The STRIDE Weight Loss and Lifestyle Intervention for Individuals Taking Antipsychotic Medications: A Randomized Trial
Publication: American Journal of Psychiatry
Abstract
Objectives:
The STRIDE study assessed whether a lifestyle intervention, tailored for individuals with serious mental illnesses, reduced weight and diabetes risk. The authors hypothesized that the STRIDE intervention would be more effective than usual care in reducing weight and improving glucose metabolism.
Method:
The study design was a multisite, parallel two-arm randomized controlled trial in community settings and an integrated health plan. Participants who met inclusion criteria were ≥18 years old, were taking antipsychotic agents for ≥30 days, and had a body mass index ≥27. Exclusions were significant cognitive impairment, pregnancy/breastfeeding, recent psychiatric hospitalization, bariatric surgery, cancer, heart attack, or stroke. The intervention emphasized moderate caloric reduction, the DASH (Dietary Approaches to Stop Hypertension) diet, and physical activity. Blinded staff collected data at baseline, 6 months, and 12 months.
Results:
Participants (men, N=56; women, N=144; mean age=47.2 years [SD=10.6]) were randomly assigned to usual care (N=96) or a 6-month weekly group intervention plus six monthly maintenance sessions (N=104). A total of 181 participants (90.5%) completed 6-month assessments, and 170 (85%) completed 12-month assessments, without differential attrition. Participants attended 14.5 of 24 sessions over 6 months. Intent-to-treat analyses revealed that intervention participants lost 4.4 kg more than control participants from baseline to 6 months (95% CI=–6.96 kg to –1.78 kg) and 2.6 kg more than control participants from baseline to 12 months (95% CI=–5.14 kg to –0.07 kg). At 12 months, fasting glucose levels in the control group had increased from 106.0 mg/dL to 109.5 mg/dL and decreased in the intervention group from 106.3 mg/dL to 100.4 mg/dL. No serious adverse events were study-related; medical hospitalizations were reduced in the intervention group (6.7%) compared with the control group (18.8%).
Conclusions:
Individuals taking antipsychotic medications can lose weight and improve fasting glucose levels. Increasing reach of the intervention is an important future step.
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History
Received: 10 February 2014
Revision received: 2 April 2014
Revision received: 14 May 2014
Accepted: 23 June 2014
Published ahead of print: 31 October 2014
Published online: 1 January 2015
Published in print: January 01, 2015
Authors
Competing Interests
Dr. Green has received grant support from AHRQ, the Kaiser Permanente Center for Safety and Effectiveness Research, the Kaiser Permanente Community Benefit Initiative, NIDA, NIDDK, NIH, NIMH, and Purdue Pharma; she has also provided research consultation for The Industry PMR (the Industry PMR consortium is comprised of Actavis, Endo Pharmaceuticals, Janssen Pharmaceuticals, Mallinckrodt, Pfizer, Purdue Pharma, Rhodes Pharmaceuticals, Roxane Laboratories, and Zogenix). Dr. Yarborough has received grant support from AHRQ, the Kaiser Permanente Center for Safety and Effectiveness Research, the Kaiser Permanente Community Benefit Initiative, NCCAM, NIDA, NIDDK, NIMH, and Purdue Pharma. Dr. Leo has received funding from GenomeDX Biosciences and Pfizer. Mr. Yarborough has received grant support from the Kaiser Permanente Community Benefit Initiative, NIDDK, NIMH, and Purdue Pharma. Mr. Stumbo has received grant support from AHRQ, the Health Resources and Services Administration, the Kaiser Permanente Community Benefit Initiative, the Lucile Packard Foundation for Children’s Health, Maternal and Child Health Bureau, NCCAM, NIDDK, NIMH, and Purdue Pharma. Ms. Janoff has received grant support from AHRQ, the Kaiser Permanente Center for Safety and Effectiveness Research, NIDA, NIDDK, NIMH, and Purdue Pharma. Dr. Perrin has received grant support from AHRQ, the Centers for Disease Control and Prevention, the Kaiser Permanente Community Benefit Initiative, Kaiser Permanente Northwest, Merck, NCCAM, NCI, NCMHD, NHLBI, NIA, NICHD, NIDA, NIDDK, NIMH, NINR, NIOSH, Purdue Pharma, and the Veterans Administration. Dr. Nichols has received grant support from AHRQ, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, NHLBI, NIDDK, NIH, Novartis Pharmaceuticals, and Merck. Dr. Stevens has received grant support from AHRQ, NCCAM, NCI, NCRR, NHLBI, NICHD, NIDDK, NIH, and Kaiser Permanente Northwest.
Funding Information
National Institute of Diabetes and Digestive and Kidney Diseases10.13039/100000062: R18DK076775
Supported by the National Institute of Diabetes and Digestive and Kidney Diseases, grant R18DK076775.Metrics & Citations
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