My first Consultant Psychiatrist post was in Liaison Psychiatry and the overlap between physical and mental health remains close to my heart (no pun intended). There has been a significant range of research shared on The Mental Elf on the cause-and-effect relationship between mental illness treatment on physical health and vice versa (e.g., these blogs on mental health and cardiovascular disease, and mental health and physical health comorbidity).
It is well known that people with severe mental illness face a major life expectancy gap, largely driven by cardiometabolic disease, and there is growing interest in the idea that metabolism and mental health are more closely linked than we used to think. However, research to date has tended to focus on such outcomes as weight or diabetes.
To address this gap, Farran et al. (2026) looked at whether metabolic interventions might also improve psychiatric symptoms, functioning, and quality of life; a much more holistic, ‘real-world’ approach. In this Lancet Psychiatry paper published just last month, the authors asked stakeholders directly what they want researchers to investigate. The aim of the paper was to identify the ‘most important’ unanswered research questions about metabolic interventions for people with severe mental illness and they used the James Lind Alliance priority-setting partnership approach to do this. This is not an approach I had heard of before; however, the website describes it as:
a structured way of bringing patients, carers, and clinicians together to decide which unanswered research questions matter most. It aims to produce a shared “Top 10” research priorities…using an inclusive and transparent approach.
All sounds good so far!
Methods
The James Lind Alliance priority-setting partnership (PSP) methodology has five stages:
- Establishing the PSP and defining scope
- Gathering and identifying questions (the first survey)
- Refining questions and processing uncertainties
- Interim prioritisation (the second survey) and
- Final priority setting workshop
The partnership included people with lived experience of severe mental illness, carers and healthcare professionals. The first online survey invited participants to submit unanswered questions about metabolic interventions. Similar questions were combined into broader “indicative questions”, and a literature search was undertaken to exclude questions that had already been adequately answered by existing evidence.
Participants then ranked the remaining questions in a second survey, before a facilitated workshop used structured discussion and consensus methods to agree the final Top 10 research priorities.
Results
In total, across an international group, 456 people submitted 1,439 questions in the first survey, 317 completed the interim prioritisation survey, and 31 people took part in the final workshop.
The paper listed 19 priorities, however, the final consensus ranking of the top 10 was:
- Do different diets (e.g. ketogenic, low carbohydrate, Mediterranean, or vegan) help improve symptoms of serious mental illness, and if so, which works best?
- What combination of strategies (e.g. physical activity and diet) is most effective for improving mental health outcomes or achieving remission in serious mental illness?
- Can weight-loss medications, e.g. GLP-1 agonists (drugs that help control blood sugar and weight), help manage or prevent weight gain caused by psychiatric medications?
- Which nutrient deficiencies are most important to address in serious mental illness, and how effective are vitamin and mineral supplements in improving mental health?
- Does gut health affect mental health in people with serious mental illness, and how can it be targeted for treatment?
- What are the best patterns of physical activity (i.e., frequency, duration, intensity, and type) to improve mental health symptoms in people with serious mental illness?
- What are the metabolic effects of psychiatric medications beyond weight gain?
- What practical supports (e.g. pre-prepared meals, online education, or recipes) help people with serious mental illness start and maintain a therapeutic diet?
- What changes occur in the brain when metabolic health improves in people with serious mental illness?
- How do hormonal changes across the menstrual cycle, perimenopause, and menopause affect how women with serious mental illness respond to the ketogenic diet?
In summary, the strongest message is that stakeholders want research looking at mental health benefits, not just physical health effects. Perhaps most strikingly, the highest-ranked priorities focused on improving psychiatric symptoms and quality of life, rather than solely reducing cardiometabolic risk. High priorities included combinations of diet and physical activity, nutrient deficiencies and supplements, the mental health effects of GLP-1 receptor agonists, and the role of gut health and ketones.
Conclusions
The results suggest a clear shift away from treating metabolic interventions as purely a way to manage weight gain, and towards testing them as potential components of psychiatric care. The authors argue that these stakeholder-derived priorities should guide future funding, policy and study design, with a greater emphasis on outcomes that matter to people living with severe mental illness.
