Obstacles and Facilitators to Healthy Dietary Habits in Individuals with a Psychotic Disorder: A Systematic Review

Abstract

Individuals diagnosed with psychotic disorders have reduced life expectancy, primarily attributed to cardiovascular diseases exacerbated by lifestyle habits and antipsychotic side effects. Poor diet quality, marked by low fruit and vegetable consumption and high discretionary food intake are also at play. Limited information exists on factors influencing healthy dietary habits in this population. This systematic review aims to analyze qualitative and quantitative data, from the past 20 years, on obstacles and facilitators to healthy dietary habits among individuals with psychotic disorders. PsycINFO, PubMed and Google scholar searches with these inclusion criteria were conducted: (a) peer-reviewed articles, (b) participants are adults, (c) at least 30% or more of the sample had a psychotic disorder, and (d) focus on obstacles, facilitators or interventions related to healthy dietary habits. Among 21 identified articles, 14 addressed obstacles 11 discussed facilitators and 12 proposed interventions. This review identified seven key obstacles (cost and accessibility, taste of healthy food, emotional role of food, social environment, cognitive challenges, symptoms, and medication) and four facilitators (social support, health-related motivation, improved self-perception and interventions). Notably, some factors, such as social support and neighborhood environment, emerged as both obstacles and facilitators depending on the context. Access to effective interventions, including educational resources, such as cooking and planning skills, and more research on group therapy and peer-based programs are discussed.

Keywords

psychotic disorders obstacles facilitators behavior change dietary habits healthy eating systematic review

Introduction

Compared to the general population, individuals with psychotic disorders, experience a reduced life expectancy of 10 to 30 years (Bogomolova et al., 2018; Chang et al., 2011; Laursen et al., 2014). Cardiovascular diseases (CVD) are recognized as the leading cause of mortality in this population (Barre, 2011; Bogomolova et al., 2018). Physical inactivity, unhealthy dietary habits, tobacco consumption, obesity, and diabetes are among the risk factors that increase cardiovascular events (Barre, 2011).

Furthermore, individuals with psychotic disorders are often prescribed second-generation antipsychotics, such as clozapine or olanzapine, to reduce their psychotic symptoms (Tamminga, 2022). However, this medication can bring undesirable side effects such as weight gain, type 2 diabetes, high blood pressure, and hyperlipidemia, making people who take antipsychotics even more vulnerable to developing a metabolic syndrome (i.e., CVD, diabetes and stroke) (Tamminga, 2022). Antipsychotic medication appears to influence eating behavior, contributing to unhealthy dietary patterns. Many antipsychotics have been shown to interfere with satiety signals and increase perceived hunger (via histamine and serotonin receptor antagonism), leading to higher caloric intake, and night eating, often from nutritionally poor sources (Blouin et al., 2008; Sentissi et al., 2009). Given that antipsychotics remain the primary and most commonly prescribed treatment for adults diagnosed with a psychotic disorder (Shiers & Curtis, 2014), it is unsurprising that research on dietary habits has increased markedly over the past two decades, aiming to prevent CVD and obesity in this population.

Nutritional factors do play a crucial role in the relationship between psychotic disorders and CVD. There is a consensus in the literature regarding the protective effects of a healthy diet on reducing the risks of obesity and CVD, namely a diet rich in fruits, vegetables, fiber, fish, and low-fat dairy products, and low in ultra-processed foods (Buttar et al., 2005). However, research indicates that individuals with psychotic disorders tend to have poorer dietary habits compared to the general population (Aucoin et al., 2020). In fact, they consume fewer fruits, vegetables, and fibers, whereas their overall caloric intake is higher than recommended (McCreadie, 2003; Teasdale et al., 2019). Moreover, approximately 47% of their energy intake comes from foods high in saturated fats, added sugars, and sodium, such as sugary beverages and processed meats (Romain et al., 2021; Teasdale et al., 2020). Food insecurity is a common reality for many individuals with psychotic disorders and could have impact on food quality and intake (Teasdale et al., 2020). Socioeconomic factors, such as the high cost and poor neighborhood availability of healthy food, make access to quality food even more challenging (Barre, 2011).

Understanding not only the obstacles, but also the facilitators to healthy dietary habits in people with psychotic disorders, including the efficacy of existing interventions, is crucial for better supporting this population in adopting healthy dietary habits.

Thus far, systematic reviews regarding dietary habits in individuals with psychotic disorders have focused on eating disorders (Kowalewska et al., 2024; Sankaranarayanan et al., 2021). Interventions on dietary habits targeting individuals with psychotic disorders are sparse and emerging. Also, limited information is available regarding the specific obstacles and facilitators individuals with psychotic disorders may meet as they attempt to adopt healthy dietary habits. In the present article, unhealthy dietary habits were defined as any eating behavior detrimental to one’s health including a diet rich in saturated fats, processed products, refined sugar, salt, and calories, or poor in fiber, fruits, and vegetables. We were interested here in typical unhealthy eating habits, rather than disordered eating behaviors (such as binge eating, restriction, etc.). We were also interested in the literature published to date regarding interventions and other facilitating factors for healthy dietary habits, specifically for people with psychotic disorders.

Specific Objective

The present systematic qualitative and quantitative literature review aimed to explore, over the past 20 years, the various obstacles and facilitators to adopting healthy dietary habits among individuals diagnosed with a psychotic disorder. The following question guided the initial research:

Apart from the pharmacological effects of antipsychotic medications and psychotic symptoms, what factors promote or hinder the adoption of healthy dietary habits in individuals with a psychotic disorder?

This study was conducted following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Higgins et al., 2023; Page et al., 2021). As no data was collected, a research ethics board approval was not necessary.

Methodology

Eligibility Criteria According to PICO Guidelines (Higgins et al., 2023)

Population

The sample included individuals aged 18 years or older, diagnosed with a primary psychotic disorder (i.e., first-episode psychosis (FEP), schizophrenia, schizoaffective disorder, or schizophreniform disorder).

Intervention

No exclusion on study design was made.

Control

There were no limits on comparison groups.

Outcome

Our outcomes were the obstacles and/or facilitators to healthy dietary habits, including the interventions promoting healthy dietary habits. Articles were excluded if (a) the number of individuals with a psychotic disorder was not provided or formed less than 30% of the total sample, (b) the study did not involve humans, (c) only pharmacological effects of antipsychotics and/or the inherent effects of psychotic symptoms on dietary habits were reported, (d) the results only addressed cognitive or behavioral aspects related to changes in dietary habits, (e) publication was written in a language other than English or French, or (g) protocol papers did not provide data. Additionally, only peer-reviewed articles were included.

Search Strategy

Electronic databases PsycINFO, PubMed and Google Scholar were accessed. The searches were limited to studies published between June 2003 and August 2025 involving human subjects. The keywords were checked for eligibility with the medical subjects heading (MeSH) terms, which is the National Library of Medicine’s controlled vocabulary thesaurus. Articles were retrieved using a combination of the following keywords: nutrition OR food OR eating OR “eating habit*” OR “disordered eating behavio*” OR hunger OR satiety AND psychosis OR psychotic OR psychoses OR schizo* OR “severe* mental* ill*” OR “severe* mental* disorder*” OR “serious* mental* ill*” OR “serious* mental* disorder*” AND “nutrition* behavio*” OR “eating behavio*” OR “health* behavior.”

Study Selection

The Covidence platform was utilized to perform this review. Two evaluators (L.T. & A.M.K.) assessed the titles and abstracts of each article to screen and choose appropriate studies for the review. Inter-rater agreement was calculated, and disagreements were resolved through discussion and consensus between the two evaluators. Screening for the full-text evaluation of articles was performed independently by the two evaluators (L.T. & A.M.K.) for the final selection of articles. A second inter-rater agreement was conducted, followed by discussion and consensus. After data extraction, a sample article was chosen to check for any missing articles using Connected Papers, an AI-supported cross-reference tool.

Data Extraction and Synthesis

The extraction grid, completed on the Covidence platform, includes the following data: (a) study characteristics (country, study design, sample size), (b) sample characteristics (mean age and standard deviation, gender %, diagnosis %), and (c) results related to the research question.

