A randomized controlled study to evaluate the effects of lifestyle intervention program for patients with severe mental illness taking Second Generation Antipsychotics (SGAs) in body weight management and monitoring their Body Mass Index (BMI)

Background: Second generation antipsychotics (SGAs) are strongly associated with accelerated body weight gain resulting in overweight and obesity in patients with severe mental illness (SMI). Evidence found that lifestyle interventions used behavioral techniques to improve dietary habits and increase physical activity can reduce the increase in patients’ body weight and BMI. Methods: Randomized Controlled Trial (RCT) on 54 patients with severe mental illness were randomized with 27 patients joined in the Lifestyle Intervention group (LIP) and 27 patients in treatment as usual group (TAU). The intervention group attended the educational talks on medication, diet control and physical exercise and use of a daily record. Result: After twelve months, the LIP presented a decrease of 1.25kg (CI 95% -0.73 to 3.24) and treatment as usual TAU presented with a significant increase of 1.65kg CI 95% -2.84 to -0.45) (p=0.009). The BMI of the LIP showed a decrease of 0.51kg/m2 (CI 95% -0.29 to 1.33) and the TAU presented an increase of 0.66kg/m2. Conclusion: The TAU shows a significant increase of body weight while the LIP group had a decrease in body weight under the Life Intervention program. This study was not intended for patient to reduce body weight, rather to prevent their body weight to increase and enhance their quality of life through understanding physical health, exercise and dietary habit.

Introduction: The aim of this study is to evaluate the effectiveness of lifestyle intervention on physical (weight, body mass index (BMI), blood pressure, waist circumference) and biochemical (fasting blood sugar (FBS), 2 hours postprandial (2HPP), and lipid profile) parameters among individuals with pre-diabetes. Methods: This study involved 185 pre-diabetics patients from fourteen selected health clinics in Melaka. The patients were divided into three groups based on the intervention that they received namely lifestyle intervention (n=62), pharmacological intervention (n=60), and control group (n=63). Each clinic applied only one type of intervention. The control group received only the conventional education. the lifestyle intervention group underwent group and individual dietary counseling together with exercise programme, and the pharmacological intervention group were given the oral Metformin (500 mg b.i.d). Results: Both blood glucose profiles included FBS and 2HPP with the mean difference of 0.24 ± 0.94 mmol/L were significantly reduced in the lifestyle intervention group. Waist circumference and LDL-cholesterol were significantly reduced while HDL-cholesterol was significantly elevated in both lifestyle and pharmacological intervention groups. The greatest reduction of body weight and BMI were seen in pharmacological intervention group with the mean difference of 2.06 ± 2.68 kg and 0.89 ± 1.17 kg/m 2 respectively as compared to the lifestyle intervention and the control group with the mean difference of 1.49 ± 2.98 kg, 0.46 ± 2.02 kg/m 2 ; 0.61 ± 1.16 kg, 0.10 ± 1.03 kg/m 2 respectively. The lifestyle intervention showed significant reduction in weight (p=0.004), BMI (p=0.023) and waist circumference (p=0.005) as compared to the control group. Multivariable analysis, the lifestyle intervention still had an effect on fasting blood sugar (FBS), 2 hours postprandial (2HPP), and body mass index (BMI) after all the baseline differences were controlled. The lifestyle intervention showed the greater decreased in FBS (0.279 mmol/L) than pharmacological intervention (0.245 mmol/L). Conclusion: Lifestyle intervention was effective in reducing blood sugar profile of pre-diabetic patients as compared to the pharmacological intervention and the control group. Keywords: Prevention T2DM, primary intervention, impaired glucose tolerance, pre-diabetes. I. INTRODUCTION Type 2 diabetes mellitus (T2DM) is a major health problem associated with excess morbidity and mortality, and is on increasing prevalence worldwide 1 . It is a widespread health problem and may be life- threatening from associated complications such as coronary artery, cerebrovascular, retinal, neurological, and renal diseases 2-4 . The rise in diabetes mellitus is largely attributed to the epidemic of obesity together with sedentary lifestyle as well as unhealthy dietary habit. Therefore, efforts are needed to determine the possible ways to early intervene those who are at high risk of T2DM. Diabetes is a lifestyle disease and preceded by pre- diabetes for years before manifests as overt hyperglycaemia. The symptoms, however, can be managed by a healthy lifestyle. Pre-diabetes is a condition of people who were diagnosed with impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG) 4 . They have increased risk of developing T2DM 5 and cardiovascular disease 6,7 . It is estimated that approximately 25% of people diagnosed with IGT or IFG progress to diabetes mellitus over a 3 to 5 year period 8 (Nathan, 2007). Patients with both IGT and IFG, older age, overweight, or other diabetic risk factors are more likely to progress to diabetes. Other risk factors for diabetes include family history of diabetes, sedentary lifestyle, hypertension, dyslipidemia, history of gestational diabetes or large for gestational age infant, and polycystic ovarian syndrome. The primary prevention of diabetes mellitus is based on knowledge of the natural history of the development of IGT and its risk factors.This is an important to identify an intervention targeted on individuals who are at highest risk of developing the disease