Strengths and limitations
This is an important and well-conducted priority-setting study because it reflects what people affected by severe mental illness actually want to know, rather than what researchers have historically chosen to study.
The major strength is the inclusive design: lived experience, carers, and professionals were all involved throughout the process. The study also checked whether questions had already been answered before putting them forward. This helps ensure that future research is directed towards genuine evidence gaps rather than duplicating existing work. The James Lind Alliance methodology is also transparent and well established, making the process reproducible and reducing the influence of individual researchers or funders on the final priorities.
The main limitations are that even though it was an international survey, respondents were mostly based in the UK, mostly women, and more often had bipolar disorder or major depression than schizophrenia-spectrum conditions, so the priorities may not fully represent every group. People living with schizophrenia, who often experience the greatest burden of physical illness, may therefore be underrepresented.
The study is also only as representative as the people who chose to participate. Online surveys may exclude individuals with poorer digital access or those who are less engaged with research, meaning some perspectives may still be missing.
Finally, this study identifies research priorities, not research answers. The high ranking of interventions such as ketogenic diets or GLP-1 receptor agonists should not be interpreted as evidence that they improve mental health outcomes. Instead, it highlights where stakeholders believe robust evidence is now most needed.
Implications for practice
Metabolic psychiatry is not just about metabolic health anymore — stakeholders want evidence on whether these interventions can actually help people feel mentally better too.
The authors say the next step is to turn these priorities into well-designed experimental and implementation studies that can be funded and tested in real-world care. If that happens, this paper could help redirect research towards questions that are more clinically meaningful and more relevant to people living with severe mental illness.
Depending on whether these novel research topics can be implemented, the results may have significant impact for clinicians on how they approach the overall mental and physical wellbeing of their patients. Having to consider different dietary changes and alternative medications (beyond psychotropics), whilst prioritising what patients would like most may be a challenging change in process for some clinicians. This may mean that additional awareness and educational processes are required for clinicians as well as patients.
For researchers and funders this study may produce a roadmap for future studies and as such may have an impact on processes such as: shaping where money should be allocated, co-production approaches to research and funding bids/selection, research on interventions that work for people and their everyday lives and care people are actually seeking rather than what they’re being told to take.
For patients themselves this may mark a shift in research approach: focusing on patient’s rather than academic’s priorities; feeling heard and involved in research and promoting a ‘no research about me without me’ approach, similar to the clinical ‘no decision about me without me’ approach.
Perhaps the most important message is that people with severe mental illness want research that reflects their priorities. Success should no longer be judged solely by kilograms lost or improvements in blood glucose, but also by whether people feel better, function better and experience meaningful improvements in their everyday lives.
This is the part of the blog where Kirsten provides a link to a song on YouTube which on occasion has had a rather tenuous link to the blog, however, today’s song is the 1990s classic ‘Killer’ by Adamski and Seal which rather speaks for itself.
Statement of interests
Dr Kirsten Lawson has no conflicts on interest in relation to this paper and did not use AI in the production of this blog. Kirsten wrote the first draft of the blog and incorporated the editor’s feedback throughout. Dr Eimear Foley edited this blog and wrote parts of the Methods, Strengths and Limitations, and Implications for Practice sections.
Editor
Edited by Éimear Foley. ChatGPT assisted with language refinement and formatting during the editorial phase.
Links
Primary paper
Dina Farran, Maria Kapi, Kate Moffat, Melanie Stratford, Sadaf Solangi, Annabel E L Walsh, Iain Campbell, Caroline Magee, Dan Siskind, Daniel Smith, Fiona Gaughran, Khalida Ismail, Toby Pillinger, on behalf of the Hub for Metabolic Psychiatry Consortium. Research priorities for metabolic interventions in severe mental illness: results of a James Lind Alliance Priority Setting Partnership. The Lancet Psychiatry. Published online July 17, 2026. https://doi.org/10.1016/S2215-0366(26)00129-X
Other references
JLA Priority Setting Partnerships: https://www.jla.nihr.ac.uk/about-priority-setting-partnerships. Accessed 2nd August 2026