Quality Assessment

The quality of the studies was assessed by a senior researcher (T.L.) using the Mixed Methods Appraisal Tool (MMAT, Supplemental Material), specifically designed for systematic reviews that include qualitative, quantitative, and mixed-method studies (Pluye et al., 2011). Depending on the type of study, there are corresponding methodological quality criteria for the appraisal (for e.g., controlled biases, representative sample, sufficient sample size, appropriate and validated measures used (for quantitative studies), or appropriate consideration of context or influence of interviewer on the analysis (for qualitative studies)). Scores for each study ranged from 1 (when only one criterion was met) to 4 (high quality, when all criteria were fulfilled). The MMAT enables the evaluation of the quality of each type of study within their specific methodology. To compare different types of included studies, we also added a criterion for the quality of the evidence (Costantino et al., 2015), which awarded an additional point (+1) to studies that allowed for the assessment of effectiveness or generalization of results (i.e., randomized controlled trials and large cohort studies).

Analysis

Initially, studies were categorized into two general themes: those addressing obstacles and those addressing facilitators for healthy dietary habits, based on the findings from each study. Subsequently, the final selection of themes was made after multiple revisions by the lead author with consensus from a co-author (T.L.).

Results

A total of 258 studies emerged through the search strategy. After applying the inclusion and exclusion criteria, 90 articles proceeded to the full-text examination stage. Following the full-text verifications, 69 articles were excluded (see PRISMA Figure 1).

Characteristics of Selected Studies

Overall, 21 articles were deemed eligible for the study. The articles originated from the United States (K = 10), Australia (K = 4), the United Kingdom (K = 3), Germany (K = 3), Turkey (K = 3), and Austria (K = 2). Sample sizes ranged from 2 to 86,810 participants. Please see Tables 1 to 3 for a detailed description of the studies.

Table 1.

Extraction Table: Obstacles to Healthy Dietary Habits in Individuals with a Psychotic Disorder.

Article type	Authors and date	Country in which the study conducted	Aim of study	Study design	Intervention	Diagnosis of population(s) studied	Sample size, age, sex	Key findings	Study quality appraisal score
Obstacles	Aschbrenner et al. (2013)	United States	To examine social contact and the demographic, health and clinical characteristics associated with perceived social support for diet and exercise among persons living with serious mental illness enrolled in a healthy lifestyle intervention.	Randomized controlled trial and cross sectional study	In SHAPE: customized health plan and weekly sessions with provided health mentor.	Sz or Sz-A (57.3%)	N = 158 Age M = 45.4 (SD 11.5) Sex = 58% F	Level of contact with friends and family is associated with more unhealthy eating among friends and unheatlhy family eating environments. Female participants were significantly more likely to be exposed to unhealthy family eating environments than male participants, (F(1,84) = 6.41, p < .05). Depressive symptoms was a significant predictor of more unhealthy family eating environments, (r(77)=.35, p < .001).	2 + 1
Obstacles	Barre (2011)	United States	To explore the understanding of a healthy diet and the barriers to healthy eating in persons with serious mental illnesses.	Qualitative research		Sz or Sz-A (35.5%) BD (35.5%)	N = 31 Age M = not provided Sex = 51.6% F	Expressed barriers to changing dietary habits were increased cost and decreased availability of healthy foods, lack of social support, both eating alone and with others, the taste of healthy foods, the emotional role of food, the convenience and time required to shop and cook food, the priorities and antipsychotic medication. For many participants, healthy diet knowledge did not translate into healthy eating habits.	3
Obstacles	Bogomolova et al. (2018)	Australia	To evaluate the effectiveness of HELFIMED (Healthy Eating for Life with a Mediterranean-style diet) for improving healthy eating and behaviors of individuals with SMI.	Mixed-methods study	HELFIMED program: 3-months intervention with nutrition education sessions, biweekly cooking workshops, provided food hampers and guided shopping trips	Sz (41%) Sz-A (16.7%) Paranoid Sz (16.7%) BD (7.7%) Unspecific non-organic psychosis (7.7%)	N = 13 Age M = 29.9 (SD 11.0) Sex = 61.5% M	Barrier to heathy eating: lack of structured planning during grocery shopping.	Qualitative: 3 Quantitative: 1
Obstacles	Cabassa et al. (2012)	United States	To engage residents at supportive housing agencies in a dialogue about their physical health to generate community-based knowledge and strategies to inform the development and implementation of health care interventions that can be effectively introduced into these agencies.	Qualitative research	6-weeks weekly photovoice sessions, digital cameras provided	Sz (31.3%) BD (31.3%)	N = 16 Age M = 56 (SD 12) Sex = 43,7% F	Expressed barriers to changing eating habits: lack of motivation, depression, difficulties following and sustaining dietary recommendations from their medical providers, eating alone, not being able to prepare a meal for one person, weight gained from taking antipsychotic medications, lack of time to cook and prepare healthy meals because of multiple demands, availability and convenience of fast food restaurants, lack of availability and affordability of fresh fruits and vegetables and the low quality of food in participants’ communities.	2
Obstacles	Çelik Ince & Partlak Günüşen (2018)	Turkey	To determine the views and habits of individuals with mentalillness on physical activities and nutrition behaviors.	Qualitative research		Sz (33.3%) Sz-A (33.3%) Psychotic disorders (13.3%)	N = 15 Age M = 41.13 (SD 13.02) Sex = 80%	Barriers to healthy eating: lack of knowledge on cooking, lack of information on healthy eating, living alone, unemployment, economic insufficiencies, antipsychotic medication, eating unhealthy foods because it is pleasant.	2

Note. Sz = schizophrenia; Sz-A = schizoaffective disorder; BD = bipolar disorder.

Table 2.

Extraction Table: Facilitators to Healthy Dietary Habits in Individuals with a Psychotic Disorder.

