Lifestyle interventions for weight loss among overweight and obese adults with serious mental illness: A systematic review and meta-analysis - PubMed (original) (raw)

Meta-Analysis

Lifestyle interventions for weight loss among overweight and obese adults with serious mental illness: A systematic review and meta-analysis

John A Naslund et al. Gen Hosp Psychiatry. 2017 Jul.

Abstract

Objective: To conduct a systematic review and meta-analysis to estimate effects of lifestyle intervention participation on weight reduction among overweight and obese adults with serious mental illness.

Method: We systematically searched electronic databases for randomized controlled trials comparing lifestyle interventions with other interventions or usual care controls in overweight and obese adults with serious mental illness, including schizophrenia spectrum or mood disorders. Included studies reported change in weight [kg] or body mass index (BMI) [kg/m2] from baseline to follow-up. Standardized mean differences (SMD) were calculated for change in weight from baseline between intervention and control groups.

Results: Seventeen studies met inclusion criteria (1968 participants; 50% male; 66% schizophrenia spectrum disorders). Studies were grouped by intervention duration (≤6-months or ≥12-months). Lifestyle interventions of ≤6-months duration showed greater weight reduction compared with controls as indicated by effect size for weight change from baseline (SMD=-0.20; 95% CI=-0.34, -0.05; 10 studies), but high statistical heterogeneity (I2=90%). Lifestyle interventions of ≥12-months duration also showed greater weight reduction compared with controls (SMD=-0.24; 95% CI=-0.36, -0.12; 6 studies) with low statistical heterogeneity (I2=0%).

Conclusion: Lifestyle interventions appear effective for treating overweight and obesity among people with serious mental illness. Interventions of ≥12-months duration compared to ≤6-months duration appear to achieve more consistent outcomes, though effect sizes are similar for both shorter and longer duration interventions.

Keywords: Bipolar disorder; Lifestyle intervention; Mental illness; Obesity; Schizophrenia; Weight loss.

Copyright © 2017. Published by Elsevier Inc.

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Conflict of interest statement

Disclosures and acknowledgements: No financial disclosures were reported by any of the authors of this manuscript. The authors report no conflicts of interest.

Disclosure

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No financial disclosures were reported by any of the authors of this manuscript. The authors report no competing interests.

Figures

Fig. 1

Fig. 1

PRISMA flow diagram of studies included in the review.

Fig. 2

Fig. 2

Funnel plot comparing the standardized mean difference (x-axis) against its standard error (y-axis) for all studies reporting change in body weight. Most studies are within the pseudo 95% CI of the funnel plot, suggesting moderate to low risk of publication bias among studies reporting change in body weight as a continuous outcome measure (change in weight [kg] or BMI [kg/m2]). In statistical tests, the Egger test (bias = − 3.18; 95% CI − 5.97, − 0.39; p = 0.029) indicated asymmetry in the funnel plot, suggesting possible publication bias. Though this was not confirmed using the Begg-Mazumdar test (Kendall’s score = − 34; z = − 1.53; p = 0.126). SMD: standard mean difference. SE: standard error. BMI: body mass index (kg/m2).

Fig. 3

Fig. 3

Forest plots for the meta-analysis. a) Forest plot comparing change in body weight among participants in lifestyle interventions of ≤ 6-months duration versus controls. b) Forest plot comparing change in body weight among participants in lifestyle interventions of ≥ 12-months duration versus controls.

Fig. 4

Fig. 4

Forest plot of the odds of achieving clinically significant (5% or greater) weight loss among participants in lifestyle interventions of ≥ 12-months duration versus controls.

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