INDIANAPOLIS, May 22, 2002 (BW HealthWire) -- Patients can control and even
reverse treatment-related weight gain by making simple lifestyle changes,
according to data presented today at the 155th annual American Psychiatric
Association (APA) meeting in Philadelphia, PA. These results support a growing
body of evidence showing that this patient population can often effectively
implement weight management strategies.
"Managing weight gain is a challenge for many Americans, especially those with
severe and persistent mental illness, who often lack healthy lifestyle habits or
have limited income," said Franca Centorrino, MD, director, Bipolar and
Psychotic Disorders Outpatient Services, McLean Hospital, Harvard Medical
School. "By designing our program specifically for the needs of people with
mental illness, we have shown that with the right counseling and choices,
patients can manage weight gain."
Simple Lifestyle Modifications Lead to Weight Loss
Dr. Centorrino presented results of her study, which showed patients who
participated in a weight management program experienced a decrease in body mass
index (BMI) and weight as well as general cardiac health benefits.
The 24-week study examined the benefits of lifestyle interventions in 17
subjects with a diagnosis of schizophrenia or schizoaffective disorder. When
they entered the study, patients were taking olanzapine (n=4), risperidone
(n=2), clozapine (n=10) or ziprasidone (n=1). Baseline body mass index (BMI)
averaged 36.6 (231.4 pounds) and each patient had gained at least 10 pounds
while on antipsychotic therapy.
The group participated in weekly dietary counseling and twice-weekly group
exercise, which included using a treadmill, step machine, bike or rowing
machine. Options for subjects on limited budgets included walking, recreational
games and strength training at home. Changes in weight and appetite were
monitored weekly. Mental status, quality of life and side effects were assessed
monthly.
Ninety-four percent of subjects had an average decrease in BMI of 2.1 points and
on average lost 13.1 pounds. Patients taking olanzapine showed the greatest
reduction in BMI and weight loss (3.8, 24.5 lbs., respectively), followed by
patients taking risperidone (2.0, 11.4 lbs.), clozapine (1.6, 10.1 lbs.), and
ziprasidone (.27, 1.8 lbs.).
The lifestyle interventions also resulted in overall health benefits, as
patients lowered their resting heart rate, blood pressure, cholesterol and
triglycerides by the end of the study.
"Dependably managing schizophrenia with appropriate medication should be the
first priority for physicians and their patients. Once their symptoms and lives
are under control, patients can then implement simple lifestyle changes to help
manage weight gain, and stay on the treatment that works best for them," said
Dr. Centorrino. Her research was supported by a grant from Eli Lilly and
Company.
Interventions Have Long-Term Benefits
Additional data presented here today show that people with severe mental illness
can adhere to lifestyle changes over the long-term, maintaining and even
improving weight loss.
"Our program was successful because patients were very satisfied with the
program and found it easy to follow," said Betty Vreeland, MSN, RN, advanced
practice nurse at the University of Medicine & Dentistry of New Jersey.
"Ninety-eight percent of patients said they felt better in general, now eat
healthier, exercise more and have found better ways to cope with stress and
would even recommend it to a friend."
The 6-month study examined the effects of intensive weight interventions in 31
patients with schizophrenia and schizoaffective disorder. Patients were taking
olanzapine (n= 14), risperidone (n=9), clozapine (n=6) and quetiapine (n=2) upon
entering the study and each patient had gained at least five pounds during
antipsychotic therapy. Weight interventions consisted of nutrition, exercise and
behavioral counseling divided into two phases. In the first 12-week phase,
patients in the intervention group attended two group sessions (including
principles of physical fitness, nutrition counseling, and an aerobic walking
activity) and one weekly individual session to assess goals. Family members and
case managers were invited to attend sessions, and subjects were encouraged to
engage in exercise at home. Subjects then participated in a less intensive
12-week program that reinforced the nutritional and physical counseling and
continued the exercise component.
A non-intervention group maintained their psychiatric treatment without
participating in any weight intervention activities.
Patients in the intervention group experienced a mean weight loss of 6.6 pounds,
which equaled three percent of their baseline weight. Their average BMI
decreased by 3.2 percent from 34.4 to 33.2. Intervention patients also reported
that they had improved their lifestyle habits and had greater nutrition
knowledge by the end of the study.
Patients in the non-intervention group, however, gained weight by the end of the
study. They experienced a mean weight gain of 7.6 pounds, which equaled 3.7
percent of their baseline weight. Their average BMI increased by 4.5 percent
from 33.4 to 34.9. Changes in weight and BMI were statistically significant
compared to the non-intervention group.
"Physicians are often concerned that patients with severe mental illness will
have difficulty managing the weight gain associated with antipsychotics," said
Vreeland. "This study shows that incorporating weight counseling into a
treatment program can make a difference in helping patients manage their weight
and remain on appropriate medication."
Olanzapine Background
Olanzapine is currently indicated for the treatment of schizophrenia, the
short-term treatment of acute manic episodes associated with bipolar disorder
and for the long-term therapy and maintenance of treatment response of
schizophrenia. Olanzapine is the first atypical antipsychotic to prove its
long-term effectiveness in patients with schizophrenia. Since olanzapine was
introduced in 1996, it has been prescribed to more than eight million people
worldwide.
In the original schizophrenia registration trials, olanzapine was generally well
tolerated. However, as with all medications, olanzapine was associated with some
side effects. In the original six-week, acute-phase schizophrenia trials, the
most common treatment-emergent adverse event associated with olanzapine was
somnolence. Other common events were dizziness, weight gain, constipation,
akathisia (restlessness) and postural hypotension. Modest elevations of
prolactin were also seen, although mean changes from baseline to endpoint were
not statistically significantly different between olanzapine and placebo. A
small number of patients experienced asymptomatic elevations of hepatic
transaminase; none of these patients developed jaundice or drug-induced
hepatitis.
In short-term (3- and 4-week) acute bipolar mania trials, the most common
treatment-emergent adverse event associated with olanzapine was somnolence.
Other common events were dry mouth, dizziness, asthenia, constipation,
dyspepsia, increased appetite and tremor.