Article type	Authors and date	Country in which the study conducted	Title	Study design	Intervention	Diagnosis of population(s) studied	Sample size, age, sex	Key findings	Study quality appraisal score
Facilitators	Aschbrenner et al. (2013)	United States	Perceived social support for diet and exercise among persons with serious mental illness enrolled in a healthy lifestyle intervention	Randomized controlled trial and cross sectional study	In SHAPE program: customized health plan and weekly sessions with provided health mentor	Sz or Sz-A (57.3%)	N = 158 Age M = 45.4 (SD 11.5) Sex = 58% F	Encouragement from friends for healthy eating is associated with readiness to change portion size.	2 + 1
Facilitators	Aschbrenner et al. (2016)	United States	Feasibility study of increasing social support to enhance a healthy lifestyle intervention for individuals with serious mental illness	Mixed-methods pilot study	12-session Fit Together intervention of weekly 1-hour sessions with a Fit Together partner support coach who reinforced and facilitated partner support for the fitness and weight loss goals that participants set in the In SHAPE intervention	Sz (14.3%) Sz-A (28.6%) BD (14.3%) Psychosis not otherwise specified (14.3%)	Primary participants N = 7 Age M = 43.3 (SD 13.7) Sex = 71% F Support Partners N = 7 Age M = 52.9 (SD 13.9) Sex = 86%	The participants and support partners expressed a desire for more interactive activities to help them acquire new skills for behavior change and for group-based cooking classes as a way to teach cooking skills and increase self-efficacy in preparing healthy meals.	Qualitative score: 3 Quantitative score: 1
Facilitators	Baker (2014)	Australia	‘Better health Choices’ by telephone: A feasibility trial of improving diet and physical activity in people diagnosed with psychotic disorders	Pre-post feasibility study	Eight manualized telephone sessions used motivational interviewing and behavioral strategies to target fruit and vegetable intake and one additional CVD risk behavior, delivered by trained psychologists and fidelity-monitored (BECCI)	Sz (65%) Sz-A or BD (18%) Delusional disorder (6%) Psychotic disorder not otherwise specified (6%)	N = 17 Age M = 33.9 (SD 6.1) Sex = 53% M	Completion of the Better Health Choices telephone intervention was associated with improvements in F&V and overall diet quality. Two participants stated they would have liked more information about healthier diets.	3
Facilitators	Burton et al. (2020)	UK	Is there an association between perceived social support and cardiovascular health behaviours in people with severe mental illnesses?	Randomized controlled trial	Over 6 months, people with SMI attended nurse-led appointments targeting CVD risk factors, and the study examined whether baseline perceived social support predicted attendance and adherence	Sz or Sz-A (34.8%) BD (45.8%)	N = 155 Age M = 50.9 (SD 10.0) Sex = 43.2% M	No significant associations were detected between perceived social support and any other secondary outcomes (sedentary behavior, diet, alcohol use, or smoking).	2 + 1
Facilitators	Cabassa et al. (2012)	United States	Health and wellness photovoice project: Engaging consumers with serious mental illness in health care interventions	Qualitative research	6-weeks weekly photovoice sessions, digital cameras provided	Sz (31.3%) BD (31.3%)	N = 16 Age M = 56 (SD 12) Sex = 43,7% F	Participants expressed a desire for health interventions that encouraged hands-on activities that were educational and enjoyable and for peer-based approaches. Healthy eating was considered essential for preventing and managing chronic health conditions.	2
Facilitators	Çelik Ince & Partlak Günüşen (2018)	Turkey	The views and habits of the individuals with mental illness about physical activity and nutrition	Qualitative research		Sz (33.3%) Sz-A (33.3%) Psychotic disorders (13.3%)	N = 15 Age M = 41.13 (SD 13.02) Sex = 80%	Needs and facilitators to healthy eating: social support, economic support, information about healthy eating, self-confidence and attractiveness.	2
Facilitators	Jimenez et al. (2016)	United States	Health behavior change benefits: Perspectives of Latinos with serious mental illness	Qualitative research	In SHAPE program: 1-year membership to local fitness facility with access to health mentor; comparison condition: 12-month YMCA Health Club membership and educational materials	Sz (25%) Sz-A (50%) BD (10%)	N = 20 Age M = 20.25 (SD 10.4) Sex = 45% F	Participants believed that engaging in health behavior change, including diet alteration, would help them lose weight and increase their muscle tone, can help manage their mental illness and increase self-esteem by believing that body changes would make them more self-confident and attractive to members of the opposite sex.	3
Facilitators	Mueller-Stierlin, Peisser, et al. (2022)	Germany, Austria, Australia	Implications of dietary intake and eating behaviors for people with serious mental illness: A qualitative study	Qualitative research		Sz and related disorders (57%)	N = 28 Age M = 43.3 (SD 13.5) Sex = 61% F	Positive implications of heathy eating: has a positive effect on physical and mental heath and well-being, helps supporting the treatment of physical comorbidities, builds self-efficacy and gives percetpion of control.	2
Facilitators	Shiner et al. (2008)	United States	Learning what matters for patients: Qualitative evaluation of a health promotion program for those with serious mental illness	Qualitative research	In Shape Program	Sz (37.5%)	N = 8 Age M = 43.0 (SD 15.3) Sex = 62.5% M	Facilitators to healthy eating: information on healthy eating, accompaniment for cooking and grocery shopping, improving physical health/comorbidities, social support (with health mentors and other participants), self-confidence and self-efficacy through healthy behaviors, new skills acquired and relationships.	3
Facilitators	Smith et al. (2020)	UK	Early intervention in psychosis: Effectiveness and implementation of a combined exercise and health behavior intervention within routine care	Mixed-methods study	In SHAPE intervention: 12-week combined intervention program, engaging in weekly, 90-min sessions comprising a healthy behavior education session (45 min), followed by a facilitated exercise session (45 min)	FEP (42.3%) Sz (42.3%)	N = 26 Age M = 27.7 (SD = 5.1) Sex = 30.8% F	Five participants reported positive changes in their eating habits reflected in eating 400 g equivalent of fruit/vegetables daily. Focus group participants attributed weight, exercise, and health behavior changes to the SHAPE program.	Qualitative: 4 Quantitative: 2

Note. Sz = schizophrenia; Sz-A = schizoaffective disorder; BD = bipolar disorder; FEP = first-episode psychosis (i.e., the first occurrence of psychotic symptoms meeting diagnostic criteria).

Table 3.

Extraction Table: Interventions to Healthy Dietary Habits in Individuals with a Psychotic Disorder.

Article type	Authors and date	Country in which the study conducted	Title	Study design	Intervention	Diagnosis of population(s) studied	Sample size, age, sex	Key findings	Study quality appraisal score
Interventions	Aschbrenner et al. (2013)	United States	Perceived social support for diet and exercise among persons with serious mental illness enrolled in a healthy lifestyle intervention	Randomized controlled trial and cross sectional study	In SHAPE program: customized health plan and weekly sessions with provided health mentor	Sz or Sz-A (57.3%)	N = 158 Age M = 45.4 (SD 11.5) Sex = 58% F	Encouragement from friends for healthy eating is associated with readiness to change portion size.	2 + 1
Interventions	Aschbrenner et al. (2016)	United States	Feasibility study of increasing social support to enhance a healthy lifestyle intervention for individuals with serious mental illness	Mixed-methods study	12-session Fit Together intervention of weekly 1-hour sessions with a Fit Together partner support coach who reinforced and facilitated partner support for the fitness and weight loss goals that participants set in the In SHAPE intervention	Sz (14.3%) Sz-A (28.6%) BD (14.3%) Psychosis not otherwise specified (14.3%)	Primary participants N = 7 Age M = 43.3 (SD 13.7) Sex = 71% F Support Partners N = 7 Age M = 52.9 (SD 13.9) Sex = 86%	The participants and support partners expressed a desire for more interactive activities to help them acquire new skills for behavior change and for group-based cooking classes as a way to teach cooking skills and increase self-efficacy in preparing healthy meals.	Qualitative: 3 Quantitative: 1
Interventions	Baker (2014)	Australia	‘Better health choices’ by telephone: A feasibility trial of improving diet and physical activity in people diagnosed with psychotic disorders	Pre-post feasibility study	Better Health Choice intervention: Eight telephone delivered sessions targeting fruit and vegetable (F&V) consumption and leisure screen time, as well as smoking and alcohol use	Sz (65%) Sz-A or BD (18%) Delusional disorder (6%) Psychotic disorder not otherwise specified (6%)	N = 17 Age M = 33.9 (SD 6.1) Sex = 53% M	Completion of the Better Health Choices telephone intervention was associated with improvements in F&V and overall diet quality. Two participants stated they would have liked more information about healthier diets.	3
Interventions	Bogomolova et al. (2018)	Australia	Dietary intervention for people with mental illness in South Australia	Mixed-methods study	HELFIMED program: 3-months intervention with nutrition education sessions, biweekly cooking workshops, provided food hampers and guided shopping trips	Sz (41%) Sz-A (16.7%) Paranoid Sz (16.7%) BD (7.7%) Unspecific non-organic psychosis (7.7%)	N = 13 Age M = 29.9 (SD 11.0) Sex = 61.5% M	Outcome of the intervention: Participants became more receptive to learning new knowledge, they experienced enjoyment from learning about and eating healthier food, increased their intentions to eat healthier food, and encouraged their peers to follow healthier lifestyles; Changes were evident in swapping unhealthy snacks for healthier options such as fruit, nuts and yogurt, in swapping energy or soft drinks to fruit-based drinks or drinks lower in sugar and caffeine and in reduced consumption of takeaway meals and convenient foods; Behaviors associated with healthier diets were engaged (consumption of breakfast; cooking and consuming regular homecooked meals; reduction in consumption of highly processed, high in fat and sugar take away meals); The intake from food groups associated with better cardiovascular health and Mediterranean diet principles was increased (vegetables and fruits, olive oil as the main dietary fat, fish and legumes).	Qualitative: 3 Quantitative: 1
Interventions	Gelberg et al. (2015)	United States	Meal replacements as a weight loss tool in a population with severe mental illness	Case study	Free meal replacement shake	Sz-A (100%)	Participant 1: Age = 50 Sex: F Participant 2: Age = 42 Sex: M	One participant, who preferred structure and routine had trouble with avoiding high-fat/fried food because it was a pattern for days at a time, managed to incorporate one shake as a meal replacement into his daily lunch routine.	2
Interventions	Jimenez et al. (2016)	United States	Health behavior change benefits: Perspectives of Latinos with serious mental illness	Qualitative research	In SHAPE program: 1-year membership to local fitness facility with access to health mentor; comparison condition: 12-month YMCA Health Club membership and educational materials	Sz (25%) Sz-A (50%) BD (10%)	N = 20 Age M = 20.25 (SD 10.4) Sex = 45% F	Participants believed that engaging in health behavior change, including diet alteration, would help them lose weight and increase their muscle tone, can help manage their mental illness and increase self-esteem by believing that body changes would make them more self-confident and attractive to members of the opposite sex.	3
Interventions	Mansuroğlu and Kutlu (2022)	Turkey	The transtheoretical model based psychoeducation’s effect on healthy lifestyle behaviours in schizophrenia: A randomized controlled trial	Randomized controlled trial	HLBPP intervention group: 6-week psychoeducation modules (3 days a week, two sessions per day) based on the Transtheoretical Model + regular rehabilitation practices at CMHC; control group: regular rehabilitation practices at CMHC	Sz (100%)	Intervention group n = 41 Age M = 38.7 (SD 9.9) Sex = 85.4% M Control group n = 41 Age M = 39.6 (SD 11.1) Sex = 80.5% M	After the TTM-based intervention, it was observed that the intervention group made progress in the stages of nutrition, physical exercise, spiritual development and stress management.	3 + 1
Interventions	McCreadie et al. (2005)	UK	Dietary improvement in people with schizophrenia	Randomized controlled trial	Free F&V with associated instrution; free F&V only; or treatment as usual	Sz (100%)	N = 102 Age M = 45 Sex = 29% F	People with Sz who habitually eat little fruit and vegetables are able and willing to consume more if the food is provided for free (the mean consumption doubled). Data suggested it was easier to increase the intake of fruit and fruit juice than that of vegetables. Fruit and fruit juice can be readily consumed, whereas most vegetables need preparation. After the intervention stopped, no difference was found between the consumption of F and V at baseline and 12 months after.	4 + 1
Interventions	Shiner et al. (2008)	United States	Learning what matters for patients: Qualitative evaluation of a health promotion program for those with serious mental illness	Qualitative research	In Shape Program	Sz (37.5%)	N = 8 Age M = 43.0 (SD 15.3) Sex = 62.5% M	Facilitators to healthy eating: information on healthy eating, accompaniment for cooking and grocery shopping, improving physical health/comorbidities, social support (with health mentors and other participants), self-confidence and self-efficacy through healthy behaviors, new skills acquired and relationships.	3
Interventions	Smith et al. (2020)	UK	Early intervention in psychosis: Effectiveness and implementation of a combined exercise and health behavior intervention within routine care	Mixed-methods study	In SHAPE intervention: 12-week combined intervention program, engaging in weekly, 90-min sessions comprising a healthy behavior education session (45 min), followed by a facilitated exercise session (45 min)	FEP (42.3%) Sz (42.3%)	N = 26 Age M = 27.7 (SD = 5.1) Sex = 30.8% F	Five participants reported positive changes in their eating habits reflected in eating 400 g equivalent of fruit/vegetables daily. Focus group participants attributed weight, exercise, and health behavior changes to the SHAPE program.	Qualitative: 4 Quantitative: 2

