Addressing Obesity in Schizophrenia: An Ecological Approach

Abstract

Individuals with schizophrenia are at high risk for obesity. Contemporary treatment approaches have concentrated on improving diet and physical activity behaviour. Guided by the Medical Research Council Framework, this thesis aimed to identify modifiable environmental factors that may influence the dietary and physical activity behaviours of clients at a psychiatric facility and examine the efficacy of intrapersonal and environmental components of a broad ecological intervention. Study one explored what environmental factors at the facility influence diet and physical activity. Participants identified that obesogenic elements involved aspects of the social and built environments and that both intrapersonal interventions and environmental changes are needed to improve physical activity and dietary behaviour. Based on the findings of the first study, study two examined the feasibility of exercise counseling amongst individuals with schizophrenia and its effect on increasing moderate and vigorous levels of physical activity (MVPA). Findings showed that exercise counseling is feasible. Accelerometer results showed that levels of MVPA decreased throughout the study, but levels of mediating psychological variables of physical activity increased. Study three examined the use of point-of-choice prompts to increase stair use at the hospital. Overall, no significant changes in stair use between the study phases were found, but male staff members increased their stair use throughout the study. Using multiple research methods, this thesis has made several contributions to the understanding of physical activity and dietary behaviours in individuals with schizophrenia. Novel solutions are needed to move beyond lifestyle interventions and address multiple individual and environmental factors that cause weight gain in this population.