The STRIDE Weight Loss and Lifestyle Intervention for Individuals Taking Antipsychotic Medications: A Randomized Trial

Abstract

Objectives STRIDE assessed whether a lifestyle intervention, tailored for individuals with serious mental illnesses, reduced weight and diabetes risk. Methods A multi-site, parallel, two-arm randomized controlled trial in community settings and an integrated health plan. Inclusion criteria: Age ≥18; taking antipsychotic medication for ≥30 days; BMI ≥27. Exclusions: significant cognitive impairment; pregnancy/breastfeeding; recent psychiatric hospitalization, bariatric surgery, cancer, heart attack or stroke. The intervention emphasized moderate caloric reduction, DASH diet, and physical activity. Blinded staff collected data at baseline, 6, and 12 months. Results Participants (56 men, 144 women), mean age = 47.2(SD =10.6), were randomized to usual care (n =96) or a 6-month weekly group intervention plus 6 monthly maintenance sessions (n =104). 181 participants (90.5%) completed 6-month, and 170 (85%) completed 12-month assessments, without differential attrition. Participants attended 14.5 of 24 sessions over 6 months. Intent-to-treat analyses found intervention participants lost 4.4 kg more than control participants from baseline to 6 months (95% CI [−6.96 kg, −1.78 kg]), and 2.6 kg more than controls (95% CI −5.14 kg, −0.07 kg] from baseline to 12 months. At 12 months, fasting glucose levels in controls had increased from 106.0 mg/dL to 109.5 mg/dL and decreased in intervention participants, from 106.3 mg/dL to 100.4 mg/dL. No serious adverse events were study-related; medical hospitalizations were reduced in the intervention group (6.7%) compared to controls (18.8%)(χ2= 6.66, p = 0.01). Conclusions Individuals taking antipsychotic medications can lose weight and improve fasting glucose levels. Increasing reach of the intervention is an important future step. Funding Source National Institute of Diabetes and Digestive and Kidney Diseases, Grant R18DK076775 Trial Registration Clinical Trials.gov, NCT00790517; http://clinicaltrials.gov/ct2/show/NCT00790517?term=STRIDE&rank=1

Facilitating Partner Support for Lifestyle Change Among Adults with Serious Mental Illness: A Feasibility Pilot Study

“…Although the probability of attaining normal body weight is low for individuals who are obese (Fildes et al 2015), significant reductions in cardiovascular risk factors can be attained from modest amounts of weight loss (Wing et al 2011). A series of randomized controlled trials of lifestyle interventions have demonstrated that individuals with SMI can achieve clinically significant weight loss by making positive changes in diet and exercise Daumit et al 2013;Green et al 2015). However, the long-term maintenance of weight loss remains elusive for the vast majority of obese individuals, even among those who receive gold standard behavioral treatments (Diabetes Prevention Program Research 2009).…”

Getting to More Effective Weight Management in Antipsychotic-Treated Youth: A Survey of Barriers and Preferences

“…Nonetheless, adult weight management programs located within community mental health clinic settings have been successfully implemented. [17][18][19] Although the available evidence base in this area is limited, a small number of studies suggest that factors specifically related to psychiatric illness, including behavioral symptoms (e.g., social anxiety, paranoia, and lack of initiative), medication effects (sedation and excessive weight gain preventing physical mobility), and lack of transportation or social support often prevent mentally ill adults from engaging in weight loss treatment. 20,21 Programming that increases health knowledge and that offers social engagement and daily structure is cited as promoting engagement in behavioral weight loss programs.…”

Anti-Psychotic Medication and the Pattern of Cardiovascular Risk Factors: A Population Based Study (The Ayrshire Diabetes Follow-Up Cohort (ADOC) Study)

“…Patients with mental health issues should be encouraged to participate in health improvement activities including weight management, physical activity, smoking cessation [28] and health care needs to be tailored to the individual [28]. A combination of motivational and behaviour change interventions, alongside appropriate pharmacological treatments, appear to provide the best results in terms of both health gain and adherence to health improvement activities.…”