Note. Sz = schizophrenia; Sz-A = schizoaffective disorder; BD = bipolar disorder; FEP = first-episode psychosis (i.e., the first occurrence of psychotic symptoms meeting diagnostic criteria).

Main Themes of Selected Studies

Obstacles

Cost and Accessibility

The growing cost and lack of accessibility to foods considered healthy, such as fresh fruits and vegetables, were reported as obstacles to a healthy diet in the population with a psychotic disorder in two qualitative studies (Barre, 2011; Cabassa et al., 2012). Financial hardship was also a factor influencing dietary choices. With limited financial resources, some participants mention poor eating habits because they cannot afford to prioritize quality food and tend to buy what is least expensive in their neighborhood, mostly ultra-processed or fast-food options (Mueller-Stierlin, Peisser, et al., 2022). Additionally, a large-scale comparison study (N = 366) found that unemployed participants with schizophrenia consumed healthy foods less frequently than unemployed participants from the general population (Roick et al., 2007). Unemployment was also highlighted as a perceived obstacle in a qualitative study (Çelik Ince & Partlak Günüşen, 2018). Another qualitative study (N = 28) reported that participants felt that it was possible to eat healthy despite a low income, but only if a good financial management plan was in place (Mueller-Stierlin, Peisser, et al., 2022). Other studies examining the influence of neighborhood characteristics on the lifestyle of residents with severe mental disorders (Salvo et al., 2023) found interesting results. Salvo et al.’s (2023) study included 314 participants with psychotic disorders receiving supported housing in New York city or Philadelphia, and found that those residing in neighborhoods with high education levels and better transportation networks (i.e., bike paths, sidewalks) consumed fewer fruits and vegetables than those residing in less privileged neighborhoods ; this was explained as potentially due to the high cost of living (Salvo et al., 2023). A smaller qualitative study, also with people with a psychotic disorder receiving supported housing, reported that the poor food quality found in grocery stores in their neighborhoods was a factor hindering healthy dietary habits (Cabassa et al., 2012). Moreover, high accessibility to fast food establishments in the participants’ environment was said to encourage unhealthy dietary habits (Cabassa et al., 2012).

Taste of Healthy Foods

Three qualitative studies found that the taste of healthy foods was perceived as an obstacle to changing dietary habits. In one study, eating healthy meant, for some individuals, consuming less satisfying or tasty foods and eliminating their favorite dishes from their diet (Barre, 2011). The enjoyable taste of foods that are not considered healthy can prevent some participants from eating healthy. During episodes of emotional eating (Tuncer & Duman, 2022) or stress (Mueller-Stierlin, Peisser, et al., 2022), some participants experience cravings and prefer certain foods such as sweets, readily available snacks, or pre-made meals (Tuncer & Duman, 2022). A cross sectional comparison study (N = 49) noted a higher likelihood among participants with a psychotic disorder and obesity, compared to the control group with obesity but without a diagnosis, of consuming food in response to external cues related to food (e.g., publicities, smell, sight, taste of food) rather than listening to their internal hunger and satiety signals (Lundgren et al., 2014).

Emotional Role of Food

Four qualitative studies explored the role that food plays on emotions and mood. Participants mentioned intentionally choosing to eat unhealthy food for the initial positive effect it had on their mood (Çelik Ince & Partlak Günüşen, 2018; Mueller-Stierlin, Cornet, et al., 2022). Participants also mentioned using food as a coping mechanism to manage negative emotions (depressive symptoms, anxiety, anger), either as a reward (Mueller-Stierlin, Peisser, et al., 2022), or as a source of comfort and pleasure to fulfill an emotional need (Barre, 2011).

Social Environment

Several qualitative studies (K = 6) observed an association between individuals with psychotic disorders’ social network and unhealthy eating habits. Two studies identified that lack of social support hindered the process of changing eating habits for participants (Barre, 2011; Mueller-Stierlin, Cornet, et al., 2022). Eating alone and eating with others can be obstacles, depending on the context. Indeed, being single and living alone was reported as having negative effect on the eating habits of some participants (Barre, 2011; Çelik Ince & Partlak Günüşen, 2018). Some reported finding it “always a bit dumb” to go to the grocery store, cook, and eat alone (Mueller-Stierlin, Peisser, et al., 2022). It can be especially challenging for some who do not know how to cook for one person (Cabassa et al., 2012; Mueller-Stierlin, Peisser, et al., 2022) or lack information on how to cook healthy meals (Çelik Ince & Partlak Günüşen, 2018). Those who tried to follow recipes complained of ending up with too much food (recipes often being for 4 or more), overeating or eating large portions, wasting food, or eating the same meal for several days (Cabassa et al., 2012; Mueller-Stierlin, Peisser, et al., 2022). Eating with others can also bring challenges, as family or friends might expose individuals to unhealthy meals (Aschbrenner et al., 2013; Barre, 2011). Also, for the sake of conformity and acceptance, some participants mentioned adjusting or changing the quantity of food consumed according to the expectations of family and friends (Mueller-Stierlin, Peisser, et al., 2022).

