., Parnarouskis, L., Jackson, J. W., & Henderson, D. C. (2016) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000149 · Cited by 10
St‐Amour, S., Hains-Monfette, G., Dancause, K. N., Cailhol, L., & Bernard, P. (2021) · Mental health and physical activity · doi:10.1016/j.mhpa.2021.100394 · Cited by 9
Richter, D., Gühne, U., Stein, J., Weinmann, S., Becker, T. M., & Riedel-Heller, S. G. (2018) · Psychiatrische Praxis · doi:10.1055/a-0677-7301 · Cited by 7
“Die Anzahl an eingeschlossenen Studien mit randomisierten kontrollierten Studiendesign in den einzelnen vollständig berücksichtigten Übersichtsarbeiten variiert zwischen 10 [58] und 25 RCTs [55].”
BackgroundInfluentialMullor, D., Cangas, A. J., Gallego, J., Aguilar-Parra, J. M., Rosado, A., & López, A. (2019) · Psychosis · doi:10.1080/17522439.2018.1559873 · Cited by 4
“(Brown, Goetz, &Hamera, 2011; Bruins et al., 2014; Carter-Morris & Faulkner, 2003; Daumit et al., 2013: Poulin et al., 2007; Skrinar, Huxley, Hutchinson, Menninger, & Glew, 2005).”
ResultCoates, D., Wright, L., Moore, T., Pinnell, S., Merillo, C., & Howe, D. J. (2019) · Child & Youth Services · doi:10.1080/0145935x.2018.1553613 · Cited by 8
“…nursing intervention and group program offered concurrently as a combination of both individual and group-based healthy lifestyle interventions has been found to be more effective than either strategy in isolation (Bruins et al., 2014; Rosenbaum, Tiedemann, Sherrington, Curtis, & Ward, 2014).”
MethodSchizophrenia and Related Psychoses
(2021) · Wiley eBooks · doi:10.1002/9781119870203.mpg001 · Cited by 9
Trajano, L. F., Hayes, J., Launders, N., Davies, N. M., Osborn, D., & Richards‐Belle, A. (2025) · BMJ Mental Health · doi:10.1136/bmjment-2024-301505 · Cited by 7
Nurse-led lifestyle intervention in a cohort of schizophrenia patients treated with clozapine
Mallorquí, A., Oliveira, C., Ríos, J., Isla-Pera, M. P., Gil-Badenes, J., Amoretti, S., Bernardo, M., Vieta, E., Parellada, E., Garriga, M., et al. (2023) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2023.06.008 · Cited by 7
Griffiths, C., & Hina, F. (2021) · Open Journal of Psychiatry · doi:10.4236/ojpsych.2021.114021 · Cited by 7
Vaiciurgis, V. T., Charlton, K. E., Clancy, A. K., & Beck, E. J. (2022) · Public Health Nutrition · doi:10.1017/s1368980022000969 · Cited by 8
Ntalkitsi, S., Efthymiou, D., Bozikas, V. P., & Vassilopoulou, Ε. (2022) · Nutrients · doi:10.3390/nu14235012 · Cited by 7
“These results are in agreement with those of several studies, such as those included in a meta-analysis [36] where no significant effects on the cholesterol levels of FEP patients were documented after dietary intervention [36].”
BackgroundResultInfluentialSeiter, H. T., Fellendorf, F. T., Popkova, D., & Reininghaus, E. Z. (2025) · International Journal of Bipolar Disorders · doi:10.1186/s40345-025-00397-4 · Cited by 7
“…exercise and/or psychological components) to control conditions in patients with psychotic disorders illustrated that these interventions were effective for both weight loss (effect size = − 0.52, p < 0.0001) and weight gain prevention (effect size = − 0.84, p = 0.0002) (Bruins et al. 2014).”
InfluentialNeuvonen, E., Lehtisalo, J., Ngandu, T., Levälahti, E., Antikaínen, R., Hänninen, T., Laatikainen, T. K., Lindström, J., Paajanen, T. I., Soininen, H. S., et al. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11051449 · Cited by 7
Mucheru, D., Hanlon, M., McEvoy, M., & MacDonald‐Wicks, L. K. (2017) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2016-003121 · Cited by 5
Søgaard, H. J., Højlund, M., Elliott, A. F., Viuff, A. G., Vandborg, K., Viuff, J. H., Munk‐Jørgensen, P., & Hjorth, P. (2018) · American Journal of Therapeutics · doi:10.1097/mjt.0000000000000708 · Cited by 5
Looijmans, A., Jörg, F., Bruggeman, R., Schoevers, R. A., Corpeleijn, E., Feenstra, T., & van Asselt, A. D. I. (2020) · Global & Regional Health Technology Assessment · doi:10.33393/grhta.2020.2027 · Cited by 5
“When effective, lifestyle interventions in SMI patients mostly lead to small physical health improvements, and sustaining these improvements in the long term is a challenge (2).”
