Non-Pharmacological Weight Management in Schizophrenia: A Network Meta-Analysis

Background Antipsychotic treatment in schizophrenia is frequently complicated by substantial weight gain and metabolic disturbances. Implementing effective weight-control strategies is crucial for improving physical health outcomes and overall quality of life in this patient population. This network meta-analysis aimed to systematically evaluate and compare the effectiveness of non-pharmacological interventions for weight management in individuals with schizophrenia. Methods We conducted comprehensive searches of PubMed, Embase, Cochrane Library, Web of Science, and PsycINFO from January 1, 2000, to August 20, 2024, to identify randomized controlled trials (RCTs) investigating non-pharmacological approaches to weight control in schizophrenia. A network meta-analysis was performed using R software to synthesize the evidence and rank intervention efficacy. Results Fourteen RCTs were included, comparing cognitive behavioral therapy (CBT; 5 studies), psychoeducation (4 studies), and lifestyle interventions (5 studies) with usual care. The primary outcome was change in body weight, and the secondary outcome was change in body mass index (BMI). For weight outcomes, lifestyle interventions demonstrated the greatest efficacy (standardized mean difference [SMD] = −3.93, 95% confidence interval [CI] −5.98–−1.90), followed by psychoeducation (SMD = −3.46, 95% CI −5.47–−1.19) and CBT (SMD = −1.95, 95% CI −3.76–−0.32). Surface under the cumulative ranking curve (SUCRA) values indicated that lifestyle interventions had the highest probability of being most effective (SUCRA = 64%), followed by psychoeducation (34%) and CBT (2%). For BMI, only lifestyle interventions showed statistically significant benefits compared to usual care (mean difference −1.47, 95% CI −2.74–−0.17). Heterogeneity was low for weight outcomes (I2 = 36%) and moderate for BMI outcomes (I2 = 63.5%). Conclusion Among non-pharmacological strategies for weight management in schizophrenia patients, lifestyle interventions incorporating dietary and exercise components appear to be the most effective and should be prioritized in clinical settings. Integrating such interventions into routine care may reduce cardiometabolic risk and improve treatment adherence. Additional high-quality randomized trials are warranted to strengthen the evidence base.