Prevalence and Correlates of Obesity in a Community Sample of Individuals with Severe and Persistent Mental Illness

Abstract

Individuals with severe and persistent mental illness (SPMI) have a preponderance of weight problems, possibly even greater than the obesity epidemic in the general population. Although atypical antipsychotics cause weight gain, their contribution to obesity has not been characterized in a community setting where individuals may take multiple psychotropics associated with weight gain. Using survey information including measured height and weight from a random sample of Maryland Medicaid recipients with SPMI, we compared obesity prevalence to the National Health and Nutrition Examination Survey (NHANES III) sample and a Maryland sample (Behavioral Risk Factor Surveillance System) of the general population adjusted to SPMI demographic characteristics. We investigated correlates of obesity in the SPMI sample. The results indicate that both men and especially women with SPMI had a higher prevalence of obesity than the general population; this portends substantial health implications. A fourfold association between atypical antipsychotics and prevalent obesity was found in men but not in women; further work should clarify mechanisms of obesity in the SPMI.

Use of medications to reduce cardiovascular risk among individuals with psychotic disorders and Type 2 diabetes

“…Consistent with this observation are findings of significantly elevated ten-year coronary heart disease risk in individuals with SMI , which is likely a consequence of this population's high rates of Type 2 diabetes (Dixon et al, 2000), metabolic syndrome (Kreyenbuhl et al, 2006;McEvoy et al, 2005), and other cardiovascular risk factors, such as obesity (Daumit et al, 2003), physical inactivity , poor nutrition (McCreadie, 2003), and cigarette smoking (de Leon et al, 1995).…”

Cigarette Smoking and Overweight/Obesity Among Individuals with Serious Mental Illnesses: A Preventive Perspective

“…70 Individuals with SMI have a greater prevalence of obesity than the general population, 71−73 even when taking age, race/ethnicity, and smoking status into account. 74 The odds ratio for obesity among individuals with SMI, compared to those without a mental illness, is approximately 1.5 (95% CI = 1.4, 1.7). 75 People with SMI (especially women and those without regular social contact) are less physically active than the general population, and walking is more likely to be their sole form of physical activity.…”

Population-Based Prevention of Obesity

“…324 There is some evidence that the disability itself may contribute to overweight and obesity, and it is well known that several antipsychotic drugs cause substantial weight gain. 304 Limited attempts have been made at achieving weight loss among persons with mental disabilities. When cognitive impairment is present, interventions to change behavior can raise ethical issues, such as in Prader-Willi syndrome, in which the appetite is increased and the ability to understand health consequences is decreased.…”

“…Depression, which is more common in women than in men, 303 has been associated with overeating and weight gain, both with respect to using food for comfort and because many antidepressants cause weight gain. 304,305 Also, stress has been associated with increased food intake, which could contribute to obesity. 306 In a recent survey, more women than men reported overeating under stress.…”