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Effectiveness of a Cognitive Behavioral Weight Management Intervention in Obese Patients With Psychotic Disorders Compared to Patients With Nonpsychotic Disorders or No Psychiatric Disorders: Results From a 12-month, Real-World Study

Zhang, Jian-Ping MD, PhD*; Weiss, Jeffrey J. PhD; McCardle, Melissa PhD; Klopchin, Hope PhD§; Rosendahl, Eileen PhD§; Maayan, Lawrence MD∥¶; Convit, Antonio MD∥#; Kane, John M. MD***††; Manu, Peter MD***; Correll, Christoph U. MD***††

Journal of Clinical Psychopharmacology: August 2012 - Volume 32 - Issue 4 - p 458–464
doi: 10.1097/JCP.0b013e31825cccd2
Original Contributions

Objective Studies of behavioral weight loss intervention in patients with psychotic disorders are sparse, and its efficacy compared to other obese patients is unknown. Therefore, we compared the effect of a cognitive-behavioral weight loss intervention in obese subjects with psychotic disorders, other psychiatric diagnoses, and without psychiatric disorders.

Methods A 12-month naturalistic study of weekly group or individual cognitive-behavioral weight management in 222 consecutively enrolled obese patients (body mass index [BMI], 43.7 ± 9.6 kg/m2) with psychotic spectrum disorders (PSDs, n = 47), other psychiatric disorders (OPDs, n = 49), and no psychiatric disorder (NPD, n = 126).

Results Patients with PSD had greater treatment persistence (48.9%) and longer treatment duration (8.7 ± 4.4 months) than those with OPD (22.4% and 5.4 ± 4.3 months) and NPD (22.2% and 4.9 ± 4.7 months) (P < 0.01 for all; number needed to treat, 3). In last-observation-carried-forward analyses, patients with PSD had greater percent baseline weight loss at 12 months (5.1% ± 9.3%) than patients with OPD and with NPD (2.7% ± 5.5% and 2.4% ± 6.3%); greater percent BMI loss at 9 and 12 months than both groups (P < 0.05 for all) and greater BMI loss at 9 months (2.1 ± 3.5 kg/m2) and 12 months (2.3 ± 4.1 kg/m2) than NPD patients (1.1 ± 2.3 and 1.2 ± 2.4 kg/m2). Furthermore, weight loss of 5% or more occurred in 42.6% of patients with PSD versus 18.4% and 23.0% in OPD and NPD patients (P < 0.01 for all; numbers needed to treat, 5 and 6). The strongest weight loss predictor was treatment duration (β = 0.51–0.54; P < 0.001). Attrition was predicted by NPD (P = 0.001) and OPD group status (P = 0.036), lower proportion of group sessions (P = 0.002), higher depression (P = 0.028), and lower baseline BMI (P = 0.030).

Conclusions Patients with PSD had greater weight loss than other obese patients. Nonadherence and depression should be targeted to enhance weight loss success.

From the *The Zucker Hillside Hospital, North Shore–Long Island Jewish Health System, Glen Oaks; †Mount Sinai School of Medicine, New York; ‡Molloy College, Rockville Center; §Long Island Jewish Medical Center, Lake Success; ∥Nathan Kline Institute for Psychiatric Research, Orangeburg; ¶New York University School of Medicine, Child Study Center; #Departments of Psychiatry and Medicine, New York University School of Medicine, New York; **Albert Einstein College of Medicine, Bronx; and ††The Feinstein Institute for Medical Research, North Shore–Long Island Health System, Manhasset, NY.

Received April 1, 2011; accepted after revision December 13, 2011.

Reprints: Christoph U. Correll, MD, Division of Psychiatry Research, The Zucker Hillside Hospital, 75-59 263rd St, Glen Oaks, NY 11004 (e-mail:

Supported in part by The Zucker Hillside Hospital Advanced Center for Intervention and Services Research for the Study of Early Phase Psychosis (P30MH090590) from the National Institute of Mental Health, Bethesda, MD.

© 2012 Lippincott Williams & Wilkins, Inc.