BMJ  2005;331:452-453 (20 August), doi:10.1136/bmj.331.7514.452-b

Letter

Prognosis in obesity

Obesity in severe mental illness poses particular problems

EDITOR—Lean's editorial on prognosis in obesity is a timely contribution to the literature on the relation between increasing weight and physical morbidity and mortality in the general population.¹ Obesity is also a problem in people with severe mental illness. Major depressive disorder, bipolar disorders, and schizophrenia rank among the top 10 causes of disability worldwide,² and this group of patients has excess physical morbidity and reduced life expectancy (less than half of which is accounted for by suicide³).

Metabolic diseases, including obesity, are likely to contribute to increased mortality in this population. Whether mental illness in itself is an independent risk factor for the development of obesity and other components of the metabolic syndrome or whether metabolic dysfunction is simply secondary to lifestyle remains unclear. Iatrogenic causes of obesity are also likely to be important as atypical antipsychotic drugs—a commonly prescribed class of psychotropic drugs—cause weight gain, disorders of glucose homeostasis, and hyperlipidaemia.⁴ A high prevalence of undiagnosed and untreated metabolic disease, including obesity, has recently been reported in psychiatric patients taking antipsychotic drugs,⁵ which may reflect poor monitoring and intervention owing to a lack of awareness in primary and secondary care of this important public health issue. Recent consensus statements make clear the need for monitoring metabolic disease in patients prescribed antipsychotic drugs.⁴

Although the first law of thermodynamics ("move a little more, eat a little less"¹) may hold scientific truth and credibility for people motivated to lose weight and potentially increase longevity, many of the core psychopathological features of patients with severe mental illness (depressed mood, lack of motivation, hopelessness, disorganised thinking, etc) conspire against such lifestyle changes.

paul.mackin{at}ncl.ac.uk
Department of Psychiatry, University of Newcastle upon Tyne, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP

Department of Psychiatry, University of Newcastle upon Tyne, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP

---

Competing interests: None declared.

References

1. Lean MEJ. Prognosis in obesity. BMJ 2005;330: 1339-40. (11 June.)[Free Full Text]
2. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997;349: 1436-42[CrossRef][ISI][Medline]
3. Hansen V, Jacobsen BK, Arnesen E. Cause-specific mortality in psychiatric patients after deinstitutionalisation. Br J Psychiatry 2001;179: 438-43[Abstract/Free Full Text]
4. Consensus development conference on antipsychotic drugs and obesity and diabetes. Obesity Res 2004;12: 362-368[Medline]
5. Mackin P, Watkinson H, Young AH. Prevalence of obesity, glucose homeostasis disorders and metabolic syndrome in psychiatric patients taking typical or atypical antipsychotic drugs: a cross-sectional study. Diabetologia 2005;48: 215-21[CrossRef][ISI][Medline]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Prognosis in obesity

M E J Lean
BMJ 2005 330: 1339-1340. [Extract] [Full Text] [PDF]