Effect of lifestyle coaching versus care coordination versus treatment as usual in people with severe mental illness and overweight: Two-years follow-up of the randomized CHANGE trial.

Plain Language Summary

The authors assessed the long-term effects of lifestyle coaching for individuals with abdominal obesity and schizophrenia spectrum disorders on cardiovascular risk. Subjects were randomized into 3 groups: 12 months of lifestyle coaching and care coordination, care coordination only or treatment as usual (control). Lifestyle coaching consisted of support from a CHANGE coach who had experience in psychiatry and special training in stopping smoking, healthy diets, and monitoring and treatment of lifestyle diseases. There was at least one face to face meeting per week, plus phone calls, text and email messages. Care co-ordination consisted of support by a specially trained psychiatric nurse, with focus on the symptoms of cardiovascular disease, diabetes or obstructive pulmonary disease. Meetings, telephone calls and messages were adjusted based on personal need. The results did not show any significant effects between the groups at 12 months. After 2 years, 25.4% in the CHANGE group, 19.7% in the care coordination group, and 16.9% in the treatment as usual group had lost at least 5% of their baseline weight. There were no statistically significant differences between the groups for cardiorespiratory fitness, BMI, blood lipids and hbA1c, lung function, smoking status, psychotic symptoms or quality of life. It was noted that self-reporting was a limitation to the study, and may have led to errors in reporting, particularly with reference to diet. In addition, only 42.8% of the CHANGE coaching group attended at least 50% of the planned sessions, and the authors note that this made it likely that there would have been no benefit to increasing or decreasing the number of sessions. The authors concluded that coaching did not improve the motivation of participants to change their lifestyle choices in either the short or long term, and therefore may not be the right approach for those with schizophrenia.