This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the effects of lifestyle interventions in treating women with gestational diabetes.

Exercise Versus Pharmacological Interventions for Reducing Visceral Adiposity and Improving Health Outcomes

BackgroundWe aimed to investigate the efficacy of the lifestyle intervention (LSI) program in controlling blood glucose regulation and health promotion in type 2 diabetic (T2D) patients.MethodsThirty adults with a diagnosed with diabetes were randomly assigned to LSI and control groups. The LSI group maintained their daily routines after participating twice in the LSI program, while control group maintained 4 weeks of daily life without participating in an intervention.ResultsHbA1c levels in the LSI group decreased significantly after participation (p = 0.025) compared with levels before the study, but there was no significant difference between the groups. The weight and body mass index (BMI) of the LSI group tended to decrease significantly compared with the control group (p = 0.054 and p = 0.055, respectively), and the waist circumference (WC) of the LSI group decreased significantly compared with that of the control group (p = 0.048). In the effects of the LSI program according to the polymorphism of GCKR genes, changes in glycated albumin (GA) (%), HbA1c, WC, BMI, and weight showed a significant decrease in the non-risk (TT genotype) GCKR group compared with the risk group (CC and TC genotype).ConclusionApplication of the four-week LSI program to diabetics revealed positive effects on blood-glucose control and improvement in obesity indicators. In particular, the risk group with variations in the GCKR gene was associated with more genetic effects on indicators such as blood glucose and obesity than was the non-risk group.

Objective: Comparison of the impact of intensified lifestyle and glucagon-like peptide-1 receptor agonist (GLP-1RA) combined with lifestyle intervention on body composition in adult patients with overweight or obesity. Methods: The clinical data of 197 overweight or obese patients who were treated at the Zhongshan Hospital, Fudan University from February 2022 to June 2024 were retrospectively analyzed, including 75 males and 122 females, aged (36.7±10.9) years. Patients were divided into an intensified lifestyle intervention group (n=84) and a GLP-1RA combined with lifestyle therapy group (n=113) based on the intervention approach. Collected clinical data of patients. After adjusting for gender, age, and baseline BMI using generalized linear models, analyze the association between the changes in various indicators [including body weight, body mass index (BMI), body fat percentage, fat mass (FM), fat mass index (FMI), fat-free mass (FFM), and fat-free mass index (FFMI)] and the intervention methods. Results: Body weight, BMI, waist circumference, diastolic blood pressure, FM, FFM, FMI, FFMI, fasting blood glucose, insulin resistance index, alanine aminotransferase, and controlled attenuation parameter were lower in the intensive lifestyle intervention group compared to the GLP-1RA combined with lifestyle intervention group (all P0.05). There was no statistically significant difference between the two groups in terms of age, gender, systolic blood pressure, body fat percentage, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, aspartate aminotransferase, and elasticity values (all P0.05). After 12 weeks of intervention, the results of the generalized linear model showed that the reduction magnitudes of body weight, FFM, and FFMI were associated with the intervention methods (all P0.05). The GLP-1RA combined with lifestyle intervention group showed greater reductions in body weight [(7.8±4.3) vs (5.1±4.5) kg], FFM [(2.2±2.1) vs (1.0±1.9) kg], and FFMI [(0.7±0.5) vs (0.3±0.5) kg/m2] compared to the intensive lifestyle intervention group (all P0.05). After 24 weeks of intervention, both groups exhibited decreases in post-weight-loss body weight, BMI, body fat percentage, FM, FFM, FMI, and FFMI compared to pre-weight-loss values (all P0.001). The results of the generalized linear model indicated that the reduction magnitudes of body fat percentage, FM, FFM, FMI, and FFMI were associated with the intervention methods (all P0.05). The intensive lifestyle intervention group showed greater reductions in body fat percentage (5.8%±3.0% vs 3.9%±4.2%), FM[(8.9±4.1) vs (7.0±5.7) kg], and FMI [(3.1±1.4) vs (2.4±1.9) kg/m2] compared to the GLP-1RA combined with lifestyle intervention group, while the reductions in FFM [(1.5±2.5) vs (2.8±3.4) kg] and FFMI [(0.5±0.9) vs (0.9±1.2) kg/m2] were smaller (all P0.05). Conclusion: In weight loss treatment, the intensive lifestyle retains more lean body mass than the GLP-1RA combined lifestyle.

