Research in briefjpm_1590 849..851
University of Nottingham, Jubilee Campus,
Nottingham, NG8 1BB, UK
Pilot study of the efficacy of an
educational programme to reduce
weight, on overweight and
obese patients with chronic
Weight gain and obesity are common conditions
among patients with schizophrenia treated with
antipsychotic drugs. Weight control has been
reported to be useful to reduce health risks among
overweight or obese patients with schizophrenia
(Vreeland et al. 2003). Lifestyle therapies and other
behavioural therapy) have been shown to be effec-
tive in controlled clinical trials for weight manage-
ment in people with schizophrenia (Faulkner et al.
2007, Citrome & Vreeland 2008).
The purpose of this randomized controlled study
was to test the preliminary efficacy of a structured
educational programme in reducing weight, in a
subject population of overweight and obese patients
with chronic stable schizophrenia, who were taking
Subjects and methods
The sample consisted of 15 outpatients taking
antipsychotics and having a DSM-IV diagnosis of
schizophrenia. They attended consecutively a com-
munity mental health centre. All the patients were
informed about the study and provided written
consent before participating. The patients included:
had a body mass index (BMI) greater than 27 Kg/
m2, had taken the same antipsychotic drug mono-
therapy and had maintained stable psychiatric
symptoms for at least 2 years prior to study inclu-
sion. Patients were excluded if they had any abnor-
mal ambulatory function or organ failure, had
severe mental retardation, were pregnant or lactat-
ing or were taking concomitant medication that
may affect weight. Selected patients were random-
ized using a computer-generated randomization
table to either the intervention group (n = 8), or the
control group (n = 7).
The screening evaluation included a detailed
revision of the clinical history, a psychiatric exami-
nation using the Composite International Diagnos-
tic Interview and a physical examination. We ruled
out other possible causes of weight gain among
these patients, including use of other medications
for which weight gain is a side effect.
The structured educative programme provides
information and counselling on three domains:
nutrition, exercise and healthy habits and self-
esteem. The intervention group attended 12 group
sessions over a 3-month period. The sessions took
place in a private room of the community mental
health centre and were conducted by an accredited
psychiatric nurse on a weekly basis and lasted 1 h.
The sessions included: structured information given
to patients and group discussion lead by the nurse
about any aspect of the programme. The control
group attended to the clinic once a week, only to
assess the anthropometric parameters.
The study assessed weight, BMI, waist circum-
ference and vital signs (blood pressure and pulse).
Anthropometric and body parameters were assessed
on a weekly basis, in standardized conditions by
the same nurse practitioner blinded to the group
assessed by using a repeated measures model with
one within-subject factor (time) and one between-
subject factor (therapeutic intervention).
Fourteen patients completed the study. One patient
in the intervention group dropped out just after the
first evaluation because he retired the informed
consent. There were 11 men (68.8%) and 3 women;
the mean age at baseline was 39.9 years (SD = 11.3),
the mean time of evolution of the schizophrenia was
Journal of Psychiatric and Mental Health Nursing, 2010, 17, 849–851
© 2010 Blackwell Publishing
12.3 years (SD = 5.7) and the mean time of treat-
ment with the current antipsychotic was 6.1 years
(SD = 3.6). Four patients were been treated with
Clozapine, three with Olanzapine, three with Arip-
iprazole, three with Flufenazine Decanoate and one
The only one difference between the two groups
at baseline, was for diastolic pressure (82.8 mmHg
in the control group and 70.7 mmHg in the experi-
mental group – P = 0.002). The mean BMI at base-
line was 32.8 in the intervention group and 33.7 in
the control group.
The progression of the anthropometric measures
is shown in Tables 1 and 2. We did not detect sig-
nificant differences in weight or BMI throughout
the study, neither in the intervention group nor in
the control group. Within the intervention group, a
small weight loss was noted in the first 4 weeks of
the study; this effect was not maintained at the last
evaluation. We could observe a small but significant
waist circumference decrease at the end of the study
in both groups; the decrease pattern was not differ-
ent between groups.
