Systematic Reviews
Copyright ©The Author(s) 2020.
World J Psychiatr. Aug 19, 2020; 10(8): 187-201
Published online Aug 19, 2020. doi: 10.5498/wjp.v10.i8.187
Table 1 All included studies
Ref.ControlRandom-ization and BlindingPopulationSample sizeInterventionMental health primary outcomeDuration (wk)SymptomDirection of Findings
Studies with one or more positive outcomes
Usher et al[17], 2019TAUNoneYouth, early psychosis33Behaviour intervention teaching mindfulness meditation, cooking classes, supermarket trips, fast-food learning, nutrition education, exercise, moderated group discussion to facilitate healthier livingYes12Positive symptoms (Quick Scale for the Assessment of Negative Symptoms)Improvement
Osborn et al[18], 2018TAURandomized, single blindBipolar disorder (50%), schizophrenia (30%) or psychosis (20%); elevated cholesterol and 1 + modifiable risk factors for CVD327Manualized intervention to decrease cholesterol and CVD risk: Adherence to statins, improve diet and activity, reduce alcohol, quit smokingNo52Psychiatric In-patient costsImprovement
QOL (Warwick-Edinburgh Mental Well-being Scale)Null
Hjorth et al[19], 2017NoneNoneChronic schizophrenia45Lifestyle program including nutrition, meal planning, walking/running group, smoking cessation, MI. individual and group componentsNo120QOL (WHOQoL)Null
Newly diagnosed schizophrenia123QOL (WHOQoL)Improvement
Juel et al[20], 2017NoneNonePsychotic disorder, affective disorder, anxiety disorder, or developmental disorder with comorbid substance use or dependence; 12.5% SSD64Nutrition, exercise and smoking cessation program. Includes health diet habits, reading nutrition labels, macronutrient recommendations. Includes individual and group componentsNo24QOL (WHOQoL)Improvement
Medication UsageWorsening
Masa-Font et al[21], 2015TAUNoneSchizophrenic, schizoaffective or bipolar, treated with antipsychotic drug (67% SSD); BMI > 25332Group nutrition education and exercise sessionsNo12QOL (SF-36)Improvement
Farhat et al[22], 2016NoneNoneSchizophrenia8Group educational program including nutritional balance, meal planning, budgeting, meal preparation, socializationYes16Negative (PANSS)Improvement
Cognitive (BECS)Null
Provencher et al[23], 2016WaitlistNoneSMI including psychotic disorders; weight concern47Program teaching nutrition and cookingNo12QOLImprovement
Sauvanaud et al[24], 2016NoneNoneSchizophrenia14Group educational program/ psychosocial program including schizophrenic disease, treatments, relationships to family, diet, social issues, relaxationYes15Functioning (GAF)Improvement
QOL (SQoL)Improvement
Medication Adherence (MARS)Improvement
Insight (French IQ8)Null
Stiekema et al[25], 2014TAUTreatment centers randomizedPatients with severe mental illness (primarily SSD), inpatient130Group diet and exercise intervention: Lifestyle intervention to change the obesogenic environment within residential setting (e.g., Whole grain bread available)No12DepressionImprovement
Psychological functioningImprovement
Robertson et al[26], 2014NoneNoneSchizophrenia-spectrum25Group healthy lifestyle group, walking group, grocery shoppingYes12Psychotic symptoms (PANSS)Improvement
Bralet et al[27], 2013NoneNoneSchizophrenia10Group nutrition education, cognitive remediation, social skills, meal preparationYes17Psychotic symptoms (PANSS)Improvement
Self EsteemImprovement
Cognition (BACS, STICCS)Improvement
Kuo et al[28], 2012TAUNoneSchizophrenia63Group weight reduction program including food recommendations (more vegetables and monounsat fats, less sugar and calories), exercise, behaviour therapyYes10Biologic (BDNF)Improvement
Psychotic symptoms (BPRS)Null
Porsdal et al[29], 2010TAUNoneSchizophrenia or bipolar I, taking psychotropic medication373Group nutrition and exercise programYes12QOL (15D)Null
Psychotic symptoms (CGI-S)Improvement
Van Citters et al[30], 2010NoneNoneDMS-IV Axis I or II diagnosis; 18% SSD76Individualized health promotion program: health eating, exercise social inclusion, decrease calories. Includes individual and group componentsNo36Mental health functioning (SF-12)Improvement
