An Integrated Risk Reduction Intervention can reduce body mass index in individuals being treated for bipolar I disorder: results from a randomized trial

• Published in: Bipolar disorders 2015-06, Vol.17 (4), p.424-437
• Main Authors: Frank, Ellen, Wallace, Meredith L, Hall, Martica, Hasler, Brant, Levenson, Jessica C, Janney, Carol A, Soreca, Isabella, Fleming, Matthew C, Buttenfield, Joan, Ritchey, Fiona C, Kupfer, David J
• Format: Article
• Language: English
• Subjects: Adult; Affect - drug effects; bipolar disorder; Bipolar Disorder - drug therapy; Bipolar Disorder - psychology; Body Mass Index; Delivery of Health Care, Integrated; Female; health risks; Humans; Life Style; Male; Middle Aged; Obesity - chemically induced; Obesity - drug therapy; Obesity - psychology; Overweight - chemically induced; Overweight - psychology; Overweight - therapy; Reference Values; Risk Reduction Behavior; Social Adjustment; weight management
• ISSN: 1398-5647; 1399-5618
• DOI: 10.1111/bdi.12283

Objectives We conducted a randomized, controlled trial comparing the efficacy of an Integrated Risk Reduction Intervention (IRRI) to a control condition with the objective of improving mood stability and psychosocial functioning by reducing cardiometabolic risk factors in overweight/obese patients with bipolar I disorder. Methods A total of 122 patients were recruited from our outpatient services and randomly allocated to IRRI (n = 61) or psychiatric care with medical monitoring (n = 61). Individuals allocated to IRRI received psychiatric treatment and assessment, medical monitoring by a nurse, and a healthy lifestyle program from a lifestyle coach. Those allocated to the control condition received psychiatric treatment and assessment and referral, if indicated, for medical problems. A mixed‐effects model was used to examine the impact of the interventions on body mass index (BMI). Exploratory moderator analyses were used to characterize those individuals likely to benefit from each treatment approach. Results Analyses were conducted on data for the IRRI (n = 58) and control (n = 56) participants with ≥1 study visit. IRRI was associated with a significantly greater rate of decrease in BMI (d = −0.51, 95% confidence interval: −0.91 to −0.14). Three variables (C‐reactive protein, total cholesterol, and instability of total sleep time) contributed to a combined moderator of faster decrease in BMI with IRRI treatment. Conclusions Overweight/obese patients with bipolar disorder can make modest improvements in BMI, even when taking medications with known potential for weight gain. Our finding that a combination of three baseline variables provides a profile of patients likely to benefit from IRRI will need to be tested further to evaluate its utility in clinical practice.