Discussion
weight loss, SMI
SECONDARY
The group-based lifestyle intervention resulted in −3.3 kg (95% CI, −6.2 to −0.4) greater body weight loss than TAU after 12 months. Participants with higher attendance rates in the lifestyle intervention lost more weight than those with medium or low attendance rates. However, with small subgroups, these findings need confirmation in future studies. We found no differences for secondary outcomes other than BMI (−1.1; 95% CI, −2.1 to −0.1).Body weight differences between lifestyle intervention and TAU groups after 6 months were smaller (−2.4 kg; 95% CI, −5.3 to 0.4) than for the STRIDE study (−4.4 kg) but were larger after 12 months (−3.3 kg [95% CI, −6.2 to −0.4] vs −2.6 kg, respectively).We did not find an effect of the lifestyle intervention on quality of life, in line with results from other lifestyle interventions.We must realize that achieving large effects within the total group of patients is not realistic. In the above-mentioned meta-analyses,A broad approach is needed in which the obesogenic living environment of people with SMI is also improved (such as introducing healthy facilities in mental health institutes and changing governmental policies, such as lowering value-added taxes on fruit and vegetables), since unhealthy living environments, low socioeconomic status, and loneliness have big impacts on lifestyle behavior.