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Weight Loss and Mental Illness
Weight gain is a major problem in those with a serious mental illness. It’s thought to be one of the main contributing factors to the increased mortality in this population. Weight gain, of course, can lead to illnesses like diabetes, cardiovascular disease and other illnesses that impact quality of life and decrease lifespan. Moreover, weight gain/obesity may be associated with greater symptom severity or decreased level of functioning in schizophrenia and bipolar disorder.
Weight gain also tends to drastically affect medication compliance. When a person gains a lot of weight, they often refuse medication causing relapse. This is the number one reason for antipsychotic treatment nonadherence.
Why are People with a Mental Illness Overweight?
There are many reasons this population is overweight. It is thought that the illness symptoms themselves contribute to weight gain.
For example, depressed people often have no energy or motivation; this can lead to a lack of exercise and a reliance on convenience foods. Another example is all the people with a mental illness who are homeless or of a low socioeconomic status. It’s highly unlikely these people have access to exercise facilities and quality dietary staples. Memory and executive function are also impaired in serious mental illness and this can also lead to unhealthy lifestyle choices.
Additionally, mental illness medication can cause weight gain. Not only can some medication cause changes to the way the body metabolizes food, but it can also increase the sensation of hunger, leading to overeating. Some people on medication have been known to gain 50 or even 100 pounds. This is most commonly seen with antipsychotics.
Can People with a Mental Illness Fight Weight Gain?
People with a mental illness can battle weight gain but I would say it’s tougher in this population than for the average person. The symptoms of a mental illness tend to decrease the likelihood that a person can really focus on proper diet and exercise like one would want on a weight reduction program.
Nevertheless, a new study published in the New England Journal of Medicine reports that a behavioral weight-loss intervention program significantly reduced weight in overweight and obese adults with serious mental illness. In this study, participants in the intervention program with schizophrenia, bipolar and major depression received tailored group and individual weight-management sessions and group exercise sessions. The goals for the intervention group included:
“. . . reducing caloric intake by avoiding sugar-sweetened beverages and junk food (e.g., candy and high-fat snacks), eating five total servings of fruits and vegetables daily, choosing smaller portions and healthy snacks, and participating in moderate-intensity aerobic exercise . . .”
Group exercise was tailored to the population (it started out slowly and built up), run by trained members of the study staff and attendance was incentivised. A simplified tracking tool was used by intervention participants.
Participants in the control group received standard nutrition and physical activity information at baseline.
Weight was then measured at 6, 12 and 18 months. Weight loss was progressively seen over the 18 months in the intervention group. At 18 months it was found that those in the intervention program lost 7 pounds more than those in the control group. Even more encouraging is that 37.8 percent of participants in the intervention group lost 5 percent or more of their initial body weight as compared to 22.7 percent in the control group and 18.5 percent of intervention participants lost more than 10 percent of their body weight while only 7 percent of the control group did.
According to the study, “This extent of weight loss, albeit modest, has been shown to have beneficial effects, such as a reduced risk of cardiovascular disease among persons with an initially elevated risk.”
What Does This Mean?
I take it to mean that people with a serious mental illness can lose weight even though they have significant barriers to doing so. The authors of the study note that “. . . persons with serious mental illness [may] take longer than those without serious mental illness to engage in an intervention and make requisite behavioral changes.” This, of course, indicates that weight loss will be slow and thus motivation may be difficult to maintain.
Nevertheless, changes do work and we can succeed. I think it’s like many other things to do with mental illness: we can achieve our goals, but we may have to work harder to do so.