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


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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    • "In Massachusetts, according to Centers for Disease Control (CDC) data, the rate of overweight and obesity in 2012 was 59.3%, closely resembling our data, however, the rate of obesity at 23% was lower than that found in our patient sample (CDC, 2012). Our prevalence results are also consistent with rates of overweight and obesity in several studies of patients with severe psychiatric illness (Allison et al., 2009;Calkin et al., 2009;Fagiolini et al., 2003;McElroy et al., 2002). We found that affective components of illness, including a diagnosis of SZA, history of lifetime major depressive episode and suicide attempt were significant predictors of overweight/obesity after adjusting for age, sex and ethnicity. "
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    ABSTRACT: Evidence suggests abnormal bioenergetic status throughout the body in psychotic disorders. The present study examined predictors of elevated body mass index (BMI) across diagnostic categories of schizophrenia, schizoaffective and bipolar disorders. In a cross-sectional study, we studied demographic and clinical risk factors for overweight and obesity in a well-characterized sample of 262 inpatients and outpatients with schizophrenia (n=59), schizoaffective disorder (n=81), and bipolar I disorder (n=122). Across the three diagnostic categories, the prevalence of overweight (29.4%) and obesity (33.2%) combined was 62.6% (164/262). Logistic regression analyses, adjusted for age, sex and ethnicity, showed that schizoaffective disorder, lifetime major depressive episode, presence of prior suicide attempt, and more than 5 lifetime hospitalizations were significantly associated with BMI≥25. Patients with schizophrenia had significantly lower risk for overweight and obesity. Overall, we found that affective components of illness were associated with elevated BMI in our cross-diagnostic sample. Our results show that patients with schizoaffective disorder have a greater risk for obesity. Identifying predictors of elevated BMI in patients with psychotic and mood disorders will help prevent obesity and related cardiovascular and cerebral complications. Future studies are needed to elucidate the mechanistic nature of the relationship between obesity and psychiatric illness.
    Full-text · Article · Jan 2016
    • "Obesity is a major public health concern and individuals with serious mental illnesses are at increased risk for overweight and obesity compared with the general public (Allison et al., 2009; Dickerson et al., 2006; Sicras, Rejas, Navarro, Serrat, & Blanca, 2008. Factors associated with obesity include poor dietary intake (Casagrande et al., 2011), lack of physical activity (Okoro et al., 2014), and psychiatric medications that contribute to weight gain (Newcomer & Haupt, 2006). "
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    ABSTRACT: This purpose of this study was to evaluate the Nutrition and Exercise for Wellness and Recovery (NEW-R) weight loss intervention. Using a pretest/posttest design, 18 participants recruited from a community-based mental health program were assessed at baseline, immediately following the intervention (8 weeks), and at 6-month follow-up. The intervention was delivered by an occupational therapist and occupational therapy graduate students and consisted of 8 weekly sessions lasting 2 hr. Outcomes included changes in weight, and levels of knowledge about nutrition and exercise. Participants lost an average of 3 pounds at immediate postintervention, and lost an average of 10 pounds at the 6-month follow-up. Participants also demonstrated significant increases in their knowledge about nutrition and physical activity. The results of this study provide preliminary support for the impact of the NEW-R intervention on weight loss and knowledge about diet and exercise. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    No preview · Article · Apr 2015 · Psychiatric Rehabilitation Journal
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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.
    Full-text · Article · Nov 2014 · General Hospital Psychiatry
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