Patient experiences of weight gain and preferences for treatment
Research type
Research Study
Full title
Understanding weight gain and preferences for treatment in patients with psychosis: A grounded theory approach.
IRAS ID
261909
Contact name
Felicity Waite
Contact email
Sponsor organisation
University of Oxford / Clinical Trials and Research Governance
Duration of Study in the UK
0 years, 11 months, 30 days
Research summary
Research Summary:
Excess weight in patients with psychosis is a major health, social, and economic problem. Shockingly, patients with psychosis have a reduced life expectancy by 14.5 years and a 3.5 times higher annual risk of mortality compared to the general population (Hayes, Marston, Walters, King, & Osborn, 2017). The onset of psychosis is a time of acute psychological distress. It is common for people to rapidly gain weight when they first start taking anti-psychotic medication. Yet this excess weight persists, even after ceasing to take medication . More than 50% of patients with psychosis are actively trying to lose weight (Strassnig, Brar, & Ganguli, 2005) however effective weight management interventions are lacking (for example, Holt et al., 2018) . This lack of successful weight management strategies could be due to a lack of understanding of the particular factors and context of weight gain in psychosis.
The aim of this study is to gain an understanding of weight gain and excess weight, as well as preferences for healthy weight interventions, in patients with psychosis. Grounded theory will be used to develop a model, generate further hypotheses, and to inform treatment development.Summary of Results:
Why do this study? Rapid weight gain is common with antipsychotic medication. Lost confidence, low mood and medication non-adherence often follow. Yet, the dynamic interactions between the physical and psychological consequences of weight gain, and implications for intervention, are unknown.
What we did: We examined first-person accounts of weight gain to identify preferences for weight change interventions. Semi-structured interviews, analysed using grounded theory, were conducted with 10 patients with psychosis.
What we found: Patients described that initially the extent and speed of weight gain was overshadowed by psychotic experiences and their treatment. This led to a shocking realisation of weight gain. The psychological impact of weight gain, most strikingly on the self-concept, was profound. Loss of self-worth and changed appearance amplified a sense of vulnerability. There were further consequences on mood, activity and psychotic experiences, such as voices commenting on appearance, that were additional obstacles in the challenging process of weight loss. Sedative effects of medication also contributed. Unsuccessful weight loss left little hope and few preferences for interventions. Early information about common weight gain trajectories and working with experts-by-experience were valued. Rebuilding self- confidence, efficacy and worth may be a necessary first step.
Study conclusions: The journey of weight gain in patients with psychosis is characterised by loss of self-worth, agency and hope. There are multiple stages in the journey, each with different psychological reactions, that may need different treatment responses.
REC name
South Central - Oxford A Research Ethics Committee
REC reference
19/SC/0255
Date of REC Opinion
14 Jun 2019
REC opinion
Favourable Opinion