Question: In people with mental health problems detained in prison or secure services, or admitted to psychiatric hospital, how effective are any weight loss interventions compared with treatment as usual for the reduction of overweight or obesity?

Answer:

Plain language summary

A few randomised controlled trials have studied weight loss treatments for psychiatric inpatients in the form of antipsychotic medication replacement, health promotion, physical activity programmes and diet control. No clear results have emerged, and most studies were not of high quality. No research at all has looked at people with mental health problems detained in prison.

Clinical and research implications

No definite clinical implications may be made based on the available evidence. The authors of a systematic review suggested that switching to an antipsychotic medication which is less likely to cause weight gain and metabolic problems may be beneficial, but that better designed trials with adequate power would provide more convincing evidence to use this approach as an intervention strategy. Trials evaluating health promotion, dietary control and physical activity interventions yielded mixed results, and similarly, higher quality trials are required to more conclusively evaluate such interventions. Of note, no relevant high quality research has been conducted in prison, nor high secure mental health services.

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