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People With Serious Mental Illnesses Can Lose Weight


Over 80% of people with serious mental illnesses are overweight or obese, which contributes to them dying at three times the rate of the overall population. They succumb mostly to the same things the rest of the population experiences-cardiovascular disease, diabetes and cancer. Although antipsychotic medications increase appetite and cause weight gain in these patients, it is not the only culprit. Like the general population, sedentary lifestyle and poor diet also play a part. Lifestyle modifications such as diet and exercise should work for these patients, yet they are often left out of weight loss studies. Other factors that preclude people with serious mental illnesses from losing weight include memory impairments or residual psychiatric symptoms that impede learning and adopting new behaviors such as counting calories. Socioeconomics are also a factor as many can’t afford or can’t get to physical activity programs like fitness gyms. Some patients additionally suffer from social phobia or have poor social interactions, and are simply afraid to work out in a public area.


According to an article published online in The New England Journal of Medicine (21 March 2013), it was shown that people with serious mental illnesses such as schizophrenia, bipolar disorder and major depression can lose weight and keep it off through a modified lifestyle intervention program. As a result, this study could usher in new forms of weight loss treatment for people with serious mental illness.


The study attempted to solve these issues by bringing the gyms and nutritionists to places most of these patients frequent — psychiatric rehabilitation outpatient programs. Under the trial name ACHIEVE, 291 participants in 10 rehab centers around Maryland were randomized to receive the usual care , consisting of nutrition and physical activity information, or six months of intensive intervention consisting of exercise classes three times a week along with individual or group weight loss classes once a week. Both groups were followed for an additional year, during which the weight loss classes of the intervention arm tapered down but the exercise classes remained constant. The intervention arm included goals such as reducing caloric intake by avoiding sugar-sweetened beverages and junk food; eating five servings of fruits and vegetables daily; choosing smaller portions and healthy snacks; and moderate intensity aerobic exercise.


Results showed that participants in the specially tailored weight loss program lost seven pounds more than the controls — and continued to lose weight and did not regain, despite the reduced frequency of classes and counseling sessions. In contrast, the general population tends to experience peak weight loss in the first six months and then rebound and gain part or all of their weight back.


On average, each participant was on three psychotropic medications, with half on lithium or mood stabilizers, all known to cause weight gain. But no matter what they were on, they lost the weight.


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