Cognitive Challenges

Participants with a psychotic disorder in three qualitative studies raised issues that appear linked to cognitive challenges, namely the amount of time it takes to prepare healthy meals was an obstacle to healthy dietary habits (Barre, 2011; Cabassa et al., 2012; Mueller-Stierlin, Peisser, et al., 2022). Indeed, many considered that healthy food took more time to prepare than ready-made meals and fast food, as it requires planning, buying, and then preparing meals, also cognitively challenging (Barre, 2011). The effect of planning challenges on eating habits among individuals with psychotic disorders was also studied. Lack of structure in daily life and forgetting to plan ahead, including during activities like grocery shopping, were challenges frequently encountered by individuals with a psychotic disorder in both a mixed and a qualitative study (Bogomolova et al., 2018; Mueller-Stierlin, Peisser, et al., 2022).

Symptoms

Lack of motivation and poor energy (both negative symptoms of psychosis) and depressive symptoms are commonly experienced by individuals with a psychotic disorder and can impact their dietary habits, impairing the individuals’ ability to prepare healthy meals and affecting their willingness to adopt healthy habits (Cabassa et al., 2012; Klingaman et al., 2014; Mueller-Stierlin, Peisser, et al., 2022). These conclusions stem from both a large population study and qualitative studies. It has also been found in a randomized controlled trial (RCT) that depressive symptoms predict unhealthy eating during family gatherings (Aschbrenner et al., 2013).

Medication

Although we excluded studies pertaining solely to medication, a number of qualitative studies investigating subjectively-perceived obstacles mentioned that antipsychotics, and their associated weight gain, were considered obstacles to healthy dietary habits by participants with a psychotic disorder (Barre, 2011; Cabassa et al., 2012; Çelik Ince & Partlak Günüşen, 2018; Mueller-Stierlin, Cornet, et al., 2022; Mueller-Stierlin, Peisser, et al., 2022).

Facilitators

Social Support

Four articles (two mixed-methods, one RCT, one qualitative) observed the effect of perceived social support on developing healthy dietary habits for individuals with a psychotic disorder. Support and encouragement related to healthy eating from close ones (Aschbrenner et al., 2013, 2016), as well as relationships formed through participating in an intervention program (Shiner et al., 2008; Smith et al., 2020), were associated with positive changes in dietary habits. Indeed, one participant mentioned that, after receiving encouragement from their friends to eat healthier, they were more inclined to change their food portion sizes (Aschbrenner et al., 2013). However, another RCT (N = 155) did not find a significant association between perceived social support and dietary habits among participants (Burton et al., 2020). This result may be due to the different social support measures used and the type of support investigated (e.g., encouragement) in the studies. Intervention programs offering group therapies and peer-based interventions facilitated changes in dietary habits as well as social support for their participants (Cabassa et al., 2012; Smith et al., 2020).

Health-Related Motivation

Participants in qualitative studies noted that adopting healthy eating habits had positive effects on their physical and mental health (Mueller-Stierlin, Cornet, et al., 2022) and helped them manage the symptoms of their mental disorders (Jimenez et al., 2016). Many reported that a healthy diet can prevent and help manage certain chronic diseases (Cabassa et al., 2012) and reported that healthy eating helped manage their medical conditions, such as type 2 diabetes (Mueller-Stierlin, Cornet, et al., 2022; Shiner et al., 2008). Several also believed that opting for a healthier diet could help them lose weight (Jimenez et al., 2016). However, weight loss was not a facilitator in changing eating behavior for those studied in a selective case study of people with psychotic disorders (N = 2). Ambivalence and disinterest in weight loss were identified as obstacles to adopt healthy eating habits (Gelberg et al., 2015). Across two qualitative and one non-randomized quantitative study, participants consistently emphasized the importance of receiving education on healthy eating to support their dietary change (Baker, 2014; Cabassa et al., 2012; Çelik Ince & Partlak Günüşen, 2018). In a small-scale qualitative study (N = 8), information provided by healthcare professionals regarding nutrition and the positive effects of a healthy diet on their condition was considered helpful by some participants (Shiner et al., 2008). In one qualitative study (N = 31), the knowledge gained about nutrition did not impact the eating habits of the participants (Barre, 2011). Although acquiring theoretical knowledge was considered relevant, participants in two qualitative studies mentioned needing practical tools and advice, such as cooking classes, to concretely take action (Aschbrenner et al., 2016; Cabassa et al., 2012).

Improved Self-Perception

In three qualitative studies, some participants with a psychotic disorder described healthy eating as contributing to increased confidence and a sense of personal effectiveness (Jimenez et al., 2016; Mueller-Stierlin, Cornet, et al., 2022; Shiner et al., 2008). Indeed, by taking actions that contribute to their health and well-being, such as cooking healthy meals, participants saw their perception of control and self-efficacy increase (Mueller-Stierlin, Cornet, et al., 2022). For this reason, participants in one study suggested including group cooking classes in the intervention to enhance their culinary skills and, consequently, increase their personal effectiveness in preparing healthy meals (Aschbrenner et al., 2016). Some also believed that better eating habits would contribute to an improvement in their physical appearance, making them more attractive to individuals of the opposite sex. This would increase their confidence and self-esteem (Çelik Ince & Partlak Günüşen, 2018; Jimenez et al., 2016).

Interventions

Although several facilitators identified in intervention studies have already been discussed, the interventions themselves can be considered facilitators, insofar as they help people with psychotic disorders adopt healthy dietary habits. Several qualitative and quantitative studies have tested promising nutritional and psychosocial interventions to help individuals with severe mental illness adopt healthier eating habits. Among these interventions, the “In SHAPE” program is the most widely used and demonstrated effectiveness, as program completion led to the adoption of healthy eating habits among individuals with severe mental illness, such as psychotic disorders (Aschbrenner et al., 2013, 2016; Jimenez et al., 2016; Shiner et al., 2008; Smith et al., 2020). Other interventions, such as “Better Health Choice” (Baker, 2014), a robust pre-post study combining motivational interviews and cognitive-behavioral strategies, and the “healthy lifestyle behaviors psychoeducation” (Mansuroğlu & Kutlu, 2022), rigorously implemented RCT based on the transtheoretical model, have also shown encouraging results. The HELFIMED program, studied with a mixed-methods approach, promoted the adoption of a Mediterranean diet and led to several positive changes in the eating habits of its participants with severe mental illness (Bogomolova et al., 2018). Finally, a RCT testing the effect of free fruits and vegetables on the eating habits of individuals with schizophrenia found that participants’ consumption of fruits and vegetables doubled this the study. However, this increase was not maintained after the intervention ended, as participants had to purchase their own produce. Financial constraints—combined with competing daily priorities—likely contributed to a return to previous low intake levels (McCreadie et al., 2005).

Discussion

The objective of the present qualitative and quantitative systematic review was to explore, through studies published over the past 20 years, the obstacles and facilitators, including interventions, to adopting healthy dietary habits in individuals diagnosed with a psychotic disorder. Seven major themes emerged in obstacles-related studies (cost and accessibility, taste of healthy food, emotional role of food, social environment, cognitive challenges, symptoms, and medication), and four major themes were discussed in facilitators-related studies (social support, health-related motivation, improved self-perception and interventions).

The high cost and lack of accessibility to fresh produce were consistently identified as obstacles. Living in an affluent neighborhood was associated with lower fruit and vegetable consumption in one study, and in another study, living in a disadvantaged neighborhood was also associated with less healthy eating among participants. In neighborhoods with high connectivity and higher education levels, some residents with low financial means may be considered “house poor,” meaning they have high housing-related expenses, leaving them with less money for other significant expenses, such as quality food (Salvo et al., 2023). Individuals living in disadvantaged neighborhoods often experience food deserts, defined as areas with low geographic accessibility to stores offering healthy and quality products at affordable prices. (Robitaille et al., 2019). These findings suggest that some important obstacles to adopting healthy eating habits experienced by the population with psychotic disorders are not solely attributable to the mental disorder itself but rather to associated psychosocial factors, such as their lower socioeconomic status. The unemployment rate among individuals with schizophrenia vary from 61% to 88% across Western countries, compared to 4% to 7% in the general North American population (Evensen et al., 2016). Psychotic symptoms such as odd beliefs and behaviors, lack of motivation, and cognitive deficits can limit employment opportunities for individuals with schizophrenia, leading to financial constraints that reduce the ability to adopt a healthy diet (Yan et al., 2024). Cognitive impairments that compromise planning, organization, and problem-solving (McGurk & Mueser, 2003) can significantly limit one’s capacity to adopt and maintain healthy dietary habits, particularly when managing scarce financial resources or meal preparation routines. In addition, the higher rates of housing instability and homelessness observed among people with schizophrenia can make it even more difficult to access and store nutritious foods, thereby amplifying the challenges linked to limited income and restrictive neighborhood food environments (Yan et al., 2024). Moreover, substance use disorders are frequently comorbid with schizophrenia. Approximately 50% of individuals with schizophrenia will also be diagnosed with a substance-related or an addictive disorder (Mueser & Marcello Duva, 2010). Money spent on purchasing addictive substances further decreases the budget allocated to quality food.

