We try -- oh, how we try! -- to lose the weight. Over the years I've tried walking 80 minutes a day for three months; a rigorous exercise program for ten weeks; the South Beach Diet for a short time; and a $2,000 diet plan for three months. I lost weight for a time with South Beach but couldn't handle the practical difficulties, and virtually no weight with any of the other programs. The most I lost on any of them was two pounds. My weight has been stable at 205 pounds for about a year. I looked great at 130 -- and not so great at just 145.
If your meds have made you gain a lot of weight, your story is probably similar. You've tried and tried, and the weight just keeps creeping up. Maybe you've given up.
Well, there's hope.
I recently viewed a presentation by Dr. Rohan Ganguli and Nurse Practitioner Betty Vreeland on this subject. Dr. Ganguli began by saying he had treated many obese patients for years without really thinking about their weight. Then a colleague did a survey that found that of their patients diagnosed with schizophrenia, less than 20% were in the normal weight range, and fully 60% were obese.
He said that, unfortunately, "... it has been assumed that people with schizophrenia are socially unaware and that, unlike the rest of us, this really does not matter to them." Yet when they asked these patients how they felt about their weight, a wide majority of the overweight and obese patients said they wanted and had tried to lose weight. And in another study, patients said the #1 worst thing about taking medications was weight gain. Clearly, the attitude that those with schizophrenia don't care about their weight was completely wrong.
Dr. Ganguli and his fellows developed a program that clinicians could easily provide. It involved 14 weeks of group sessions with training in such areas as developing good eating habits, burning more calories, and changing snacking habits. Self-monitoring in the form of daily weighing and records of food eaten and physical activity was found to be very important.
They lost weight
The results after the 14 weeks were very encouraging -- two-thirds of patients lost at least 3% of body weight and around 40% lost 5% of body weight or more. This may not sound like a lot, but for me, 3% would mean a little over six pounds in 2 1/2 months -- a lot more than I've been able to do in all these years!
One of the program's ideas was that of "wasting" food. Many people with schizophrenia eat at fast food restaurants because these are inexpensive and convenient. A key issue in their strategy was teaching people not to eat the entire meal -- that it was okay to throw part of the food away.
Preventing weight gain
Finally, they tested the program with patients who were just starting on some of the medications that are known to cause weight gain, including Seroquel (quetiapine), Risperdal (risperidone), Clozaril (clozapine) and Zyprexa (olanzapine). In all cases, intervention was found to prevent weight gain in more patients than in the control group, although the success rate depended on the medication. In this small study, the most dramatic difference was with Seroquel, where more than 60% of the control group gained significant weight, while only about 10% of those in the intervention group gained.
Another successful program
Ms. Vreeland's Healthy Living study was another test of intervention to promote weight loss in the mentally ill. In this program, the key points were:
- Use the food label
- Pay attention to portion size
- Eat more slowly
- Make healthy snack choices
- Differentiate between stomach and psychological hunger
- Reduce fast food intake
- Keep food/activity diaries
- Increase physical activity
- Minimize soft drinks with sugar
First, mental health practitioners of all kinds need to pay more attention to the problem of overweight/obesity in their patients. We are not in a state where we don't care. We care -- a lot. And they can help. A doctor who just says, "Join Weight Watchers" isn't getting it. Many of us aren't up for going to meetings when depressed. Some, like me, are not "group" people. A therapy group, with people like me who have gained weight because of their psychotropic meds, would be different.
But just knowing what made these programs successful can help. Knowing that there is solid research to show it is possible to lose weight and still take my Seroquel makes a difference to me.
Now, I know keeping a calorie and exercise diary is no fun. The easiest way is to get software that has a food database that keeps being updated with more foods. But still, you have to figure out how much of a food you ate, and if the food isn't in the list, you have to add it yourself from the food label. And you have to do it every day, every time you eat. It gets old, fast. (In the sidebar is an article about keeping a food diary if you don't want to buy software.)
But it works better than anything else I've found. Having made a lot of diet changes already, I recently I started keeping such a diary. I find out what I eat that piles up the calories. And after learning that general housework burns about 240 calories an hour, I'm doing a lot more of that now as well.
My scale says I've lost four pounds as of this morning.
Weight loss for those of us on psychotropic meds isn't going to be fast. But if I get tired of keeping a food/exercise diary, or just don't want to wash the dishes, I have the encouragement of knowing it's been proved possible to lose weight with this approach. I hope it helps you, too.
Reference: Ganguli, R., Vreeland, B., & Newcomer, J.W. Strategies to integrate physical health care into mental health: Monitoring and managing weight gain in the mentally ill. Physicians Postgraduate Press, Inc. March 2007. 11/1/07.