Negative symptoms (SANS)Improvement
Gretchen-Doorly et al[31], 2009NoneNoneSchizophrenia9Nutrition (avoid high fat food, increase fiber, strategies for weight loss), exercise and stress management coachingYes6Self-efficacy for health practices, psychological wellbeing, health responsibilityImprovement
Castiglioni et al[32], 2008Monthly clinical examNonePsychotic disorders26Group health and Wellness programNo24QOL (Quality of Life Index)Improvement
Guimarães et al[33], 2008TAUNoneSchizophrenia67Calorie-restricted diet; reduction in saturated fat and sugar, increase in fruit and vegetables. Individual deliveryNo4BDNFImprovement
Raine et al[34], 2003TAURandomizedChildren aged 3-5 years, no diagnosis438Group nutrition, education and physical exercise program: structured nutrition program provided the children with milk, fruit juice, a hot meal of fish or chicken or mutton, and a salad each dayYes104positive schizotypal personality (Schizotypal personality questionnaire)Improvement
Cognition (Schizotypal personality questionnaire)Improvement
Aquila et al[35], 2000NoneNoneInpatients with severe persistent mental illness taking atypical antipsychotics32Group diet intervention to decrease fat, calories, sugar, snackingNo78Negative (subjective assessment)Improvement
Studies without positive outcomes
Holt et al[36], 2019TAURandomizationSchizophrenia, schizoaffective disorder or first-episode psychosis, antipsychotic medication, BMI > 25 or concern about weight412Education on nutrition, physical activity and weight management. individual and group componentsNo40DepressionNull
Psychotic symptoms (BPRS)Null
Stiekema et al[37], 2018TAURandomized, BlindedPsychotic disorder, mood disorder, personality disorder, anxiety, substance use disorder, developmental disorder or psychiatric comorbidity; 74% SSD; inpatient770Diet and exercise lifestyle intervention to adjust obesogenic environment (offer low-fat cheese, whole wheat alternatives, less sweets, smaller portions of snacks, fresh rather than canned vegetables) Includes individual and group componentsYes52Psychotic symptoms (PANSS)Null
QOL (MANSA)Worsening
Depression (CDSS)Null
Naslundet al[38], 2017Gym membershipRandomizedMajor depressive disorder, schizoaffective disorder, or schizophrenia; 46% SSD343Individual nutrition, MI, fitness goal settingYes52Depressive Symptoms (CESD)Null
Detke et al[39], 2016Single 15-min session of basic informationNoneSchizophrenia or Bipolar I203Individual intense behavioural weight counseling – nutrition education, pedometer, motivational enhancement, guidance on caloric restriction, low-fat, nutrient dense foods in moderate portion sizesNo52Psychotic symptoms (BPRS-C)Null
Speyer et al[40], 2016TAURandomized, blindedSchizophrenia, schizoaffective disorder or persistent delusional disorder, abdominal obesity428Individual lifestyle program teaching healthy diet, cooking, smoking cessation, physical activity, coordination of care for somatic healthNo52Psychotic symptoms (SANS and SAPS)Null
Perceived health and stressNull
Cognition (BACS)Null
QOL (MANSA/Euro QoL)Null
Jones et al[41], 2007NoneNoneTaking antipsychotic medication50Group psychoeducation and physical activity program including nutrition, budgeting, cooking, goal settingNo10QOL (SF-36)Null
Table 2 Characteristics of studies that reported benefit in mental health outcomes and those that did not
Number of studies reporting benefit (%)Number of studies not reporting benefit (%)P value
Studies with greater than 200 participants4 of 19 (21)5 of 6 (83)0.00559
Studies that included patients with non-SSD diagnoses (e.g., Depression, Bipolar, substance use disorder)8 of 19 (42)4 of 6 (67)0.29380
Studies with an individual intervention component2 of 19 (11)3 of 6 (50)0.03509
Studies designed with primary outcome related to mental health9 of 19 (47)2 of 6 (33)0.54599
Studies that used a control10 of 19 (53)5 of 6 (83)0.18081
Studies that used randomization3 of 19 (16)4 of 6 (67)0.01553
Studies with positive finding in an outcome related to body weight7 of 10 (70)1 of 4 (25)0.12428