A comprehensive review of behavioral interventions for weight management in schizophrenia

Obesity in patients with schizophrenia has been associated with both lifestyle habits and the side effects of medications, with serious implications for physical and mental health, and mortality. Behavioral techniques to mitigate weight gain have been employed with variable success in patients with schizophrenia. This review seeks to assess the potential of behavioral therapy for the management of obesity in individuals diagnosed with schizophrenia through a comprehensive review of all available literature on this subject.

An electronic search of published articles pertaining to the use of behavioral interventions in individuals with schizophrenia was conducted using PsycINFO and Medline.

The search strategy produced 23 articles that met inclusion criteria, with an aggregate sample of 701 participants. The types of behavioral interventions consisted of behavioral modification techniques, caloric restriction, and psychoeducation. Weight loss was reported in 19 studies, while the remaining studies showed either maintenance of baseline weight or minimal weight gain.

Much of the literature is anecdotal, methodologically unsound, poorly documented, or applicable only to inpatient settings. Nonetheless, recent data from controlled studies suggest that behavioral interventions in patients diagnosed with schizophrenia may prevent future weight gain, and in some instances promote weight loss. High drop-out rates, and the absence of extended post-treatment follow-up still limit the conclusions regarding general efficacy of behavioral treatment of obesity in patients with schizophrenia.