BackgroundSelf-citationThompson, A., Senders, A., Seibel, C. L., Usher, C. T., Borgatti, A. C., Bodden, K., Calabrese, C., Hagen, K., David, J., BOURDETTE, D. N., et al. (2020) · Early Intervention in Psychiatry · doi:10.1111/eip.12913 · Cited by 5
“Controlled studies evaluating diet education, and physical activity in early psychosis report benefit in attenuated weight gain, weight loss, improved dietary choices and improved psychotic symptoms (Bonfioli, Berti, Goss, Muraro, & Burti, 2012; Bruins et al., 2014; Curtis et al., 2016; Firth, Carney, Elliott, et al.,…”
BackgroundGill, P., King, K., & Flego, A. (2022) · Australian Psychologist · doi:10.1080/00050067.2022.2107889 · Cited by 5
“, 2016) and reduction in other cardiometabolic risk factors such as waist circumference and blood pressure (Bruins et al., 2014; Cabassa et al., 2010; Daumit et al., 2013), while encouraging increased physical activity, reduction of alcohol consumption and smoking cessation (Naslund et al.”
BackgroundGurusamy, J., Gandhi, S., Dinakaran, D., Palaniappan, M., & Venkatasubramanian, G. (2024) · Schizophrenia Research · doi:10.1016/j.schres.2024.02.002 · Cited by 4
Kuzman, M. R., Kuharić, D. B., Kekin, I., Makarić, P., Madžarac, Z., Makar, A. K., Mikulić, S. K., Bajić, Ž., Bistrović, P., Bonacin, D., et al. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00488 · Cited by 4
“While several interventions involving exercise proved to be efficient over a shorter period, this effect is lost over a longer period (19, 20).”
BackgroundMarano, G., Marzo, E. M., Sfratta, G., Traversi, G., Capristo, E., Gaetani, E., & Mazza, M. (2026) · Life · doi:10.3390/life16010146 · Cited by 3
“Lifestyle interventions that include dietary counseling have shown effectiveness in reducing BMI, body weight, triglycerides, and fasting glucose [175,176], while also contributing to improvements in psychosocial well-being, quality of life, and symptom severity [177,178].”
Integrative Interventions for Improving Outcomes in Depression: A Narrative Review
Halma, M. T. J., Plothe, C., & Marik, P. E. (2024) · Psychology International · doi:10.3390/psycholint6020033 · Cited by 2
“We performed a literature search on lifestyle treatment for depression and found several reviews (Supplementary Table S3) [281–289].”
MethodMetabolic screen and intervene: improving mental health inpatient metabolic monitoring
Viglione, L., & Short, B. L. (2020) · Australasian Psychiatry · doi:10.1177/1039856220936147 · Cited by 3
Raad, T., George, E. S., Griffin, A., Larkin, L., Fraser, A. D., Kennedy, N., & Tierney, A. C. (2023) · medRxiv · doi:10.1101/2023.02.21.23286250 · Cited by 3
Mukherjee, S., Skrede, S., & Fernø, J. (2025) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-025-10009-2 · Cited by 2
“Lifestyle changes, such as diet, physical activity, and altera - tions in behavioral habits, are the first-line intervention for the treatment of obesity and should also serve as the first step in counteracting APD-induced obesity [ 89, 90].”
Zhang, M., Shi, J.-X., Li, H., Chen, R., Zheng, M., Yan, L.-J., Wu, N.-J., & He, Q. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.09.028 · Cited by 2
Mucheru, D., Hanlon, M., McEvoy, M., & MacDonald‐Wicks, L. K. (2019) · Health Promotion Journal of Australia · doi:10.1002/hpja.293 · Cited by 2
Thege, B. K., Emmanuel, T., Hill, S., & Wells, L. K. (2021) · Current Psychology · doi:10.1007/s12144-021-02269-3 · Cited by 4
Therapeutic management of obesity induced by antipsychotic drugs
Merk, W., & Lew‐Starowicz, M. (2021) · Wiedza Medyczna · doi:10.36553/wm.70 · Cited by 1
Metadata
- Authors
- Bruins, J., Jörg, F., Bruggeman, R., Slooff, C., Corpeleijn, E., & Pijnenborg, M.
- Affiliations
- University Medical Center Groningen (NL)
- Corresponding author
- Bruins, Jojanneke
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-12-04
- Volume
- 9
- Issue
- 12
- Pages
- e112276
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4256304
- OpenAlex
- W2118574085
- Cited by
- 129
- References
- 81
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 8 · 2023: 9 · 2022: 10 · 2021: 13 · 2020: 16 · 2019: 15 · 2018: 16 · 2017: 18 · 2016: 8 · 2015: 6
- FWCI
- 1.47
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- Funders
- Eli Lilly and Company
- 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
- lifestyle intervention, psychosis, weight management, weight loss, weight gain prevention, cardiometabolic risk, depressive symptoms, obesity, waist circumference, triglycerides, fasting blood glucose, insulin, blood pressure, cholesterol
- MeSH terms
- Blood Pressure, Body Weight, Depression, Humans, Insulin Resistance, Life Style, Obesity, Psychotic Disorders, Risk Factors, Weight Loss, Exercise, Body Mass Index
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