title: Behavioral interventions for antipsychotic medication-associated obesity: a randomized, controlled clinical trial.
abstract: OBJECTIVE
  To demonstrate the effectiveness of a Diabetes Prevention Program-inspired 12-month behavioral intervention for patients with severe mental illness (SMI) and medication-associated obesity.
  
  
  METHODS
  This randomized, controlled, parallel, superiority study screened 225 volunteers from November 2005 to August 2008 at the VA Greater Los Angeles Healthcare System. 122 outpatients with DSM-IV-diagnosed SMI taking antipsychotic medications who had ≥ 7% weight gain or body mass index (BMI) > 25 were randomized by computer-generated number to Lifestyle Balance treatment intervention (n = 60) or usual care control (n = 62) groups. Clinical raters were masked to randomization. Treatment intervention included weekly classes and individual counseling for 8 weeks, food and exercise diaries, rewards, caregiver consultations, and monthly booster classes and counseling for 1 year. Controls received self-help materials and visited at equivalent intervals without formal classes or counseling. Outcomes were changes in anthropometric measurements, psychiatric symptoms, health knowledge, and glucose, hemoglobin A1c, and lipid levels.
  
  
  RESULTS
  Our intention-to-treat analysis found significant differences in predicted trajectory of mean weight change between the groups over 12 months (P < .01), with treatment participants expected to lose an average 4.6 kg, while control participants would gain an average 0.6 kg. BMI and body fat percentage followed the same pattern. Both groups demonstrated statistically significant improvements in health knowledge quiz scores over time (P = .006), without significant difference between groups.
  
  
  CONCLUSIONS
  Treatment was more effective than usual care control in treating medication-associated obesity, independent of SMI diagnosis, antipsychotic medication, and knowledge gained, suggesting that behavioral interventions are effective in SMI patients.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT00344500.
authors.affiliation: Research Department, VA Greater Los Angeles Healthcare System, Los Angeles, California.
authors.forename: Zachary D
authors.initials: ZD
authors.lastname: Erickson
authors.forename: Shirley J
authors.initials: SJ
authors.lastname: Mena
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Pierre
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Blum
authors.forename: Eda
authors.initials: E
authors.lastname: Martin
authors.forename: Gerhard S
authors.initials: GS
authors.lastname: Hellemann
authors.forename: Dixie R
authors.initials: DR
authors.lastname: Aragaki
authors.forename: Lisa
authors.initials: L
authors.lastname: Firestone
authors.forename: Catherine
authors.initials: C
authors.lastname: Lee
authors.forename: Paul
authors.initials: P
authors.lastname: Lee
authors.forename: Charles F
authors.initials: CF
authors.lastname: Kunkel
authors.forename: Donna
authors.initials: D
authors.lastname: Ames
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects*; D001521:Behavior Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000139:chemically induced* / Q000628:therapy*; D017063:Outcome Assessment, Health Care
chemical_list: D014150:Antipsychotic Agents