People with a severe mental illness (SMI) have a life expectancy reduced by 10 to 20 years compared with the general population, primarily attributable to cardiometabolic disorders. Lifestyle interventions for people with SMI can improve health and reduce cardiometabolic risk. To evaluate the effectiveness of a group-based lifestyle intervention among people with SMI in outpatient treatment settings compared with treatment as usual (TAU). The Severe Mental Illness Lifestyle Evaluation (SMILE) study is a pragmatic cluster randomized clinical trial performed in 8 mental health care centers with 21 flexible assertive community treatment teams in the Netherlands. Inclusion criteria were SMI, age of 18 years or older, and body mass index (calculated as weight in kilograms divided by height in meters squared) of 27 or greater. Data were collected from January 2018 to February 2020, and data were analyzed from September 2020 to February 2023. Weekly 2-hour group sessions for 6 months followed by monthly 2-hour group sessions for another 6 months, delivered by trained mental health care workers. The intervention targeted overall lifestyle changes, emphasizing establishing a healthy diet and promoting physical activity. TAU (control) did not include structured interventions or advice on lifestyle. Crude and adjusted linear mixed models and multivariable logistic regression analyses were performed. The main outcome was body weight change. Secondary outcomes included changes in body mass index, blood pressure, lipid profiles, fasting glucose level, quality of life, self-management ability, and lifestyle behaviors (physical activity and health, mental health, nutrition, and sleep). The study population included 11 lifestyle intervention teams (126 participants) and 10 TAU teams (98 participants). Of 224 included patients, 137 (61.2%) were female, and the mean (SD) age was 47.6 (11.1) years. From baseline to 12 months, participants in the lifestyle intervention group lost 3.3 kg (95% CI, -6.2 to -0.4) more than those in the control group. In the lifestyle intervention group, people with high attendance rates lost more weight than participants with medium and low rates (mean [SD] weight loss: high, -4.9 [8.1] kg; medium, -0.2 [7.8] kg; low, 0.8 [8.3] kg). Only small or no changes were found for secondary outcomes. In this trial, the lifestyle intervention significantly reduced weight from baseline to 12 months in overweight and obese adults with SMI. Tailoring lifestyle interventions and increasing attendance rates might be beneficial for people with SMI. Netherlands Trial Register Identifier: NTR6837.

