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Mental Health and Obesity – the Double Epidemic



The January issue of the Canadian Journal of Psychiatry focuses on the close relationship between mental health problems and obesity.

The issue (just released online) features two review articles: One looks at the many links between obesity and chronic mental illness – as it turns out, a two-way street. The other reviews current approaches to improving obesity management in individuals with chronic mental illness.

The same issue also features an original article examining the relationship between abdominal obesity and cardiometabolic risk factors in kids with mental health problems – particularly in those who require treatment with new-generation antipsychotic medications.

In a guest editorial, I comment on the importance of understanding and addressing the links between these two co-epidemics. As regular readers are well aware, assessment for mental health problems has to be part and parcel of any assessment for obesity (the first of the 4Ms of obesity assessment).

When present, managing these mental health issues, more often than not, will be the lynchpin of successful weight management. Not addressing these issues will likely guarantee failure in weight management.

For readers, who do not have access to this journal, I will discuss these articles in more detail in upcoming posts.

AMS
Saskatoon, Saskatchewan

7 Comments

  1. Dr. Sharma, I recognize that this is a major problem in both Canada and the USA. Unfortunately, there is a popular bias against overweight people that they automatically have “psych issues,” indeed that these issues are a cause of their weight problems.

    I would like to hope that as you move forward with your commentary, you can also work to dispel some of the bias/prejudice problems in this area.

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  2. Additionally, some drugs that are used to treat mental illness cause dramatic weight gain. That should be mentioned prominently in any discussion of mental health and weight, but you don’t mention it here.

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  3. For the most part I agree with @Elizabeth Niederer above. The “psych issues” are waaaaaaaay overplayed. I haven’t really ever found a psychiatrist or psychologist or any other of these “mental health professionals” who ever added anything meaningful to the process.

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  4. Anyone who has carefully read the most recent version of DSM (soon to be updated) will realize, with some careful analysis, that it reads like a complex horoscope, something to be found for everyone, so “psych issues” are in some ways distractions from seeing real human beings who are suffering and have few options to find long term help and care (of the caring variety). Of course fat people have “psych” issues. People have “psyche” issues. Fat people are people. In hospital, on MED-SURG or Oncology floors, the patients for whom I provided care were all “psych” patients, in a significant way, because all were vulnerable under those conditions of illness and while enduring institutionalized medical services. Fat people suffer oppressive conditions of prejudice–less in some places than in others–and to deny their psychological suffering in the hope of decreasing stigma is problematic thinking. If social conditions allowed fat people to be fully self actualized at work and in public settings, secure and autonomous and socially connected with respectful relationships at every size, then mental health issues would diminish.

    Also, DeeLeigh is right about psychotropic meds, many of which contribute (especially over long term use) to weight gain, maybe as severely for those who have strong social supports and have justice and equality on their side (such as wealthier folks) but certainly for people who are already struggling to access decent nutrition and safe environments.

    Thank you for this forum to share our thoughts Dr. Sharma.

    Sincerely,
    RNegade (hopefulandfree)

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  5. Not to mention, DeeLeigh, that many of the psych disorders that are treated with the meds causing the weight gain have an extremely high mortality rate — I believe it’s a 15% lifetime mortality risk for suicide in bipolar disorder and schizophrenia. These are brutal illnesses.

    Doctors need to be very careful that they’re not scaring mentally ill patients away from potentially life-saving medications over a vague future health threat of diabetes, high BP, etc. Weight gain is one of the biggest complaints about psych drugs that I see, and I suspect a reason some patients are non-compliant. It’s a case of treating the illness most likely to kill you first, and dealing with whatever health consequences may occur as they happen.

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  6. I am a dietitian in a mental health hospital. I have done some presentations on mental health and obesity. There is research showing that weight gain is one of the most common reasons for non-compliance with psychiatric medications. These clients already have a mental health condition that brings them discrimination, affects self-esteem, affects their personal life etc. Taking a medication that contributes to weight gain (which can be significant and rapid in the initial weeks) creates an even more visible issue that will further cause discrimination and this is simply not acceptable to many.

    I would like to see government funding for the antipsychotics that are considered “weight neutral”, improved education to clients starting on these medications rather than just “this may cause weight gain”, improved tracking of weight gain for clients taking these medications, healthy lifestyle programs and services available to outpatients to help reduce the amount of weight gained (studies show this can be done), and more attention paid in general to the physical health of clients who access the mental health system.

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  7. Christina, you’re right on the mark, but one thing you don’t mention is working to remove the social stigma against fat people. It’s amazing to me how with this physical characteristic and only this physical characteristic, most people in authority expect the people being discriminated against to remove themselves from the stigmatized group (which, for most, it’s impossible to do permanently).

    This is why that 10% weight loss (or whatever) that really makes a difference in fat people’s health is rarely enough to be acceptable. When it comes down to it, the stigma is the real issue.

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