Background
Methods
Eligibility criteria
Search strategy
Study selection
Data extraction
Results
Study (year) | Sample size | Participants/ setting | Diagnosis | Antipsychotic medication | Primary outcomes | Intervention | Control | Duration* | Followup** |
---|---|---|---|---|---|---|---|---|---|
Álvarez Jiménez et al. (2006) [15] | (a) 28 | Outpatients | Schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, brief reactive psychosis, or psychosis not otherwise specified (NOS) | Olanzapine, risperidone, haloperidol | - Body weight | 10 to 14 individual sessions (weight check, agenda setting, review of self monitoring records, homework assignments) provided by clinical psychologists | Usual care + nonstructured information about weight gain and encouragement to limit food intake and/or increase physical activity | 12 | 0 |
(b) 33 | - BMI change | ||||||||
- Percentage of patients whose weight increased by more than 7 % of the initial weight | |||||||||
Brar et al. (2005) [13] | (a) 35 | Outpatients or stable long-term inpatients | Schizophrenia (38), Schizoaffective disorder (33) | Risperidone | Body weight change | 20 group-based behavioural treatment sessions for weight loss (manual driven didactic programme) | Usual care | 14 | 0 |
(b) 37 | Concomitant medications: sedative-hypnotics, antidepressants | ||||||||
Brown & Smith (2009) [29] | (a) 15 | Outpatients | Schizophrenia (11), bipolar disorder (5), depression (9), borderline personality disorder (3) | Weight gain drugs (not specified) | Body weight change | 5 semistructured health promotion sessions using an operational manual based on motivational interviewing, education, diary keeping, and facilitation of access to mainstream facilities, facilitated by mental health key workers | Usual care | N/A | 0 |
(b) 11 | |||||||||
Evans et al. (2005) [14] | (a) 29 | Outpatients | Schizophrenia (16), Schizoaffective disorder (11), schizophreniform psychosis (10), bipolar disorder (8), depression (5) | Olanzapine | - Body weight | 6 individual nutritional education sessions conducted by an accredited practicing dietician | Passive nutritional education from the booklet “Food for the mind” | 12 | 12 |
(b) 22 | - BMI change | ||||||||
- Waist circumference change | |||||||||
Forsberg et al. (2008) [27] | (a) 27 | Supported housing facilities | Schizophrenia (23), bipolar disorder (3), other psychotic disorders (7), other psychiatric diagnoses (8) | Antipsychotic medication | - Weight | Programme for healthy living: 2 sessions weekly focusing on the cooking of good nourishing food and on physical activity (indoor and outdoor activities) lead by a circle leader (no training in mental health field and no own experience of working with person with psychiatric disabilities but has a personal interest in healthy food and experience as a fitness instructor) | “aesthetic study circle” (learn and practice artistic techniques) | 52 | 0 |
(b) 19 | - Waist | ||||||||
- BMI | |||||||||
- Physiological values | |||||||||
Khazaal et al. (2007) [20] | (a) 31 | Outpatients | Schizophrenia and schizoaffective disorders (73.8 %), bipolar disorder (8.2 %), schizotypal disorder (6.6 %), other (11.5 %) | Olanzapine, risperidone, clozapine, quetiapine, amisulpride, classical antipsychotics | - Body weight | 12 2-hour group sessions weekly (motivational interview), tasting sessions, psychoeducation on links between weight gain and antipsychotics, food intake moderation prescribed, provided by two psychologists | Brief Nutritional Education (one informative 2 hour group session) | 12 | 3 |
(b) 30 | - BMI | ||||||||
- Eating and weight-related cognitions (MAC-R) - Binge eating simptomatology (SCID-IV) | |||||||||
Kwon et al. (2006) [16] | (a) 33 | Outpatients | Schizophrenia or schizoaffective disorder | Olanzapine | - Body weight | Diet and exercise management programme based on cognitive and behavioural therapy, nutritional education, diary and exercise lead respectively by a dietician and an exercise coordinator | Usual care + recommendations as to physical activity and eating | 12 | 0 |
(b) 15 | - BMI | ||||||||