Lifestyle intervention could help obese pregnant women to limit their weight gain during pregnancy and improve their psychological comfort, but has not yet been evaluated in randomized controlled trials. We evaluated whether a targeted antenatal lifestyle intervention programme for obese pregnant women influences gestational weight gain (GWG) and levels of anxiety or depressed mood. This study used a longitudinal interventional design. Of the 235 eligible obese pregnant women, 205 (mean age (years): 29±4.5; body mass index (BMI, kg m(-)(2)): 34.7±4.6) were randomized to a control group, a brochure group receiving written information on healthy lifestyle and an experimental group receiving an additional four antenatal lifestyle intervention sessions by a midwife trained in motivational lifestyle intervention. Anxiety (State and Trait Anxiety Inventory) and feelings of depression (Edinburgh Depression Scale) were measured during the first, second and third trimesters of pregnancy. Socio-demographical, behavioural, psychological and medical variables were used for controlling and correcting outcome variables. We found a significant reduction of GWG in the brochure (9.5 kg) and lifestyle intervention (10.6 kg) group compared with normal care group (13.5 kg) (P=0.007). Furthermore, levels of anxiety significantly decreased in the lifestyle intervention group and increased in the normal care group during pregnancy (P=0.02); no differences were demonstrated in the brochure group. Pre-pregnancy BMI was positively related to levels of anxiety. Obese pregnant women who stopped smoking recently showed a significant higher GWG (β=3.04; P=0.01); those with concurrent gestational diabetes mellitus (GDM) (β=3.54; P=0.03) and those who consumed alcohol on a regular base (β=3.69; P=0.04) showed significant higher levels of state anxiety. No differences in depressed mood or obstetrical/neonatal outcomes were observed between the three groups. A targeted lifestyle intervention programme based on the principles of motivational interviewing reduces GWG and levels of anxiety in obese pregnant women.

Efficacy of lifestyle interventions in the reversion to normoglycemia in Korean prediabetics: One-year results from a randomised controlled trial

Background: The use of antipsychotic medication, particularly second generation antipsychotics (SGAs) is a major risk factor for cardiovascular disease in people with severe mental illness (SMI). Few studies have compared body measures of people with SMI taking first generation antipsychotics (FGAs) to those taking SGAs. Aim: We compare body measures between long-term male inpatients using either FGAs or SGAs. Setting: The study was conducted at Weskoppies Psychiatric Hospital, in Pretoria, Gauteng. Methods: A total of 30 patients were selected from a list of male inpatients and were included in our study. Each participant had the following anthropometric measures done and these were compared between the two groups: Waist circumference (WC), body mass index (BMI), waist to hip ratio (WHR), waist to height ratio (WHtR) and hip circumference (HC). Hospital records were used to record demographic variables, diagnosis, comorbid disease and psychotropic medication for each participant. Results: Participants in the FGA and SGA groups had similar body measures, resulting in similar BMI, WHR and WHtR. Participants had a mean HC of 100.5 cm, 95% confidence interval (CI) (97.68, 103.22). BMI ranged from 21.87 kg/m² to 37.65 kg/m², with an overall mean of 28.5 kg/m², 95% CI (26.69, 30.22). Participants had a mean WHtR of 0.59, 95% CI (0.56, 0.61). Participants had a mean WC of 100.6 cm and 95% CI (96.26, 104.87), and the mean WHR of both groups was 1.0. Conclusion: Participants using FGAs and SGAs had similar body measures, and these indicated that this sample of male inpatients with SMI is at high risk for CVD.

PCN23 - Effects Of Lifestyle Interventions On Body Mass Index In Breast Cancer Patients

BackgroundThe use of antipsychotic medication, particularly second generation antipsychotics (SGAs) is a major risk factor for cardiovascular disease in people with severe mental illness (SMI). Few studies have compared body measures of people with SMI taking first generation antipsychotics (FGAs) to those taking SGAs.AimWe compare body measures between long-term male inpatients using either FGAs or SGAs.SettingThe study was conducted at Weskoppies Psychiatric Hospital, in Pretoria, Gauteng.MethodsA total of 30 patients were selected from a list of male inpatients and were included in our study. Each participant had the following anthropometric measures done and these were compared between the two groups: Waist circumference (WC), body mass index (BMI), waist to hip ratio (WHR), waist to height ratio (WHtR) and hip circumference (HC). Hospital records were used to record demographic variables, diagnosis, comorbid disease and psychotropic medication for each participant.ResultsParticipants in the FGA and SGA groups had similar body measures, resulting in similar BMI, WHR and WHtR. Participants had a mean HC of 100.5 cm, 95% confidence interval (CI) (97.68, 103.22). BMI ranged from 21.87 kg/m² to 37.65 kg/m², with an overall mean of 28.5 kg/m², 95% CI (26.69, 30.22). Participants had a mean WHtR of 0.59, 95% CI (0.56, 0.61). Participants had a mean WC of 100.6 cm and 95% CI (96.26, 104.87), and the mean WHR of both groups was 1.0.ConclusionParticipants using FGAs and SGAs had similar body measures, and these indicated that this sample of male inpatients with SMI is at high risk for CVD.

