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Structured lifestyle education for people with schizophrenia, schizoaffective disorder and first-episode psychosis (STEPWISE): randomised controlled trial

Research output: Contribution to journalArticle

  • Richard I. G. Holt
  • Rebecca Gossage-worrall
  • Daniel Hind
  • Michael J. Bradburn
  • Paul Mccrone
  • Tiyi Morris
  • Charlotte Edwardson
  • Katharine Barnard
  • Marian E. Carey
  • Melanie J. Davies
  • Chris M. Dickens
  • Yvonne Doherty
  • Angela Etherington
  • Paul French
  • Fiona Gaughran
  • Kathryn E. Greenwood
  • Sridevi Kalidindi
  • Kamlesh Khunti
  • Richard Laugharne
  • John Pendlebury
  • And 7 others
  • Shanaya Rathod
  • David Saxon
  • David Shiers
  • Najma Siddiqi
  • Elizabeth A. Swaby
  • Glenn Waller
  • Stephen Wright
Background - Obesity is a major challenge for people with schizophrenia.

- We assessed whether STEPWISE, a theory-based, group structured lifestyle education programme could support weight reduction in people with schizophrenia.

- In this randomised controlled trial (study registration: ISRCTN19447796), we recruited adults with schizophrenia, schizoaffective disorder or first-episode psychosis from ten mental health organisations in England. Participants were randomly allocated to the STEPWISE intervention or treatment as usual. The 12-month intervention comprised four 2.5 h weekly group sessions, followed by 2-weekly maintenance contact and group sessions at 4, 7 and 10 months. The primary outcome was weight change after 12 months. Key secondary outcomes included diet, physical activity, biomedical measures and patient-related outcome measures. Cost-effectiveness was assessed and a mixed-methods process evaluation was included.

- Between 10 March 2015 and 31 March 2016, we recruited 414 people (intervention 208, usual care 206) with 341 (84.4%) participants completing the trial. At 12 months, weight reduction did not differ between groups (mean difference 0.0 kg, 95% CI −1.6 to 1.7, P = 0.963); physical activity, dietary intake and biochemical measures were unchanged. STEPWISE was well-received by participants and facilitators. The healthcare perspective incremental cost-effectiveness ratio was £246 921 per quality-adjusted life-year gained.

Conclusions - Participants were successfully recruited and retained, indicating a strong interest in weight interventions; however, the STEPWISE intervention was neither clinically nor cost-effective. Further research is needed to determine how to manage overweight and obesity in people with schizophrenia.
Original languageEnglish
Pages (from-to)63-73
JournalBritish Journal of Psychiatry
Issue number02
Early online date25 Sep 2018
Publication statusPublished - 1 Feb 2019
Externally publishedYes


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