Many of the challenges outlined by participants in various studies related to eating habits are also experienced by the general population, such as the high cost of healthy foods, the prevalence of unhealthy food, taste preferences, lack of time and motivation for grocery shopping and cooking, as well as the influence of peers and family (Ashton et al., 2017; Munt et al., 2017; Pinho et al., 2018). Nonetheless, some results remain specific to the studied population. For instance, a need for support and education regarding healthy eating (nutrition information, meal preparation) was expressed by several participants. Moreover, unemployment appears to have a more pronounced impact on the eating habits of individuals diagnosed with psychotic disorders compared to those without such disorders. Additionally, individuals with psychotic disorders may face more significant challenges related to planning, as mentioned above, because of their cognitive deficits (Mueser & Marcello Duva, 2010; O’Carroll, 2000). The results of this review also suggest that negative symptoms, particularly lack of motivation and low energy may complicate participants’ attempts to change eating habits (Marder & Galderisi, 2017; Morris et al., 1995).

Regarding intervention studies, the results suggest that addressing dietary obstacles in individuals with psychotic disorders requires a comprehensive approach that considers economic, social, psychological, and environmental factors. Several intervention programs demonstrated success in promoting healthy eating. Programs like In SHAPE and HELFIMED effectively combined social support, education, and practical skills, leading to improved dietary habits in participants. These programs have demonstrated that it is possible to help people with psychotic disorders adopt healthy dietary habits, at least during the course of the study. More long-term follow-up studies are warranted to determine what might help sustain long-term healthy dietary habits while considering personal, financial and systemic constraints.

Nonetheless, the intervention studies included in this review have pinpointed important elements needed for healthy dietary habits in people with psychotic disorders. The social aspect appears essential, as social encouragements and group interventions were particularly successful. Given the high rate of loneliness in this population (Michalska da Rocha et al., 2018), this result comes as no surprise. Also, teaching practical applications, like cooking classes or planning tools, were often mentioned as effective in driving long-term change. These results concur with the extant literature on errorless learning which suggests that concrete, hands-on, and incremental learning is highly effective for helping people with schizophrenia learn new manual skills (Kern & Reddy, 2014). It is also worth mentioning that most of the interventions combined physical exercise and dietary changes, making it difficult to separate the results of the dietary component from the overall program.

Limitations and Recommendations

Our study is one of the first to review both qualitative and quantitative studies investigating dietary habits in people with psychotic disorders. As such, our review contains a high number of qualitative studies, that bring interesting insights but might be specific to the subjective experience of those included in these studies. It is crucial to note that, other than qualitative studies, we find several studies with small sample sizes, or for which dietary questions were secondary analyses to a larger study. Our systematic review revealed that most of the studies investigating dietary changes and psychosocial interventions report success in improving healthy eating and dietary habits among participants with psychotic disorders. However, the studied interventions were most often measured immediately after the intervention, using a pre-post design, or were pilot studies, with very few RCTs. Thus, we observe quality scores ranging from low-moderate to moderate-high, suggesting the need to interpret these results with caution. In total, only six studies were of very high quality, as they met all the MMAT quality criteria.

It is also important to note that studies focusing exclusively on medication side effects or diagnosed eating disorders were excluded, as our aim was to concentrate on factors associated with healthy dietary habits rather than on comorbid pathologies requiring intensive clinical interventions. However, this choice may have resulted in missing some information present in the omitted studies. The exclusion of grey literature and the limited number of databases searched may have further restricted the scope of the findings. High heterogeneity was present in the articles included. This could be attributed to the variability in study designs, rigor, and sample sizes. It is important to note that limited consideration was given to the risk of bias in the presentation of results.

Nevertheless, our systematic literature review identified various obstacles and facilitators to adopting healthy eating habits. To enhance the effectiveness of interventions aiming to promote a healthy lifestyle among the population with psychotic disorders, promising strategies should involve increasing social support and offering educational tools related to culinary skills and meal planning. It is noteworthy that individuals with psychotic disorders acknowledged the benefits of healthy eating not only on their physical health but also on their mental health, particularly in terms of mood and symptom management. These findings highlight the importance of implementing strategies that encourage improved dietary habits and lifestyle in this population. Given the heterogeneity of the quality of the evidence, and that only one of the intervention studies obtained a perfect score, we recommend that more quality and generalizable intervention studies, including long-term follow-ups be conducted.

As this field continues to emerge, it may be valuable to integrate components of evidence-based interventions already established for individuals with psychotic disorders—such as motivational interviewing to enhance motivation (often affected by negative symptoms) and cognitive-behavioral therapy to address dysfunctional beliefs related to self-efficacy and problem-solving (Norman et al., 2017; Reddy et al., 2023). Given the systemic barriers previously discussed, applying the Capability, Opportunity & Motivation Behavior model (COM-B) framework (Michie et al., 2011) to refine and strengthen existing interventions could also foster more sustainable behavioral change. This model also considers the social network, an important theme found in both obstacles and facilitators. It emphasizes how social support influences eating habits and further support the recommendation to integrate group-based or peer-supported approaches to maximize the healthy dietary habits interventions’ effectiveness.

Footnotes

Abbreviations

BD: bipolar disorder

Sz: schizophrenia

Sz-A: schizoaffective disorder

ORCID iD

Lorilou Thériault

Ethical Considerations

No ethical approval was required to conduct this study.

Author Contributions

LT, KC, A-MK were responsible for the data extraction. LT is responsible for the drafting of the manuscript. TL and AJR provided critical manuscript feedback. All authors read and approved the final manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The data that support the findings of this study are openly available in PubMed at https://pubmed.ncbi.nlm.nih.gov/, PsycINFO at https://psycnet.apa.org/search/advanced and Google Scholar at

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Lorilou Thériault, BSc in Psychology, is a PhD student in Psychology at the University of Quebec in Trois-Rivières. Her research interests focus on healthy aging, lifestyle behaviors, and physical activity among older adults.

Anne-Marie Kik, BSc in Psychology, is a doctoral student in clinical psychology at the University of Montreal. Her research interests include behavior modification concerning eating habits among people with psychotic disorders.

Kathya Carrier, BSc in Psychology, is a doctoral student in clinical psychology at the Université Laval. Her research interests include the rehabilitation and well-being of people experiencing a psychotic disorder and the prevention of further personal and professional difficulties.

Ahmed Jérôme Romain, PhD, is associate professor at the School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, at the University of Montreal and researcher at Montreal mental health university institute - research center (CR-IUSMM), and FRQS Junior 1 - research fellow. His research primarily focuses on the relationships between obesity, mental health, and physical health.

Tania Lecomte, PhD, is a Professor in the Department of Psychology at the University of Montreal. She is a researcher at the CR-IUSMM and CRIPCAS, and Director of the Canadian Network for Research in Schizophrenia and Psychoses. Her research primarily focuses on improving and developing treatments for individuals living with severe mental illnesses, such as schizophrenia.