To study effects of lifestyle intervention on metabolic and clinical outcomes in obese women fulfilling the World Health Organization (WHO) 2013 diagnostic criteria for gestational diabetes mellitus (GDM) in early gestation. Secondary analysis of data from the Lifestyle in Pregnancy (LiP) study, a lifestyle randomized controlled trial in 304 pregnant women with BMI ≥30 kg/m2. Early GDM (week 12-15) was diagnosed according to modified WHO 2013 GDM criteria: fasting venous plasma glucose ≥5.1 mmol/L and/or 2-h capillary blood glucose (CBG) ≥8.5 mmol/L (75-g oral glucose tolerance test [OGTT]). Women with treated GDM fulfilling local Danish GDM criteria (2-h CBG ≥9.0 mmol/L) (n = 16) and women with normal OGTT (n = 198) were excluded. Of 90 women with early GDM, 36 received lifestyle intervention and 54 standard care. All were Caucasian, and median age was 29 years (interquartile range 27-33) and BMI 34.5 kg/m2 (32.3-38.1). All baseline characteristics were similar in the lifestyle intervention and standard care groups. At gestational week 28-30, the women in the lifestyle intervention group had significantly higher fasting total cholesterol and fasting LDL. All other metabolic parameters including measurements of glucose, insulin, and HOMA of insulin resistance were similar. There were more planned cesarean sections in the lifestyle intervention group (22.2 vs. 5.6%), but all other obstetric outcomes were similar. Lifestyle intervention in obese women fulfilling WHO 2013 GDM criteria in early pregnancy was not effective in improving obstetric or metabolic outcomes. Future studies should focus on interventions starting prepregnancy.

Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males

Excessive gestational weight gain (EGWG) during pregnancy increases the risk of fetal macrosomia, maternal overweight status, and postpartum weight retention. Its prevention potentially improves maternal and neonatal outcomes. Important contributing factors to EGWG include excessive caloric intake and inadequate levels of physical activity. A number of studies have examined the effects of lifestyle intervention (dietary intervention with or without increased physical activity) on the prevalence of EGWG, but the results have been mixed. This prospective, randomized, controlled trial tested the hypothesis that use of a community-based exercise and dietary intervention program during pregnancy can improve dietary habits, increase physical activity, and reduce EGWG in an urban population of pregnant women. The intervention group included nondiabetic pregnant volunteers who underwent a program, including community-based group exercise sessions, instructed home exercise, diet, and counseling between 20 and 36 weeks of gestation. The control group included pregnant women receiving standard prenatal care, with no exercise instruction or dietary intervention. Physical activity and food intake in both groups were assessed by surveys at enrollment and 2 months after the enrollment. The primary study outcome measure was the prevalence of EGWG in the 2 groups. The participants who completed the study included 88 women in the control group and 102 in the intervention group. The daily intake of calories, fat, saturated fat, and cholesterol was significantly lower at 2 months after enrollment among women in the intervention group than in the control group (P < 0.01). Two months after the enrollment, the levels of physical activity were significantly higher in the intervention group compared with the control group (P < 0.01). Participants in the lifestyle intervention group also had significantly lower prevalence of EGWG compared with those in the control group using the 2009 Institute of Medicine (IOM) guidelines (P < 0.01). These findings demonstrate that a community-based program of lifestyle intervention during pregnancy, including increased physical activity and improved dietary habits, can reduce the prevalence of EGWG in pregnant women.