ABSTRACT BACKGROUND: Antipsychotic medication (APM) treatment has risen dramatically over the past 15 years in children/adolescents with serious mental illness, increasing risk for serious cardiometabolic sides effects such as rapid weight gain, increased lipids/triglycerides, reduced insulin sensitivity and hyperglycemia. Given the long-term nature of childhood onset mental illness these youths are at considerable high risk for early onset diabetes, cardiovascular disease, chronic morbidity and shortened lifespan. Although clinical practice guidelines for assessment/monitoring have been established none have been developed for dietary assessment/interventions in weight management. Studies examining APM effects eating behaviors and nutritional composition/adequacy are lacking. METHODS: This dissertation includes a literature review related to weight loss strategies in youth treated with APM. Next a secondary analysis of dietary data collected from 117 overweight/obese youth treated with APM was conducted to examine baseline dietary status and change over 6 months after 8 session of healthy lifestyle education. Lastly, qualitative data collected from the parent/child regarding facilitators/barriers to healthy eating was analyzed.
RESULTS: Literature review found primarily intervention studies with metformin, which was moderately effective, but without examining diet/exercise. Several dietary/exercise studies reported decreased weight/BMI but did not report dietary intake. Analysis in this study found excess consumption of carbohydrates, protein, fat and total/added sugar while deficient in fruits, vegetables, whole grains, fiber and water when compared to the USDA recommended daily allowance. Change in dietary intake over 6 months found significant decreases in calories, carbohydrates, protein, total/saturated/solid fat, total/added sugar, refined grains, total dairy and cheese with small increases in whole fruit, total vegetables and dark green/orange vegetables, although not statistically significant. Qualitative responses from youths/parents on barriers/facilitators to healthy eating identified barriers as excessive appetite/cravings for sweets, junk food in the home, fast food, disliking fruits/vegetables, and lack of meal planning and food shopping/preparation. Facilitators included encouragement from family, removing junk foods, eating home more, making healthy foods tasteful and including the child in meal planning.
CONCLUSIONS: This study provides new information which contributes to understanding dietary intake/eating behaviors in youth treated with APM. Findings suggest a possible influence of a simple dietary intervention on changes in food intake.