Diet and exercise interventions for mitigating the effects of antipsychotic medications on body weight in individuals with severe mental illness (Narrative review)

Abstract

Background: Individuals with severe mental illness (SMI), including bipolar disorder and schizophrenia, who are treated with antipsychotic medication are at higher risk for early death, obesity, and chronic diseases such as diabetes, hypertension, and cardiovascular disease. Antipsychotic medications are strongly associated with rapid weight gain, and a variety of interventions are available to help patients using these medications to lose weight. Aim: This review aimed to identify dietary patterns and physical activity that can be adopted by patients with SMI to aid in weight loss while receiving treatment with antipsychotic medication. Method: A narrative review of the literature with the use of three electronic multidisciplinary databases: Psych info via Ovid, CINHAL via EBSCO, and Medline via Ovid. Cross-referencing and a manual search of journals were also employed. A systematic search was implemented for studies on lifestyle intervention that combined diet and physical activity in adult participants. All studies were published in the English language. Results: A total of 1176 relevant research papers were identified from all sources, and 12 studies met the inclusion criteria. There were different dietary patterns that were used to reduce body weight in SMI patients using antipsychotics. These dietary patterns were a diabetic diet, Dietary approaches to stop hypertension (DASH diet), a low-fat diet, a Mediterranean diet, a low-calorie diet, and recommendations based on German and Canadian dietary guidelines. In addition, most of the studies focused on the effects of aerobic exercise, such as walking or cycling, and a few studies examined the use of resistance exercise. Conclusion: Lifestyle interventions that combine aerobic exercise and a personalised reduced-calorie diet may result in promising effects for reducing weight in adult patients with SMI who are treated with second-generation antipsychotic (SGAs) medications. In addition, lifestyle interventions also may help reduce central obesity, waist circumference, fasting blood glucose, and cholesterol levels.