Littrell et al. (2003) | (a) 35 | Outpatients | Schizophrenia (54), schizoaffective disorder (16) | Olanzapine | - Body weight | 16 1-hour psychoeducation classes using the "Solutions of wellness" modules ("Nutrition, wellness and living a healthy lifestyle", "Fitness and exercise") held by a clinician | Usual care + olanzapine | 16 | 8 |
(b) 35 | Concomitant medications: lithium, valproate, SSRI | - BMI | |||||||
Mauri et al. (2008) [28] | (a) 21 | Outpatients | Bipolar I disorder (41), bipolar II disorder (2), depressive disorder with psychotic symptoms (1) | Olanzapine | - Body weight | dietary group programme for weight control: 30-minutes psychoeducational meetings + diet | N/A | 12 | 0 |
(b) 27 | - BMI | ||||||||
McKibbin et al. (2006) [17] | (a) 32 | Board-and-care and community clubhouse | Schizophrenia (48), schizoaffective disorder (9) | Antipsychotics | - Body weight | 24 weekly, 90 min sessions addressing diabetes education, nutrition, and lifestyle exercise conducted by healthcare providers, dieticians, and diabetes educators | Usual care + 3 brochures from American Diabetes Association | 24 | 0 |
(b) 32 | - BMI | ||||||||
- Waist circumference change | |||||||||
Milano et al. (2007) [26] | (a) 22 | Outpatients | Schizophrenia or manic episodes in bipolar disease | Olanzapine | - Body weight change | Psychoeducational programme with information on correct alimentary practices and personal health; diet (reduction of 500 kcal/ die); programme on physical exercise (3/wk, 30-60 min) | Regular diet, no physical activity | 8 | 0 |
(b) 14 | |||||||||
- BMI | |||||||||
Weber & Wyne (2006) [19] | (a) 8 | Outpatients | Schizophrenia or schizoaffective disorder | One oral atypical antipsychotic | - Body weight | 1-hour group session based on cognitive- behavioural strategies to promote risk reduction (with food and activity diary) provided by a trained psychiatric nurse practitioner supervised weekly | Usual care | 16 | 16 |
(b) 9 | - BMI | ||||||||
- Waist-hip ratio - Blood glucose level | |||||||||
Wu et al. (2007) [21] | (a) 28 | Hospitalized patients | Schizophrenia | Clozapine | - Body weight | Dietary control by a registered dietician. 1-hour physical activity sessions 3 times a week | N/A | 24 | 0 |
(b) 28 | - BMI | ||||||||
- Body fat | |||||||||
- Waist-hip ratio |
Risk of bias
Results for all interventions
Drop-outs
Subgroup analyses
Subgroups | Number of studies | Number of subjects | MD (CI)* | I2
|
---|---|---|---|---|
Weight gain prevention | 4 | (a) 108 (b) 93 | - 1.09 (−1.51, -0.68) | 0 % |
Weight loss | 9 | (a) 203 (b) 179 | −0.86 (−1.38, -0.33) | 49 % |
Group intervention | 9 | (a) 203 (b) 189 | −0.70 (−1.24, -0.15) | 37 % |
Individual intervention | 4 | (a) 108 (b) 83 | −1.20 (−1.57, -0.83) | 8 % |
CBT | 5 | (a) 124 (b) 114 | −0.66 (−1.15, -0.16) | 41 % |
Psychoeducation | 8 | (a) 187 (b) 158 | −1.28 (−1.64, -0.93) | 0 % |
First-episode psychosis | 1 | (a) 28 (b) 33 | −0.99 (−1.71, -0.27) | N/A |
Chronic psychosis | 11 | (a) 260 (b) 228 | −0.92 (−1.34, -0.49) | 39 % |
Mixed sample | 1 | (a) 23 (b) 11 | −1.30 (−2.02, -0.58) | N/A |
Physical activity | 4 | (a) 93 (b) 90 | −1.22 (−1.59, -0.85) | 2 % |
No physical activity | 9 | (a) 218 (b) 182 | −0.75 (−1.22, -0.28) | 27 % |
Diet | 3 | (a) 65 (b) 57 | −1.31 (−1.78, -0.83) | 21 % |
No diet | 10 | (a) 246 (b) 215 | −0.80 (−1.19, -0.42) | 20 % |
Sensitivity analyses
Heterogeneity of studies
Discussion
Strengths of the study
Limitations
Limitations at study level
Limitations at review level
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few studies describe the randomisation method;
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no study describes allocation concealment;
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few studies describe blinding;
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some studies only report data for completers or do not report the reasons for missing data;
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in one study subjects received money for their participation ( Additional file 1: Table S1).