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Behavioral Treatment of Obesity in Patients Taking Antipsychotic Medications

Melissa A. Kalarchian, Ph.D.; Marsha D. Marcus, Ph.D.; Michele D. Levine, Ph.D.; Gretchen L. Haas, Ph.D.; Catherine G. Greeno, Ph.D.; Lisa A. Weissfeld, Ph.D.; and Li Qin, M.S.

Objective: Antipsychotic medications are associated with weight gain and metabolic dysregulation, yet little is known about the management of obesity among individuals with severe and persistent mental illness. Thus we sought to evaluate the potential utility of a behavioral weight control program for this population.

Method: Outpatients receiving psychiatric care at a university medical center who had a body mass index (BMI; weight in kg/[height in m]2) >= 30 and were currently taking antipsychotic medication participated in a 12-week group behavioral weight control program. A medical chart review was conducted for each participant's body weight over the 10 months prior to beginning the program. A multiple baseline design was used to determine the impact of the intervention on BMI through 12-month posttreatment follow-up. We also assessed self-reported eating behavior, physical activity, and health-related quality of life. Data were collected from October 2000 to July 2003.

Results: Among 35 patients who began the program, 29 (83%) completed treatment, with mean (± SD) weight loss of 5.04 (± 7.52) pounds (p = .001) and improvements in eating, activity, and quality of life. At 3-month posttreatment follow-up (N = 27; 77%), total mean weight loss was 7.14 (± 11.47) pounds (p = .003). Results of a longitudinal model based on general estimating equations indicated that, relative to the pretreatment period, BMI decreased significantly during treatment and remained stable through 12-month posttreatment follow-up.

Conclusion: Behavioral weight control is a promising approach to the treatment of obesity among outpatients taking antipsychotic medications, but longer and more robust interventions are needed.

(J Clin Psychiatry 2005;66:1058-1063)

Received Nov. 1, 2004; accepted Jan. 10, 2005. From the Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pa. (Drs. Kalarchian, Marcus, Levine, Haas, and Greeno); Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa. (Dr. Weissfeld and Ms. Qin).

Research supported by the National Alliance for Research on Schizophrenia and Depression (NARSAD) 2000 Young Investigator Award, Essel Investigator and K23 DK62291 (principal investigator: Melissa A. Kalarchian).

The authors report no other financial affiliations or other relationships relevant to the subject of this article.

We gratefully acknowledge the contributions of nutritionist Lauren Carlson, M.S., R.D., to the project.

Corresponding author and reprints: Melissa A. Kalarchian, Ph.D., Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213 (e-mail: