People with schizophrenia are two to three times more likely to be obese than the general population, largely due to antipsychotic medication, and this project will test whether a structured group education programme can help them lose weight. The problem is urgent. Obesity in this group drives physical illness—heart disease, diabetes—and can lead patients to stop taking their medication, which raises the risk of relapse. Short-term trials suggest that lifestyle interventions can work, but no programme has been rigorously tested in routine community mental health settings for people with schizophrenia or first episode psychosis. The team will adapt the NICE-approved DESMOND diabetes education programme, then run a randomised trial across ten UK Mental Health Trusts. They will invite around 5,000 adults to participate. The programme includes four one-hour foundation sessions followed by quarterly booster sessions, covering diet, physical activity, and goal setting. The primary measure is weight change after one year. If the programme works, it could give mental health services a practical, scalable tool to tackle a major physical health inequality—without requiring specialist staff or expensive equipment.
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Aim: Obesity & overweight occur 2-3 times more commonly among people with schizophrenia receiving antipsychotics. It causes a wide range of adverse physical health consequences & may be an important factor in non-adherence which increases the risk of relapse. There is an urgent need to develop interventions to reduce overweight & obesity in people with schizophrenia, including those with first episode psychosis. Both short-term randomised controlled trials & observational studies suggest that non-pharmacological interventions may aid weight loss. This project will adapt a structured lifestyle education programme, based on the NICE approved Diabetes Education & Self-Management for On-going & Newly Diagnosed (DESMOND) approach that can help people with schizophrenia to lose weight. We will then undertake a randomised controlled trial with an internal pilot in community mental health settings to evaluate the extent to which the lifestyle programme, when delivered to people with schizophrenia or first episode psychosis, can support weight loss. Design: A multicentre open-labelled individually randomised trial of a group lifestyle education programme in people with schizophrenia including those with first episode psychosis. Setting: The study will be run in 10 UK Mental Health Trusts in a variety of different community mental health locations that are convenient and familiar to participants including hospitals & primary care or community venues. Target population: We will invite ~5000 adults with schizophrenia or first episode psychosis to participate through clinics run by the Mental Health Trusts. We will also seek the views of carers, advocates & mental healthcare professionals to assess the acceptability of the intervention. Health technologies being assessed: We will deliver a structured lifestyle education programme that encourages increased physical activity, improved diet & weight reduction in people with schizophrenia. The programme will be based on the DESMOND approach, which provides person-centred structured group self-management education for people with, or at risk of, type 2 diabetes, & which uses a described philosophy & psychological theories of adult learning. The adapted programme is likely to include the following sessions: the patient story, healthcare professional story, consequences & personal risk, diet & weight loss, physical activity, emotion management & goal setting. The programme will be supported by specially developed resources which may include: a patient diary, goal setting sheets & other materials. Our programme will focus on 5 key lifestyle targets: weight reduction, moderate dietary intake of total fat, low dietary saturated fat intake, high dietary fibre intake, regular physical activity. It is envisaged that the programme will comprise a foundation programme (4 x 1-hr sessions) followed by “booster” sessions every 3 months. The programme will be delivered by 2 trained community mental health facilitators (educators) to groups of 6-8 people. The final structure will be informed by participants in the development phase. Measurement of outcomes: The primary outcome measure will be weight at 1 year after entry to the trial. All secondary outcome measures will be assessed at baseline & after 3 & 12 months except where stated. • Weight; the proportion who maintained or reduced weight; % weight change • Waist circumference • Body mass index • Wrist worn accelerometry (GeneActiv) • Dietary intervention in primary care questionnaire • Blood pressure • Fasting glucose, lipid profile, HbA1c (baseline & 1 year only) • Health-related quality of life (EQ-5D & RAND SF36) • Illness Beliefs Questionnaire – revised (IPQ-R) • Brief Psychiatric Rating Scale • Changes in medication • Smoking status • Adverse events • Client Service Receipt Inventory Sample size: The primary outcome is weight (kg) at 12 months after randomisation. Previous data on UK patients with severe mental i
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