References

Aschbrenner

K. A.

Mueser

K. T.

Bartels

S. J.

Pratt

S. I.

(2013). Perceived social support for diet and exercise among persons with serious mental illness enrolled in a healthy lifestyle intervention. Psychiatric Rehabilitation Journal, 36(2), 65–71. https://doi.org/10.1037/h0094973

Aschbrenner

K. A.

Mueser

K. T.

Naslund

J. A.

Gorin

A. A.

Kinney

Daniels

Bartels

S. J.

(2016). Feasibility study of increasing social support to enhance a healthy lifestyle intervention for individuals with serious mental illness. Journal of the Society for Social Work and Research, 7(2), 289–313. https://doi.org/10.1086/686486

Ashton

L. M.

Hutchesson

M. J.

Rollo

M. E.

Morgan

P. J.

Collins

C. E.

(2017). Motivators and barriers to engaging in healthy eating and physical activity: A cross-sectional survey in young adult men. American Journal of Men’s Health, 11(2), 330–343. https://doi.org/10.1177/1557988316680936

Aucoin

LaChance

Cooley

Kidd

(2020). Diet and psychosis: A scoping review. Neuropsychobiology, 79(1), 20–42. https://doi.org/10.1159/000493399

Baker

A. L.

(2014). ‘Better health choices’ by telephone—A feasibility trial of improving diet and physical activity in people diagnosed with psychotic disorders. Psychiatry Research, 220(1–2), 63–70. https://doi.org/10.1016/j.psychres.2014.06.035

Barre

L. K.

(2011). Healthy eating in persons with serious mental illnesses: Understanding and barriers. Psychiatric Rehabilitation Journal, 34(4), 304–310. https://doi.org/10.2975/34.4.2011.304.310

Blouin

Tremblay

Jalbert

M.-E.

Venables

Bouchard

R.-H.

Roy

M.-A.

Alméras

(2008). Adiposity and eating behaviors in patients under second generation antipsychotics. Obesity, 16(8), 1780–1787. https://doi.org/10.1038/oby.2008.277

Bogomolova

Zarnowiecki

Wilson

Fielder

Procter

Itsiopoulos

O’Dea

Strachan

Ballestrin

Champion

Parletta

(2018). Dietary intervention for people with mental illness in South Australia. Heath Promotion International, 33(1), 71–83. https://doi.org/10.1093/heapro/daw055

Burton

Walters

Marston

Osborn

(2020). Is there an association between perceived social support and cardiovascular health behaviours in people with severe mental illnesses? Social Psychiatry and Psychiatric Epidemiology: The International Journal for Research in Social and Genetic Epidemiology and Mental Health Services, 55(12), 1659–1669. https://doi.org/10.1007/s00127-020-01879-9

10.

Buttar

H. S.

Ravi

(2005). Prevention of cardiovascular diseases: Role of exercise, dietary interventions, obesity and smoking cessation. Experimental & Clinical Cardiology, 10(4), 229–249.

11.

Cabassa

L. J.

Parcesepe

Nicasio

Baxter

Tsemberis

Lewis-Fernández

(2012). Health and wellness photovoice project. Qualitative Health Research, 25(3), 618–630. https://doi.org/10.1177/1049732312470872

12.

Çelik Ince

Partlak Günüşen

. (2018). The views and habits of the individuals with mental illness about physical activity and nutrition. Perspectives in Psychiatric Care, 54(4), 586–595. https://doi.org/10.1111/ppc.12289

13.

Chang

C.-K.

Hayes

R. D.

Perera

Broadbent

M. T. M.

Fernandes

A. C.

Lee

W. E.

Hotopf

Stewart

(2011). Life expectancy at birth for people with serious mental illness and other major disorders from a secondary mental health care case register in London. PLoS One, 6(5), e19590. https://doi.org/10.1371/journal.pone.0019590

14.

Connected Papers. https://www.connectedpapers.com/

15.

Costantino

Montano

Casazza

(2015). When should we change our clinical practice based on the results of a clinical study? The hierarchy of evidence. Internal and Emergency Medicine, 10(6), 745–747. https://doi.org/10.1007/s11739-015-1230-8

16.

Covidence. https://www.covidence.org/

17.

Evensen

Wisløff

Lystad

J. U.

Bull

Ueland

Falkum

(2016). Prevalence, employment rate, and cost of schizophrenia in a high-income welfare society: A population-based study using comprehensive health and welfare registers. Schizophrenia Bulletin, 42(2), 476–483. https://doi.org/10.1093/schbul/sbv141

18.

Gelberg

H. A.

Kwan

C. L.

Mena

S. J.

Erickson

Z. D.

Baker

M. R.

Chamberlin

Nguyen

Rosen

J. A.

Shah

Ames

(2015). Meal replacements as a weight loss tool in a population with severe mental illness. Eating Behaviors, 19(1), 61–64. https://dx-doi-org.web.bisu.edu.cn/10.1016/j.eatbeh.2015.06.009

19.

Higgins

J. P. T.

Thomas

Chandler

Cumpston

Page

Welch

(2023). Cochrane handbook for systematic reviews of interventions (version 6.4). Cochrane. https://training.cochrane.org/handbook

20.

Jimenez

D. E.

Burrows

Aschbrenner

Barre

L. K.

Pratt

S. I.

Alegría

Bartels

S. J.

(2016). Health behavior change benefits: Perspectives of Latinos with serious mental illness. Transcultural Psychiatry, 53(3), 313–329. https://doi.org/10.1177/1363461516632388

21.

Kern

R. S.

Reddy

L. F.

(2014). Evolution of errorless learning in psychiatric rehabilitation. American Journal of Psychiatric Rehabilitation, 17(3), 254–271. https://doi.org/10.1080/15487768.2014.935677

22.

Klingaman

E. A.

Viverito

K. M.

Medoff

D. R.

Hoffmann

R. M.

Goldberg

R. W.

(2014). Strategies, barriers, and motivation for weight loss among veterans living with schizophrenia. Psychiatric Rehabilitation Journal, 37(4), 270–276. https://dx-doi-org.web.bisu.edu.cn/10.1037/prj0000084

23.

Kowalewska

Bzowska

Engel

Lew-Starowicz

(2024). Comorbidity of binge eating disorder and other psychiatric disorders : A systematic review. BMC Psychiatry, 24(1), 556. https://doi.org/10.1186/s12888-024-05943-5

24.

Laursen

T. M.

Nordentoft

Mortensen

P. B.

(2014). Excess early mortality in schizophrenia. Annual Review of Clinical Psychology, 10(1), 425–448. https://doi.org/10.1146/annurev-clinpsy-032813-153657

25.

Lundgren

J. D.

Rempfer

M. V.

Lent

M. R.

Foster

G. D.

(2014). Perceptions of factors associated with weight management in obese adults with schizophrenia. Psychiatric Rehabilitation Journal, 37(4), 304–308. https://dx-doi-org.web.bisu.edu.cn/10.1037/prj0000098

26.

Mansuroğlu

Kutlu

(2022). The transtheoretical model based psychoeducation’s effect on healthy lifestyle behaviours in schizophrenia: A randomized controlled trial. Archives of Psychiatric Nursing, 41(1), 51–61. https://doi.org/10.1016/j.apnu.2022.07.018

27.

Marder

S. R.

Galderisi

(2017). The current conceptualization of negative symptoms in schizophrenia. World Psychiatry, 16(1), 14–24. https://doi.org/10.1002/wps.20385

28.

McCreadie

R. G.

(2003). Diet, smoking and cardiovascular risk in people with schizophrenia: Descriptive study. The British Journal of Psychiatry, 183(6), 534–539. https://doi.org/10.1192/03-162

29.

McCreadie

R. G.

Kelly

Connolly

Williams

Baxter

Lean

Paterson

J. R.

(2005). Dietary improvement in people with schizophrenia: Randomised controlled trial. The British Journal of Psychiatry, 187(4), 346–351. https://doi.org/10.1192/bjp.187.4.346

30.

McGurk

S. R.

Mueser

K. T.

(2003). Cognitive functioning and employment in severe mental illness. The Journal of Nervous and Mental Disease, 191(12), 789–798. https://doi.org/10.1097/01.nmd.0000100921.31489.5a

31.

MeSH. (n.d.). National library of medicine. https://www.ncbi.nlm.nih.gov/mesh/

32.

Michalska da Rocha

Rhodes

Vasilopoulou

Hutton

(2018). Loneliness in psychosis: A meta-analytical review. Schizophrenia Bulletin, 44(1), 114–125. https://doi.org/10.1093/schbul/sbx036

33.

