A Behavioral Weight-Loss Intervention in Persons with Serious Mental Illness

被引：389

作者：

Daumit, Gail L. ^{[1
,2
,3
,4
,5
,6
]}

Dickerson, Faith B. ^{[10
]}

Wang, Nae-Yuh ^{[1
,2
,7
]}

Dalcin, Arlene ^{[2
]}

Jerome, Gerald J. ^{[2
,11
]}

Anderson, Cheryl A. M. ^{[13
]}

Young, Deborah R. ^{[14
]}

Frick, Kevin D. ^{[5
]}

Yu, Airong ^{[2
]}

Gennusa, Joseph V., III ^{[2
]}

Oefinger, Meghan ^{[2
]}

Crum, Rosa M. ^{[1
,3
,4
,6
]}

Charleston, Jeanne ^{[1
,2
]}

Casagrande, Sarah S. ^{[12
]}

Guallar, Eliseo ^{[1
,3
,4
,15
]}

Goldberg, Richard W. ^{[8
,9
]}

Campbell, Leslie M. ^{[2
]}

Appel, Lawrence J. ^{[1
,2
,3
,4
]}

机构：

[1] Johns Hopkins Univ, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD USA

[2] Johns Hopkins Univ, Sch Med, Div Gen Internal Med, Baltimore, MD USA

[3] Johns Hopkins Univ, Sch Med, Dept Psychiat, Baltimore, MD 21205 USA

[4] Johns Hopkins Univ, Sch Med, Dept Epidemiol, Baltimore, MD USA

[5] Johns Hopkins Univ, Dept Hlth Policy & Management, Sch Med, Baltimore, MD 21218 USA

[6] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Mental Hlth, Baltimore, MD USA

[7] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Biostat, Baltimore, MD USA

[8] Capitol Hlth Care Network VISN 5, Dept Vet Affairs, Mental Illness Educ & Clin Res Ctr, Baltimore, MD USA

[9] Univ Maryland, Sch Med, Dept Psychiat, Baltimore, MD 21201 USA

[10] Towson Univ, Sheppard Pratt Hlth Syst, Towson, MD USA

[11] Towson Univ, Dept Kinesiol, Towson, MD USA

[12] Social & Sci Syst, Silver Spring, MD USA

[13] Univ Calif San Diego, Div Prevent Med, Dept Family & Prevent Med, La Jolla, CA 92093 USA

[14] Kaiser Permanente So Calif, Dept Res & Evaluat, Pasadena, CA USA

[15] Natl Ctr Cardiovasc Res, Madrid, Spain

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2013年 / 368卷 / 17期

关键词：

RANDOMIZED CONTROLLED-TRIAL; LIFE-STYLE INTERVENTIONS; PHYSICAL-ACTIVITY; MEDICAL COMORBIDITY; DIABETES-MELLITUS; BLOOD-PRESSURE; SCHIZOPHRENIA; OBESITY; PREVALENCE; DISORDERS;

D O I：

10.1056/NEJMoa1214530

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Overweight and obesity are epidemic among persons with serious mental illness, yet weight-loss trials systematically exclude this vulnerable population. Lifestyle interventions require adaptation in this group because psychiatric symptoms and cognitive impairment are highly prevalent. Our objective was to determine the effectiveness of an 18-month tailored behavioral weight-loss intervention in adults with serious mental illness. METHODS We recruited overweight or obese adults from 10 community psychiatric rehabilitation outpatient programs and randomly assigned them to an intervention or a control group. Participants in the intervention group received tailored group and individual weight-management sessions and group exercise sessions. Weight change was assessed at 6, 12, and 18 months. RESULTS Of 291 participants who underwent randomization, 58.1% had schizophrenia or a schizoaffective disorder, 22.0% had bipolar disorder, and 12.0% had major depression. At baseline, the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 36.3, and the mean weight was 102.7 kg (225.9 lb). Data on weight at 18 months were obtained from 279 participants. Weight loss in the intervention group increased progressively over the 18-month study period and differed significantly from the control group at each follow-up visit. At 18 months, the mean between-group difference in weight (change in intervention group minus change in control group) was -3.2 kg (-7.0 lb, P = 0.002); 37.8% of the participants in the intervention group lost 5% or more of their initial weight, as compared with 22.7% of those in the control group (P = 0.009). There were no significant between-group differences in adverse events. CONCLUSIONS A behavioral weight-loss intervention significantly reduced weight over a period of 18 months in overweight and obese adults with serious mental illness. Given the epidemic of obesity and weight-related disease among persons with serious mental illness, our findings support implementation of targeted behavioral weight-loss interventions in this high-risk population. (Funded by the National Institute of Mental Health; ACHIEVE ClinicalTrials. gov number, NCT00902694.)

引用

页码：1594 / 1602

页数：9

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