title: A Randomized, Controlled Multisite Study of Behavioral Interventions for Veterans with Mental Illness and Antipsychotic Medication-Associated Obesity.
abstract: BACKGROUND
  Weight gain and other metabolic sequelae of antipsychotic medications can lead to medication non-adherence, reduced quality of life, increased costs, and premature mortality. Of the approaches to address this, behavioral interventions are less invasive, cost less, and can result in sustained long-term benefits.
  
  
  OBJECTIVE
  We investigated behavioral weight management interventions for veterans with mental illness across four medical centers within the Veterans Affairs (VA) Healthcare System.
  
  
  METHODS
  We conducted a 12-month, multi-site extension of our previous randomized, controlled study, comparing treatment and control groups.
  
  
  METHODS
  Veterans (and some non-veteran women) diagnosed with mental illness, overweight (defined as having a BMI over 25), and required ongoing antipsychotic therapy.
  
  
  METHODS
  One group received "Lifestyle Balance" (LB; modified from the Diabetes Prevention Program) consisting of classes and individual nutritional counseling with a dietitian. A second group received less intensive "Usual Care" (UC) consisting of weight monitoring and provision of self-help.
  
  
  METHODS
  Participants completed anthropometric and nutrition assessments weekly for 8 weeks, then monthly. Psychiatric, behavioral, and physical assessments were conducted at baseline and months 2, 6, and 12. Metabolic and lipid laboratory tests were performed quarterly.
  
  
  RESULTS
  Participants in both groups lost weight. LB participants had a greater decrease in average waist circumference [F(1,1244) = 11.9, p < 0.001] and percent body fat [F(1,1121) = 4.3, p = 0.038]. Controlling for gender yielded statistically significant changes between groups in BMI [F(1,1246) = 13.9, p < 0.001]. Waist circumference and percent body fat decreased for LB women [F(1,1243) = 22.5, p < 0.001 and F(1,1221) = 4.8, p = 0.029, respectively]. The majority of LB participants kept food and activity journals (92%), and average daily calorie intake decreased from 2055 to 1650 during the study (p < 0.001).
  
  
  CONCLUSIONS
  Behavioral interventions specifically designed for individuals with mental illness can be effective for weight loss and improve dietary behaviors. "Lifestyle Balance" integrates well with VA healthcare's patient-centered "Whole Health" approach. ClinicalTrials.gov identifier NCT01052714.
authors.affiliation: Research Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Zachary D
authors.initials: ZD
authors.lastname: Erickson
authors.affiliation: Research Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Crystal L
authors.initials: CL
authors.lastname: Kwan
authors.affiliation: Research Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Hollie A
authors.initials: HA
authors.lastname: Gelberg
authors.affiliation: Research Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Irina Y
authors.initials: IY
authors.lastname: Arnold
authors.affiliation: Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA.|David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA.
authors.forename: Valery
authors.initials: V
authors.lastname: Chamberlin
authors.affiliation: Department of Pharmacy at VA Northern California Healthcare System, Martinez, CA, USA.|University of the Pacific School of Pharmacy, Stockton, CA, USA.|University of Southern California School of Pharmacy, Los Angeles, CA, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Rosen
authors.affiliation: Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA.
authors.forename: Chandresh
authors.initials: C
authors.lastname: Shah
authors.affiliation: Department of Mental Health at VA Medical Center, Long Beach, CA, USA.
authors.forename: Charles T
authors.initials: CT
authors.lastname: Nguyen
authors.affiliation: Semel Institute for Neuroscience & Human Behavior at University of California-Los Angeles, Los Angeles, CA, USA.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hellemann
authors.affiliation: David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA.|Physical Medicine and Rehabilitation Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Dixie R
authors.initials: DR
authors.lastname: Aragaki
authors.affiliation: David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA.|Physical Medicine and Rehabilitation Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Kunkel
authors.affiliation: Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Lewis
authors.affiliation: Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA.|David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA.
authors.forename: Neena
authors.initials: N
authors.lastname: Sachinvala
authors.affiliation: Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Sonza
authors.affiliation: Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA.|David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Pierre
authors.affiliation: Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA. donna.ames@va.gov.|David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA. donna.ames@va.gov.
authors.forename: Donna
authors.initials: D
authors.lastname: Ames
mesh_terms: D000368:Aged; D000886:Anthropometry / Q000379:methods; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001521:Behavior Therapy / Q000379:methods*; D015992:Body Mass Index; D003376:Counseling / Q000379:methods; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008019:Life Style; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D009765:Obesity / Q000139:chemically induced / Q000628:therapy*; D000073319:Obesity Management / Q000379:methods; D010349:Patient Compliance; D014728:Veterans / Q000523:psychology
chemical_list: D014150:Antipsychotic Agents
keywords: antipsychotic; behavioral intervention; mental health; obesity; weight management