A lifestyle intervention to reduce risk factors for cardiometabolic diseases in individuals with obsessive-compulsive disorder (OCD)

Background: Cardiovascular diseases (CVD) are responsible for almost one third of the deaths worldwide. Individuals with mental disorders have shown to be a group particularly vulnerable to suffer from CVD. For example, using data from the Swedish registers, our team has established that individuals with obsessive-compulsive disorder (OCD), an impairing disorder affecting about 2% of the population, have an increased risk of obesity, type 2 diabetes, circulatory system diseases, and specific CVDs, with the subtypes venous thrombo-embolism and heart failure being the most relevant.

We have also established that these risks in OCD are likely to be a consequence of the disorder itself, rather than attributable to familial factors or medication. Given this, it is crucial to consider lifestyle habits (e.g., physical activity, diet) which may be responsible for the observed CVD risks and are known to be amenable to modification.

Objectives: This project is a collaboration between Karolinska Institutet, the Department of Cardiology at Karolinska Universitetssjukhuset, and the specialist OCD and related disorders clinic at Psykiatri Sydväst, Region Stockholm. With the help and support of the Swedish OCD association (Svenska OCD-förbundet), we have developed a lifestyle intervention to reduce metabolic and cardiovascular risk factors in individuals with OCD, which we aim to evaluate in this project.

Workplan: We will follow a two-step approach. First, we will conduct a pilot study to test whether our lifestyle intervention, including physical exercise, modification of dietary habits, and other behavioural changes is feasible, safe, and acceptable for the participants. Second, we will conduct a fully powered randomized controlled trial to establish the efficacy of this intervention, compared to medical advice and treatment as usual. We will also evaluate whether this intervention is cost-effective from a societal perspective.

Meaning: Our results have the potential to prevent and reduce the cardiometabolic outcomes observed in individuals with OCD. If the lifestyle intervention program proves to be successful in reducing this risk and does so in a cost-effective manner, we will aim to implement the intervention in routine clinical care. Additionally, the intervention could be expanded to individuals with other common mental disorders, such as anxiety and depression, as well as other groups at risk.