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Weight Gain in Mental Illness

The widening gap between the life expectancy of people with mental illness and Australia’s general population is a problem that requires urgent attention and weight gain in mental illness has become a mental health national priority.

Statistics show that the average life expectancy of someone diagnosed with a mental illness is 50 to 59 years, which can be up to 20 years less than the general population. This is due to higher rates of physical illness, higher deaths from cardiometabolic conditions and cancers, and significant under treatment of these conditions.

People with mental illness often state that they feel unsupported in their management of weight gain and associated conditions especially those in rural and remote areas. Many say they would consider stopping medications because of their weight gain which was shown in a study about patient’s perspectives and attitudes. (1)

It is well documented that Australia is heading towards an obesity epidemic with 65% of the population considered overweight or obese. Metabolic syndrome and weight gain in mental illness has become a priority with more than 50% of people with mental illness developing this syndrome. Yet, the physical health of those with mental illness is often neglected with the main responsibility not assigned clearly in the health system.

What is Metabolic Syndrome?

Metabolic syndrome is defined as three or more of the following:

  1. central (abdominal) obesity
  2. raised blood pressure (hypertension)
  3. high blood triglycerides
  4. low levels of high density lipoproteins (HDL)
  5. impaired glucose levels

Many people have discussed the role that psychotropic medication may play in contributing to weight gain in mental illness. It is the first step on the road to the metabolic syndrome through increasing hunger and appetite.

However, we also have found that people with mental illness, even before starting medication (2) already show signs of metabolic syndrome suggesting that the two conditions are associated.

How can we manage weight gain in mental illness and metabolic syndrome?

Encouraging those with mental illness to stop smoking, reduce alcohol and exercise are the foundations of lifestyle interventions of managing this condition. Unfortunately, in this group of patients, the rates of poor lifestyle are still high and are impacted by the negative symptoms of their illness.

There is good research showing that mindfulness and cognitive behavioural therapy (CBT) (3) can help with the drug induced hunger and the emotional eating.

Being involved in multidisciplinary lifestyle programs are important for education, motivation and monitoring.

The Role of the GP

GPs often have strong relationships with patients which is so important in being able to help facilitate behavioural change. They can also prescribe medications to help suppress psychotropic hunger. With new anti-obesity medications arriving on the market, GPs will also have more options in treating this condition.

More mental health multidisciplinary programs must be set up to tackle weight gain in mental illness. GPs and psychiatrists must work together in monitoring both physical and mental health. Until more resources are developed, GPs should not underestimate the impact they can have on these patients’ physical health, moving away from progression to the metabolic syndrome and its associated poor health outcomes.

Dr Marlene Tham,  Director of Medical & Mind Weight Loss. Epworth Weight Management Doctor. Honorary Research Fellow, Department of Psychiatry, University of Melbourne.

Medical & Mind Weight Loss: www.medicalmindweightloss.com

Contact: mtham@melbourneweightloss.com

Resources:

  1. Marlene S. P. Tham, Simon G. Jones, James A. Chamberlain, and Professor David J. Castle The impact of psychotropic weight gain on people with psychosis – patient perspectives and attitudes. Journal of Mental Health Vol. 16 , Iss. 6,2007
  2. Ryan MC, Flanagan S, Kinsella U, Keeling F, Thakaore. The effects of atypical antipsychotics on visceral fat distribution in first episode, drug-naive patients with Scizophrenia. JG Life. 2004 Mar 5;74(16):1999-2008.
  3. Alimoradi, Mohammad et al. Cognitive Behavioral Therapy for Treatment of Adult Obesity. International Journal of Medical Reviews, [S.l.], v. 3, n. 1, p. 371-379, jun. 2016. ISSN 2345-525X