Naslund John A, Aschbrenner Kelly A, Scherer Emily A, Pratt Sarah I, Bartels Stephen J
Mr. Naslund is with the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire (e-mail:
Psychiatr Serv. 2017 Feb 1;68(2):137-143. doi: 10.1176/appi.ps.201600091. Epub 2016 Nov 1.
Young adulthood represents a critical time to address elevated obesity rates and the risk of early mortality, particularly among people with serious mental illness. Few studies have assessed the benefits of lifestyle interventions targeting weight loss among these young adults. This study examined the impact of the 12-month In SHAPE lifestyle intervention on weight loss and fitness among overweight and obese young adults with serious mental illness (ages 21-30) compared with participants over age 30.
Data were combined from three trials of the 12-month In SHAPE program delivered through community mental health centers. In SHAPE includes weekly fitness trainer meetings, a gym membership, and nutrition education. Primary outcomes were weight loss and change in fitness at 12 months.
Participants (N=194) had a schizophrenia spectrum disorder (53%) or a mood disorder (47%). The overall sample achieved significant weight loss and improved fitness; differences between young adults (N=29) and participants over age 30 (N=165) were not significant. An important finding was that 42% of young adults achieved clinically significant reductions in cardiovascular risk, defined as ≥5% weight loss or improved fitness (>50-m increase on the 6-Minute Walk Test), compared with 54% of adults over age 30 (a nonsignificant difference between age groups).
Among persons enrolled in a lifestyle intervention, overweight and obese young adults experienced benefits comparable with those of adults over age 30. Young adults with serious mental illness face high risk of gaining weight, but a meaningful proportion of these individuals can achieve clinically significant cardiovascular risk reduction, thus highlighting the need to promote lifestyle intervention participation in this group.
青年时期是应对肥胖率上升和过早死亡风险的关键时期，尤其是在患有严重精神疾病的人群中。很少有研究评估针对这些年轻人的减肥生活方式干预措施的益处。本研究比较了12个月的“塑造健康体型”（In SHAPE）生活方式干预对21至30岁患有严重精神疾病的超重和肥胖年轻人与30岁以上参与者的体重减轻和健康状况的影响。
数据来自通过社区心理健康中心开展的三项为期12个月的“塑造健康体型”项目试验。“塑造健康体型”项目包括每周与健身教练会面、健身房会员资格和营养教育。主要结局是12个月时的体重减轻和健康状况变化。
参与者（N = 194）患有精神分裂症谱系障碍（53%）或情绪障碍（47%）。总体样本实现了显著的体重减轻和健康状况改善；年轻人（N = 29）与30岁以上参与者（N = 165）之间的差异不显著。一项重要发现是，42%的年轻人实现了临床上显著的心血管风险降低，定义为体重减轻≥5%或健康状况改善（6分钟步行试验增加>50米），而30岁以上成年人的这一比例为54%（年龄组之间无显著差异）。
在参加生活方式干预的人群中，超重和肥胖的年轻人获得的益处与30岁以上成年人相当。患有严重精神疾病的年轻人面临体重增加的高风险，但这些个体中有相当一部分能够实现临床上显著的心血管风险降低，因此凸显了促进该群体参与生活方式干预的必要性。
