Health Psychology Research / HPR / Online First / DOI: 10.14440/hpr.0360
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RESEARCH ARTICLE

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

Junhua Shi1 ,  Lili Jia2 ,  Muqin Zhang3,4 ,  Xin Xu1 ,  Shicong Liang3,4* ,  Haiou Qi1*
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1 Department of Nursing, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang, China
2 Medical College of Zhengzhou Institute of Industrial Application Technology, Zhengzhou 451100, Henan, China
3 The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, Guangdong, China
4 Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou Medical University, Guangzhou 510370, Guangdong, China
HPR, e81240058 https://doi.org/10.14440/hpr.0360
Submitted: 4 November 2025 | Revised: 15 December 2025 | Accepted: 12 January 2026 | Published: 13 February 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

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.

Keywords
Schizophrenia
Non-pharmacological interventions
Weight management
Lifestyle intervention
Network meta-analysis
Funding
The study was funded by Guangzhou Key Clinical Specialty (Clinical Medical Research Institute).
Conflict of interest
All authors declare no conflicts of interest.
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