In some studies behavioural interventions have
shown to be effective in reducing or attenuating
the weight gain in schizophrenic patients taking
antipsychotics. In all of them, the intervention was
carried out earlier than in our study. In two studies
the behavioural intervention coincides with the
beginning of the treatment (Littrell et al. 2003,
Evans et al. 2005). One of them, examined
antipsychotic-naïve patients (Alvarez-Jimenez et al.
2006); and other was focused in first-episode
schizophrenic patients (Wu et al. 2008). In the only
one study on chronic schizophrenia with positive
results the sample was small and it did not have
control group (Umbricht et al. 2001). It seems that
the educational interventions could be not as effec-
tive on chronic schizophrenia as in early stages of
In our study, individuals with chronic schizo-
phrenia were willing to attend a structured educa-
tional programme focused on nutrition, exercise
and healthy habits and self-esteem. The small
Measures of weight, body mass index and waist circumference, in the intervention and control group throughout the study
Intervention group (n = 7) Control group (n = 7)
Body mass index (Kg/m2)
Waist circumference (cm)
Two to two comparisons between anthropometric measures throughout the study
Evaluation (I)Evaluation (J) Mean difference (I–J)Standard error
0.3 Week 6
Body mass index
0.37 Week 6
C. Iglesias-García et al.
© 2010 Blackwell Publishing
sample size makes it difficult any generalization Download full-text
of the data; nevertheless, the programme did not
obtain significant differences in weight and corre-
sponding BMI in the intervention group of our
sample (obese, chronic and clinically stable schizo-
phrenic outpatients). The limited results may be due
to different effects of non-pharmacological weight
management interventions in the different stages
of antipsychotic treatment (Alvarez-Jimenez et al.
2008). The small sample size, also could have
accounted for a lack of difference between groups.
In conclusion, when we investigate or launch strat-
egies to deal with weight gain in schizophrenia, it
may be important to be concerned about the possi-
bility of loss of efficacy of non-pharmacological
interventions for weight loss in chronic schizo-
phrenic patients. Further studies to test the efficacy
of non-pharmacological interventions for weight
control focused in this population may be useful.
C. IGLESIAS-GARCÍA MD PhD
Hospital “Valle del Nalon”
Langreo, Asturias, Spain
A. TOIMIL-IGLESIAS RN
Langreo, Asturias, Spain
M. J. ALONSO-VILLA HD
Area VI Servicio de Salud del Principado de
antipsychotic-induced weight gain with early behav-
ioral intervention in drug-naive first-episode psychosis
patients: a randomized controlled trial. The Journal of
Clinical Psychiatry 67, 1253–1260.
Alvarez-Jimenez M., Hetrick S.E., Gonzalez-Blanch C.,
et al. (2008) Non-pharmacological management of
antipsychotic-induced weight gain: systematic review
and meta-analysis of randomised controlled trials. The
British Journal of Psychiatry 193, 101–107.
Citrome L. & Vreeland B. (2008) Schizophrenia, obesity,
and antipsychotic medications: what can we do? Post-
graduate Medicine 120, 18–33.
Evans S., Newton R. & Higgins S. (2005) Nutritional
intervention to prevent weight gain in patients com-
menced on olanzapine: a randomized controlled trial.
The Australian and New Zealand Journal of Psychiatry
Faulkner G., Cohn T. & Remington G. (2007) Interven-
tions to reduce weight gain in schizophrenia. Cochrane
Database of Systematic Reviews, Issue 1. Art. No.
Littrell K.H., Hilligoss N.M., Kirshner C.D., et al. (2003)
Theeffects ofan educational
antipsychotic-induced weight gain. Journal of Nursing
Scholarship 35, 237–241.
Umbricht D., Flury H. & Bridler R. (2001) Cognitive
behavior therapy for weight gain. The American
Journal of Psychiatry 158, 971.
Vreeland B., Minsky S., Menza M., et al. (2003) A
program for managing weight gain associated with
atypical antipsychotics. Psychiatric Services 54, 1155–
Wu R.R., Zhao J.P., Jin H., et al. (2008) Lifestyle inter-
vention and metformin for treatment of antipsychotic-
induced weight gain: a randomized controlled trial.
JAMA 299, 185–193.
et al. (2006)
Educational programme to reduce weight in schizophrenia
© 2010 Blackwell Publishing