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Individuals with severe mental illness benefit greatly from lifestyle interventions, not just from a weightloss perspective, but also from a mental health perspective.¹

A team, led by Florine Sanna Walburg, PhD, Department Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, evaluated the effectiveness of group-based lifestyle interventions for patients with severe mental illnesses in an outpatient treatment setting compared to treatment as usual.

Severe Mental Illness

Patients with severe mental illnesses have reduced life expectancy of 10-20 years compared to the general population. This is generally because of potential risks of cardiometabolic disorders, as well as adverse effects of antipsychotic medication, insufficient treatmernt of somatic diseases, genetic vulnerability, poor access to health care, and unhealthy lifestyles.

In the pragmatic, cluster, randomized, clinical Severe Mental Illness Lifestyle Evaluation (SMILE) study, the investigators examined patients at 8 mental health care centers with 21 flexible assertive community treatment teams in the Netherlands. Each participant has been diagnosed with a severe mental illness, was aged 18 years or older, and had a body mass index of 27 or greater.

There were 126 patients in 11 lifestyle intervention teams and 98 participants in 10 treatment as usual teams. In addition, 61.2% (n = 137) of participants were female and the mean age was 47.6 years.

Each patient participated in weekly two-hour group sessions for 6 months, followed by monthly two-hour group sessions for an additional 6 months, which targeted overall lifestyle changes, emphasizing establishing a healthy diet and promoting physical activity.

The treatment as usual group did not participant in structured interventions or were given advice on lifestyle.

The investigators sought main outcomes of body weight change and secondary outcomes of changes in BMI, blood pressure, lipid profiles, fasting glucose levels, quality of life, self-management ability, and lifestyle behaviors such as physical activity and health, mental health, nutrition, and sleep.

Results From the SMILE Trial

The team performed crude and adjusted linear mixed models and multivariable logistic regression.

The results show from baseline to month 12, patients in the lifestyle interveion group lost 3.3 kg (95% confidence interval [CI], -6.2 to -.04) more than those in the treatment as usual group.

Moreover, patients with high attendance rates within the lifestyle intervention group lost more weight than those with medium and low rates (mean [SD] weight loss: high, −4.9 [8.1] kg; medium, −0.2 [7.8] kg; low, 0.8 [8.3] kg).

“In this trial, the lifestyle intervention significantly reduced weight from baseline to 12 months in overweight and obese adults with [severe mental illness],” the authors wrote. “Tailoring lifestyle interventions and increasing attendance rates might be beneficial for people with [severe mental illness].

References:

Walburg FS, van Meijel B, Hoekstra T, et al. Effectiveness of a Lifestyle Intervention for People With a Severe Mental Illness in Dutch Outpatient Mental Health Care: A Randomized Clinical Trial. JAMA Psychiatry. Published online June 21, 2023. doi:10.1001/jamapsychiatry.2023.1566