ANZJP Correspondence 1063 Australian & New Zealand Journal of Psychiatry, 48(11) Observation to action: Progressive implementation of lifestyle interventions to improve physical health outcomes in a community-based early psychosis treatment program Simon Rosenbaum 1,2 , Li Xian Lim 3 , Hannah Newall 4 , Jackie Curtis 1,2 , Andrew Watkins 1,5 , Katherine Samaras 6,7 and Philip B Ward 2,8 1 Early Psychosis Programme, The Bondi Centre, South Eastern Sydney Local Health District, Bondi Junction, Australia 2 School of Psychiatry, University of New South Wales, Randwick, Australia 3 Faculty of Medicine, University of New South Wales, Randwick, Australia 4 Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, Australia 5 Faculty of Health, University of Technology, Sydney, Sydney, Australia 6 Department of Endocrinology, St Vincent’s Hospital, Darlinghurst, Australia 7 Diabetes and Obesity Program, Garvan Institute of Medical Research, Darlinghurst, Australia 8 Schizophrenia Research Unit, South Western Sydney Local Health District, Liverpool, Australia Corresponding author: Jackie Curtis, Bondi Community Centre, 26 Llandaff St, Bondi Junction, Sydney, NSW 2022, Australia. Email: j.curtis@unsw.edu.au DOI: 10.1177/0004867414539400 To the Editor The prevalence of metabolic abnormali- ties, including elevated waist circumfer- ence, hypertension, dyslipidaemia and impaired blood glucose levels, are a criti- cal issue within first-episode psychosis (FEP) (Vancampfort et al., 2013). In 2011, we reported a retrospective, cross-sec- tional naturalistic study in which the files of FEP patients (n=85) attending the Bondi Early Psychosis Service between 2006 and 2008 were audited (Curtis et al., 2011). Greater than 40% of the sample had an at-risk waist circumfer- ence, whilst 12.5% met International Diabetes Federation (IDF) criteria for metabolic syndrome. In total, 55% of males and 42% of females were over- weight or obese (Curtis et al., 2011). During the data collection period (2006–2008), no formalised screening or intervention protocol existed. Pragmatic approaches to counteract the modifiable risk factors began to develop, involving dietetic and exer- cise physiology students, volunteers and a focus on optimal psychophar- macological prescribing. In addition, the role of metformin to attenuate Table 1. Descriptive statistics: demographic and risk factor variables. Total (n=85) Male (n=56) Female (n=29) Statistical test Age, years, mean (SD) 21.4 (2.9) 21.5 (3.0) 21.3 (2.7) t = 0.4, p = 0.69, ns Ethnicity, n (%) Asian 17 (20) 9 (16) 2 (7) Indigenous 7 (8) 5 (9) 8 (28) Caucasian 61 (72) 42 (75) 19 (65) Time in EPP, months, median 9.23 9.57 5.2 t = −0.6, p = 0.57, ns Smokers (%) 38/78 (49) 25/52 (48) 13/26 (50) χ 2 = 0.03, p = 0.50, ns FH diabetes (%) 27/71 (38) 16/46 (35) 11/25 (44) χ 2 = 0.6, p = 0.30, ns FH CVD (%) 30/67 (45) 21/45 (47) 9/22 (41) χ 2 = 1.3, p = 0.47, ns BMI, mean (range) 25.6 (17.71–39.57) 26.79 (20.16–39.57) 23.35 (17.71–34.77) Waist circumference, female ≥80, male ≥90 a or 94 cm b (%) 34/79 (43) 20/52 (39) 14/27 (52) χ 2 = 0.1, p = 0.25, ns Blood pressure (%) 20/80 (25) 17/53 (32) 3/27 (11) χ 2 = 4.2, p = 0.04* Fasting blood glucose (%) 6/58 (10) 6/39 (10) 0/19 (0) χ 2 = 3.3, p = 0.07, ns Triglyceride (%) 15/64 (23) 11/44 (25) 4/20 (20) χ 2 = 0.2, p = 0.66, ns HDL (%) 17/58 (29) 13/39 (33) 4/19 (21) χ 2 = 0.9, p = 0.34, ns IDF metabolic syndrome (%) 9/79 (11) 6/52 (11) 3/27 (11) χ 2 = 0.0, p = 0.63, ns The denominator varied across different measures as not all were available for each subject. HDL: males <1.03 mmol L –1 ; females <1.29 mmol L –1 ; BSL >5.6 mmol L –1 . ns: not significant; EPP: Early Psychosis Program; FH: family history; CVD: cardiovascular disease; BMI: body mass index; HDL: high-density lipoprotein; BSL: blood sugar level; IDF: International Diabetic Federation. a SE Asian, Japanese, Central or South American males; b Europid males. *p<0.05.