Michie

Van Stralen

M. M.

West

(2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6(1), 42. https://doi.org/10.1186/1748-5908-6-42

34.

Morris

R. G.

Rushe

Woodruffe

P. W. R.

Murray

R. M.

(1995). Problem solving in schizophrenia: A specific deficit in planning ability. Schizophrenia Research, 14(3), 235–246. https://doi.org/10.1016/0920-9964(94)00044-9

35.

Mueller-Stierlin

A. S.

Cornet

Peisser

Jaeckle

Lehle

Moerkl

Teasdale

S. B.

(2022). Implications of dietary intake and eating behaviors for people with serious mental illness: A qualitative study. Nutrients, 14(13), 2616. https://doi.org/10.3390/nu14132616

36.

Mueller-Stierlin

A. S.

Peisser

Cornet

Jaeckle

Lehle

Moerkl

Teasdale

S. B.

(2022). Exploration of perceived determinants of disordered eating behaviors in people with mental illness—A qualitative study. International Journal of Environmental Research and Public Health, 20(1), 442. https://doi.org/10.3390/ijerph20010442

37.

Mueser

K. T.

Marcello Duva

(2010). Schizophrenia. In Barlow

D. D. H.

(Dir.), The Oxford handbook of clinical psychology (pp. 470–504). Oxford University Press. https://doi.org/10.1093/oxfordhb/9780195366884.013.0022

38.

Munt

A. E.

Partridge

S. R.

Allman-Farinelli

(2017). The barriers and facilitators of healthy eating among young adults: A missing piece of the obesity puzzle: A scoping review. Obesity Reviews, 18(1), 1–17. https://doi.org/10.1111/obr.12472

39.

Norman

Lecomte

Addington

Anderson

(2017) CPA treatment guidelines on psychosocial treatment of adults. Canadian Journal of Psychiatry, 62(9), 617–623. https://doi.org/10.1177/0706743717719894

40.

O’Carroll

(2000). Cognitive impairment in schizophrenia. Advances in Psychiatric Treatment, 6(3), 161–168. https://doi.org/10.1192/apt.6.3.161

41.

Page

M. J.

McKenzie

J. E.

Bossuyt

P. M.

Boutron

Hoffmann

T. C.

Mulrow

C. D.

Shamseer

Tetzlaff

J. M.

Akl

E. A.

Brennan

S. E.

Chou

Glanville

Grimshaw

J. M.

Hróbjartsson

Lalu

M. M.

Loder

E. W.

Mayo-Wilson

McDonald

, . . . Moher

(2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. British Medical Journal, 372, 71. https://doi.org/doi.org/10.1136/bmj.n71

42.

Pinho

M. G. M.

Mackenbach

J. D.

Charreire

Oppert

J.-M.

Bárdos

Glonti

Rutter

Compernolle

De Bourdeaudhuij

Beulens

J. W. J.

Brug

Lakerveld

(2018). Exploring the relationship between perceived barriers to healthy eating and dietary behaviours in European adults. European Journal of Nutrition, 57(5), 1761–1770. https://doi.org/10.1007/s00394-017-1458-3

43.

Pluye

Robert

Cargo

Bartlett

O’Cathain

Griffiths

Boardman

Gagnon

M. P.

Rousseau

M. C.

(2011). Proposal: A mixed methods appraisal tool for systematic mixed studies reviews. http://mixedmethodsappraisaltoolpublic.pbworks.com.

44.

Reddy

L. F.

Glynn

S. M.

McGovern

J. E.

Sugar

C. A.

Reavis

E. A.

Green

M. F.

(2023). A novel psychosocial intervention for motivational negative symptoms in schizophrenia: Combined motivational interviewing and CBT. American Journal of Psychiatry, 180(5), 367–376. https://doi.org/10.1176/appi.ajp.20220243

45.

Robitaille

É.

Chaput

Paquette

M.-C

. (2019). Interventions visant à modifier l’accessibilité géographique à des commerces d’alimentation et impacts sur l’alimentation et le poids corporel ([Synthèse des connaissances]). Institut national de santé publique du Québec.

46.

Roick

Fritz-Wieacker

Matschinger

Heider

Schindler

Riedel-Heller

Angermeyer

M. C.

(2007). Health habits of patients with schizophrenia. Social Psychiatry and Psychiatric Epidemiology, 42(1), 268–276. https://doi.org/10.1007/s00127-007-0164-5

47.

Romain

A. J.

Bernard

Piché

Kern

Ouellet-Plamondon

Abdel-Baki

Roy

M.-A.

(2021). Mens sana in corpore sano : L’intérêt de l’activité physique auprès des jeunes ayant eu un premier épisode psychotique. Santé mentale au Québec, 46(2), 249. https://doi.org/10.7202/1088185ar

48.

Salvo

Resendiz

Stefancic

Cabassa

L. J.

(2023). Examining place-based neighborhood factors in a multisite peer-led healthy lifestyle effectiveness trial for people with serious mental illness. International Journal of Environmental Research and Public Health, 20(9), 5679. https://doi.org/10.3390/ijerph20095679

49.

Sankaranarayanan

Johnson

Mammen

S. J.

Wilding

H. E.

Vasani

Murali

Mitchison

Castle

D. J.

Hay

(2021). Disordered eating among people with schizophrenia spectrum disorders: A systematic review. Nutrients, 13(11), Article 11. https://doi.org/10.3390/nu13113820

50.

Sentissi

Viala

Bourdel

M. C.

Kaminski

Bellisle

Olié

J. P.

Poirier

M. F.

(2009). Impact of antipsychotic treatments on the motivation to eat: Preliminary results in 153 schizophrenic patients. International Clinical Psychopharmacology, 24(5), 257–264. https://doi.org/10.1097/YIC.0b013e32832b6bf6

51.

Shiers

Curtis

(2014). Cardiometabolic health in young people with psychosis. The Lancet Psychiatry, 1(7), 492–494. https://doi.org/10.1016/S2215-0366(14)00072-8

52.

Shiner

Whitley

Van Citters

A. D.

Pratt

S. I.

Bartels

S. J.

(2008). Learning what matters for patients: Qualitative evaluation of a health promotion program for those with serious mental illness. Health Promotion International, 23(3), 275–282. https://doi.org/10.1093/heapro/dan018

53.

Smith

Griffiths

L. A.

Band

Hird-Smith

Williams

Bold

Bradley

Dilworth

Horne

(2020). Early intervention in psychosis: Effectiveness and implementation of a combined exercise and health behavior intervention within routine care. Frontiers in Endocrinology, 11, 577691. https://www.frontiersin.org/articles/10.3389/fendo.2020.577691

54.

Tamminga

(2022). Médicaments antipsychotiques – Troubles psychiatriques. Édition professionnelle du Manuel MSD. https://www.merckmanuals.com/fr-ca/professional/troubles-psychiatriques/schizophr%C3%A9nie-et-troubles-apparent%C3%A9s/m%C3%A9dicaments-antipsychotiques

55.

Teasdale

S. B.

Burrows

T. L.

Hayes

Hsia

C. Y.

Watkins

Curtis

Ward

P. B.

(2020). Dietary intake, food addiction and nutrition knowledge in young people with mental illness. Nutrition & Dietetics, 77(3), 315–322. https://doi.org/10.1111/1747-0080.12550

56.

Teasdale

S. B.

Ward

P. B.

Samaras

Firth

Stubbs

Tripodi

Burrows

T. L.

(2019). Dietary intake of people with severe mental illness: Systematic review and meta-analysis. The British Journal of Psychiatry, 214(5), 251–259. https://doi.org/10.1192/bjp.2019.20

57.

Tuncer

G. Z.

Duman

Z. Ç

. (2022). Emotional eating experiences of individuals with severe mental disorders: A qualitative study. Perspectives in Psychiatric Care, 58(4), 2723–2732. https://doi.org/10.1111/ppc.13113

58.

Yan

Zhou

Chen

(2024). Navigating nutritional inequality in schizophrenia: A comprehensive exploration of diet, genetics, and holistic management across the life cycle. Nutrients, 16(21), 3738.

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