 |
 |
|
||||||||||||||||||||||||||
| Subscribe to Clinical Compass™ | VOLUME 2, ISSUE 7 - MARCH 27, 2007 | |||||||||||||||||||||||||||
 |
||||||||||||||||||||||||||||
|
|
|||||||||||||||||||||||||||
|
FROM THE CLINICAL KNOWLEDGE CENTER Weight Management Through a Behavioral Intervention in Patients with Severe Mental Illness by Michelle Ostrander, PhD On March 21, 2007, CME Outfitters launched the debut of neuroscienceCME TV, titled Weight Gain with the Atypicals: How to Screen, Monitor, and Intervene. This continuing education program focused on how obesity and overweight impact cardiovascular and metabolic health in patients with severe mental health illness (SMI) and provided strategies that clinicians can employ to manage weight and improve physical wellbeing in these patients. Archived versions of this program are available now at www.cmeoutfitters.com and www.neuroscienceCME.com. As discussed during this neuroscienceCME TV program, overweight and obesity in patients with SMI are an important public health concern. Patients with SMI exhibit a greater prevalence of overweight and obesity than the general population and many of the agents utilized to treat these patients may cause weight gain, further compounding health risk. Overweight and obesity are associated with increased cardiovascular risk and metabolic disturbances, and weight gain during antipsychotic treatment is associated with poor medication compliance that may increase the risk of psychotic relapse. While the most common intervention to manage antipsychotic-induced weight gain is to switch medications, behavioral interventions may also play an important role in weight management within a comprehensive treatment program for patients with SMI. A newly published study reports the results from a behavioral weight management clinic for patients with SMI. This weight management clinic was established at The Cromwell House in the UK with a primary objective of helping patients with SMI to lose weight. The results of this study are from the first 4 years of this program. Patients referred themselves to the clinic, which consisted of voluntary attendance at weekly group sessions. Patients were permitted to come to as many or as few of the sessions as they chose. During the first 15 minutes of each session, patients were weighed and privately informed of how much weight they had gained or lost since the last session. The second 15 minutes of the session consisted of a voluntary group discussion of alterations in weight, as well as sharing of personal dietary experiences during the preceding week. The last 30 minutes of the session were devoted to a rotating series of educational topics focusing on issues such as dietary considerations, physical activity, and self-esteem. Although patients were permitted to re-enroll in the program at any point, an absence of more than 3 months followed by a re-enrollment was considered a new patient episode. Patients' weight was monitored for as long as they were in the program, but once they had discontinued the program weight measurements were no longer available. Clinically significant weight loss was defined as a value of 7% change in body weight. Ninety-three patients (36 men, 57 women) with an average age of 43.7 ± 1.2 years self-referred into the clinic during the first 4 years of the program. Eighty patients had a diagnosis of schizophrenia whereas 13 patients had a diagnosis of an affective disorder. The mean baseline for the first clinic visit was 197.3 ± 4.0 pounds with a body mass index (BMI) of 32.3 ± 0.5 kg/m² (normal BMI = 18.5 to 24.9; overweight BMI = 25.0 to 29.9; obese BMI ≥ 30). Body weight and BMI were significantly reduced throughout the duration of the study. Clinically significant weight loss was achieved by 12% of patients at 3 months into the program, 37% of patients at 6 months, 58.5% of patients at 1 year, 81.2% of patients at 2 years, and 100% of patients at 4 years. Of note, however, is the high number of patients who discontinued participation in the program; at 1 year only 40% of patients were still in the program, and at 2 years and 4 years the participation rate plummeted to 16% and 3%, respectively. The data were further analyzed to determine whether any specific factors were determinants of weight loss. Percentage weight loss did not differ by gender or baseline weight or BMI. Younger patients lost more weight during the first 3 months of the program (p = .031), but this difference was not significant after 6 months. Weight loss was greater in patients with schizophrenia compared to patients with affective disorders during the first 8 weeks, but this difference did not persist beyond this time point. Similarly, patients on typical or atypical antipsychotic drugs exhibited greater weight loss compared to patients on antidepressant medications during the first 8 weeks, but this difference was not significant at any other time point. Weight loss was significantly correlated with attendance at the clinic (p < .0001) and patients on multiple medications went to twice as many sessions as patients on monotherapy (p = .0001). The researchers note several limitations to this study. Participants of this weight management program were well-motivated, self-referring patients and the results may not be replicable in other populations of patients with SMI. Because the study was not a randomized, controlled trial, the effectiveness of the intervention cannot be determined. Patients were not monitored following discontinuation of the program so it is not known whether weight loss achieved during the program was maintained. The lack of patient monitoring following program discontinuation also prevented the researchers from learning why patients dropped out. It may be that patients dropped out of the program because they believed that it was not an effective intervention for them. Although preliminary, these data suggest that behavioral interventions may be an effective way for patients with SMI to manage weight, and thus to modify their risk for cardiovascular disease and metabolic disturbances. Do you have feedback for the author? Click here to send us an email. References
|
||||||||||||||||||||||||||||
 |
||||||||||||||||||||||||||||
| ©2007 CME Outfitters, LLC |
||||||||||||||||||||||||||||