Obesity Among Those with Mental Disorders. A National Institute of Mental Health Meeting Report

University of Alabama at Birmingham, Birmingham, Alabama, USA.
American journal of preventive medicine (Impact Factor: 4.53). 05/2009; 36(4):341-50. DOI: 10.1016/j.amepre.2008.11.020
Source: PubMed

ABSTRACT The National Institute of Mental Health convened a meeting in October 2005 to review the literature on obesity, nutrition, and physical activity among those with mental disorders. The findings of this meeting and subsequent update of the literature review are summarized here. Levels of obesity are higher in those with schizophrenia and depression, as is mortality from obesity-related conditions such as coronary heart disease. Medication side effects, particularly the metabolic side effects of antipsychotic medications, contribute to the high levels of obesity in those with schizophrenia, but increased obesity and visceral adiposity have been found in some but not all samples of drug-naïve patients as well. Many of the weight-management strategies used in the general population may be applicable to those with mental disorders, but little is known about the effects of these strategies on this patient population or how these strategies may need to be adapted for the unique needs of those with mental disorders. The minimal research on weight-management programs for those with mental disorders indicates that meaningful changes in dietary intake and physical activity are possible. Physical activity is an important component of any weight-management program, particularly for those with depression, for which a substantial body of research indicates both mental and physical health benefits. Obesity among those with mental disorders has not received adequate research attention, and empirically-based interventions to address the increasing prevalence of obesity and risk of cardiovascular and metabolic diseases in this population are lacking.

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    • "Collectively, these studies demonstrate that individuals with MHDs can lose a clinically important amount of weight, but results were variable. Furthermore, few of the interventions tested in these studies were scalable or were implemented in realworld settings [11]. The Veterans Health Administration (VHA) is the largest integrated US health care provider, caring for over 6 million Veterans each year [21]. "
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    ABSTRACT: The objective was to determine whether obesity screening and weight management program participation and outcomes are equitable for individuals with serious mental illness (SMI) and depressive disorder (DD) compared to those without SMI/DD in Veterans Health Administration (VHA), the largest integrated US health system, which requires obesity screening and offers weight management to all in need. We used chart-reviewed, clinical and administrative VHA data from fiscal years 2010-2012 to estimate obesity screening and participation in the VHA's weight management program (MOVE!) across groups. Six- and 12-month weight changes in MOVE! participants were estimated using linear mixed models adjusted for confounders. Compared to individuals without SMI/DD, individuals with SMI or DD were less frequently screened for obesity (94%-94.7% vs. 95.7%) but had greater participation in MOVE! (10.1%-10.4% vs. 7.4%). MOVE! participants with SMI or DD lost approximately 1 lb less at 6 months. At 12 months, average weight loss for individuals with SMI or neither SMI/DD was comparable (-3.5 and -3.3 lb, respectively), but individuals with DD lost less weight (mean=-2.7 lb). Disparities in obesity screening and treatment outcomes across mental health diagnosis groups were modest. However, participation in MOVE! was low for every group, which limits population impact. Published by Elsevier Inc.
    General Hospital Psychiatry 11/2014; 37(1). DOI:10.1016/j.genhosppsych.2014.11.005 · 2.61 Impact Factor
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    • "Several neuropathological and neuroimaging studies suggest that schizophrenia may be a neurodevelopmental disorder with obstetric complication, brain structural changes, and neurotrophin imbalance (Mueser and McGurk, 2004; Shoval and Weizman, 2005; Chaldakov et al., 2009; Kuo et al., 2012). In addition, schizophrenia patients are at an increased prevalence of obesity, metabolic diseases, and type 2 diabetes (Allison et al., 2009), caused by increased physical inactivity and antipsychotic medications (Holt et al., 2004). Brain-derived neurotrophic factor (BDNF), the most abundant of neurotrophins in the brain, is known to be responsible for development, regeneration, survival and maintenance of neurons has been implicated in the pathology of schizophrenia. "
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    ABSTRACT: Brain-derived neurotrophic factor (BDNF), the most abundant of neurotrophins in the brain, is known to be responsible for maintenance of neurons has been implicated in the pathology of schizophrenia. In the present pilot study, we investigated the effect of a combined exercise program on circulating BDNF expression and the relationship between BDNF and improvements in physical fitness. Twenty-four patients with schizophrenia participated in the exercise intervention, three nonconsecutive days per week for 12 weeks. The resistance exercise program used the elastic band for eight different exercises for 25min, and the aerobic exercise consisted of moderate walking for 25min. After the training program, there were positive improvements in body composition and blood pressure. Also, there was significant improvement in leg strength, cardiovascular fitness, balance, and jump. Serum BDNF values had significantly increased following the combined exercise program. The elevation in serum BDNF concentrations correlated significantly with improvements in cardiovascular fitness and leg strength. These results suggest that exercise induced modulation of BDNF may play an important role in developing non-pharmacological treatment for chronic schizophrenic patients. In addition, these preliminary results serve to generate further hypothesis and facilitate the planning the exercise training program and management of participants. Copyright © 2014. Published by Elsevier Ireland Ltd.
    Psychiatry Research 10/2014; 220(3):792-796. DOI:10.1016/j.psychres.2014.09.020 · 2.47 Impact Factor
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    • "A high prevalence of depression with onset by early adulthood (Kessler et al. 2005) and co-morbidity with other chronic health conditions (Prince et al. 2007; Atlantis et al. 2012) represents a major public health issue. There has been particular interest in the co-morbidity of depression and depressive symptoms with obesity, with many cross-sectional studies showing that obese individuals are more likely to suffer from depression than non-obese individuals (Onyike et al. 2003; Scott et al. 2007; Atlantis & Baker, 2008; Allison et al. 2009; de Wit et al. 2009, 2010). "
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    ABSTRACT: Background: An unhealthy body mass index (BMI) has been associated with depression but the direction of association is uncertain. Our aim was to estimate the co-morbidity and direction of association between BMI and depressive symptoms at several ages, from childhood to mid-adulthood. Method: The data were from 18,558 individuals born in 1 week in March 1958, in England, Scotland and Wales, with follow-up at ages 7, 11, 16, 23, 33, 42, 45 and 50 years. Depression (scores>or=90th percentile) was identified from child/adolescent (teacher questionnaires) and adult (self-complete questionnaires and clinical interview) measures. BMI (kg/m2) measured in child/adolescence and adulthood was classified as underweight, normal, overweight or obese. Results: In cross-sectional analyses, obesity and underweight (not overweight) from 11 to 45 years were associated respectively with 1.3-2.1 and 1.5-2.3 times the risk of depression compared with normal weight. Using the time-lagged generalized estimating equation (GEE) approach, we tested (a) whether underweight or obesity at prior ages (7 to 45 years) predicted subsequent risk of depression (11 to 50 years), adjusting for baseline depression; and (b) whether depression at prior ages (7 to 42 years) predicted subsequent risk of underweight or obesity (11 to 45 years), adjusting for baseline BMI. In longitudinal analyses, underweight predicted subsequent depression in both sexes [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.11-1.40] and depression predicted subsequent underweight in males only (OR 1.84, 95% CI 1.52-2.23). Obesity predicted subsequent depressive symptoms in females only (OR 1.34, 95% CI 1.14-1.56), but depression did not predict obesity. Conclusions: Clinicians should consider screening routinely for depression patients with unhealthy BMI, namely underweight and obesity, and vice versa.
    Psychological Medicine 09/2014; 44(12):2641-2652. DOI:10.1017/S0033291714000142 · 5.94 Impact Factor
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