Sample characteristics

The response rate among those eligible to enter the study was 41%. Twenty-five men and twelve women participated in the study. All had schizophrenia or schizoaffective disorder.

The mean duration of illness was 11.6 years (95% confidence interval: 7.3–18.2). The mean age was 46.2 years (46.2–49.2). Of the group, 30 (81%) were unemployed, four were in paid employment, one was in voluntary employment, one was retired, and one was off work due to sickness at the time of interview. The majority of participants (35 out of 37) were of White European origin, with one of South Asian ethnicity, and one of Chinese ethnicity. In keeping with the protocol, all patients were taking neuroleptic medication. The key results are summarised in Table 1.

Table 1 Details of sample and key results Full size table

Of the participants, 20 out of 37 were taking oral atypical agents (eight were taking Clozapine) with 13 on depot neuroleptics (of which two were receiving depot Risperidone) and four on mood stabilisers as the primary psychotropic agent.

Smoking and alcohol use

Twenty-four out of 37 subjects (64.9%) were current smokers, six (16.2%) were ex-smokers with seven (18.9%) never having smoked. Of the current smokers, four smoked between 1 and 10 cigarettes per day, nine between 11 and 20 cigarettes per day, and eleven between 21 and 60 cigarettes per day. 15% of male subjects consumed above the recommended safe levels of alcohol in a week (21 units per week). No women consumed above the recommended safe levels of alcohol in a week (14 units per week). Of the total sample of 37 patients, 14 took no alcohol in a week.

Weight and related measurements

Within the group, BMI ranged from 18.4 to 52.4 kg/m2 (normal range: 18.5–25.0 kg/m2; World Health Organisation [16]). Mean (95% CI) BMI for men was 31.2 (28.2–34.3) kg/m2, and for women was 31.8 (26.3–37.3) kg/m2. 47.2% of the group had a BMI in the obese range (≥30.0 kg/m2). Thirty-two (86.5%) reported that they did not find it difficult to put on weight.

For men (all of White European origin), mean (95% CI) waist circumference was 106.9 (100.8–112.9) cm (Fig. 1). For Caucasian men, central adiposity is defined as waist ≥94 cm [15]. For men (one was South Asian), waist circumference was 96.5 (86.7–106.3) cm (Fig. 1). For women of European and South Asian ethnicity, central adiposity is defined as waist ≥80 cm [16]. 92.0% of men had central adiposity as defined, as did 91.7% of women.

Fig. 1 Distribution of waist circumference for men and women. The 80 and 94-cm marks on the figure indicate the cut points for the International Diabetes Federation [15] definition of central adiposity Full size image

Pulse and blood pressure

Mean (±SD) systolic blood pressure was 126 ± 19 mmHg and mean diastolic blood pressure was 80 ± 13 mmHg. 21.6% had a systolic blood pressure >140 mmHg and 45.9% a diastolic blood pressure >80 mmHg.

Laboratory results

Four out of 37 patients were known to have diabetes, and three of the 37 patients (8.1%) had a fasting glucose between 6.1 and 6.9 mmol/L [17]. Fasting total cholesterol was >5 mmol/L in 48% of individuals with fasting LDL-cholesterol >3 mmol/L in 43.3% of patients. 16.7% of the patients had a serum prolactin >1000 μL, the threshold agreed by local endocrine services as meriting further investigation.

Metabolic syndrome

Twenty-five patients (67.6%) would be categorised as having the metabolic syndrome using the International Diabetes Federation (IDF) Criteria [15]. This was more likely if the individual was older (odds ratio 1.4 (95% CI 1.32–1.48).

Diet

Thirty-two participants completed the dietary questionnaire. A total of 13.5% of participants ate ≥5 portions of fruit and vegetables per day. Mean (±SD) portions of fruit per day were 1.1 ± 1.0 and of vegetables were 1.7 ± 1.2. Total fruit and vegetable portions were 2.8 ± 1.8. For the group, oily fish was eaten on average on 0.5 ± 0.6 days of each week.

Fruit was only eaten on ≥3 days each week by 34.4% of the group, with 37.5% reporting not eating fruit on any day of the week (Table 2). Vegetables were eaten on ≥3 days of each week by 59.4% of individuals.

Table 2 Breakdown of fruit and vegetable intake in a week for the whole group Full size table

With regard to takeaway foods, twelve (37.5%) did not have any in the previous week, 18 (56.3%) had 1–2 takeaways and two (6.3%) had >2 takeaways. For ready meals, the breakdown was similar with 50% (16 out of 32) having none, 34.4% (11/32) having 1–2 ready meals, 9.4% (3 out of 32) having 3–4 ready meals but 6.3% (2 out of 32) having ≥7.

For crisps, 18 out of 32 (56.3%) had no crisps in the last week and for bread 56.3% (18 out of 32) had white bread, 13 wholemeal/granary bread/brown bread, and one had no bread.

Activity

41.9% of participants reported doing no vigorous activity in the last week (see Additional file 1 for definition). 35.5% did <1 h of vigorous activity per week. Only 29% did ≥10 min of vigorous activity per week. 29% described doing no moderate activity in any week and 39% of patients did so for <1 h per week (Fig. 2). Of 31 responders, 21 walked for <1 h each day, 14 said that they walked for ≥10 min each day with five walking once or not at all in any week, and the remaining twelve walking 2–6 times each week for >10 min.

Fig. 2 Moderate exercise activities (hours per week) in a typical week Full size image

Likert scale ratings

The people studied displayed an understanding that their lifestyle was less healthy than might be achieved, in terms of both diet and exercise.

Diet

Patient ratings on a visual scale of 1–10 for the question ‘Would you describe your diet as healthy (average over the last 3 months)?’ gave a mean ± SD of 5.7 ± 2.2. The anchor points were 0 = very unhealthy, 10 = very healthy.

Activity

Patient ratings on a visual scale of 1–10 for the question ‘Would you consider yourself fairly physically active (average over the last 3 months)?’ gave a mean ± SD of 5.0 ± 2.9. The anchor points were 0 = very physically inactive, 10 = very physically active.

Medication compliance

Patient ratings on a visual scale of 1–10 for the question ‘Are you compliant with medication prescribed for you to take (over the last 3 months)?’ gave a mean ± SD of 9.8 ± 0.8. The anchor points were 0 = not compliant, 10 = very compliant.

If a score of <5.0 on the Likert scales is used to indicate that a patient does not think they have a healthy diet, and a score <5.0 as a patient regarding themselves as not physically active, then the percentage of patients who accepted that they had a problem in these two areas was 54.1 and 51.4%, respectively.