title: A behavioral weight-loss intervention in persons with serious mental illness.
abstract: 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.).
authors.affiliation: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland 21287, USA. gdaumit@jhmi.edu
authors.forename: Gail L
authors.initials: GL
authors.lastname: Daumit
authors.forename: Faith B
authors.initials: FB
authors.lastname: Dickerson
authors.forename: Nae-Yuh
authors.initials: NY
authors.lastname: Wang
authors.forename: Arlene
authors.initials: A
authors.lastname: Dalcin
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Jerome
authors.forename: Cheryl A M
authors.initials: CA
authors.lastname: Anderson
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Young
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.forename: Airong
authors.initials: A
authors.lastname: Yu
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Gennusa
authors.forename: Meghan
authors.initials: M
authors.lastname: Oefinger
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Crum
authors.forename: Jeanne
authors.initials: J
authors.lastname: Charleston
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Casagrande
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.forename: Richard W
authors.initials: RW
authors.lastname: Goldberg
authors.forename: Leslie M
authors.initials: LM
authors.lastname: Campbell
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
mesh_terms: D000328:Adult; D001521:Behavior Therapy; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D009765:Obesity / Q000523:psychology / Q000628:therapy*; D050177:Overweight / Q000523:psychology / Q000628:therapy; D010349:Patient Compliance / Q000706:statistics & numerical data; D015431:Weight Loss