Schizophrenia and Obesity: Understudied and Underserved
Wednesday, November 24, 2010
Regular readers will recall the importance of mental health problems in the context of obesity. Not only can mental health problems (and often their treatments) promote weight gain but they can also pose significant barriers to weight management.
This is particularly true for individuals with schizophrenia, who are particularly vulnerable to poverty, substance abuse, metabolic syndrome, diabetes, cardiovascular disease, and obesity. In addition these individuals often face significant barriers to accessing health care and when they do, many antipsychotic medications can actually markedly promote weight gain.
So how much do we know about the physical problems including obesity in individuals with schizophrenia here in Canada?
This question was now addressed by Debora Nitkin and Denise Gastaldo from the University of Toronto in a paper just published in the Canadian Journal of Nursing Research.
In their systematic review, the researchers were able to identify all of 9 original research articles and 6 literature reviews, clearly demonstrating a dearth of studies in this area in Canada.
Not surprisingly, these studies confirmed that in Canada too, schizophrenia is associated with a markedly increased risk for coronary heart disease, diabetes, dysglycemia, weight gain in long-term patients, and high rates of substance abuse.
On the issue of obesity, a 2001 study from Manitoba reported that the prevalence of obesity in a series of almost 200 patients with schizophrenia was about 42%, or 3.5 times the Canadian average at the time (12%). Moreover, 11% of those classified as obese, could be considered morbidly obese. In this sample women with schizophrenia appeared more prone to develop obesity than men with schizophrenia.
Similarly, a 2007 study from Ontario likewise found significantly higher rates of increased adiposity in patients with schizophrenia, which resulted in limited physical functioning among patients and restricted everyday activities due to physical health problems.
The authors conclude that, although limited, these Canadian studies clearly show that Canadian professionals are inadequately prepared to address co-morbidities and that health-care practices that neglect physical disease as well as the organization of health-care systems further disadvantages this vulnerable population.
They recommend that more studies be conducted to better understand and help prevent and treat these physical problems including weight gain and obesity in patients with schizophrenia.
AMS
Calgary, Alberta
Nitkin DI, & Gastaldo D (2010). Addressing physical health problems experienced by people with schizophrenia in Canada: a critical literature review. The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres, 42 (3), 124-40 PMID: 21086781
Wednesday, November 24, 2010
Very interesting. If obesity falls to a lack of nutrients that leads to an inability to metabolise fat, isn’t it perfectly feasible that the same lack of nutrients lead to the chemical inbalances in the brain that trigger schizophrenia?
Given we already know morbidly obese are have extremely low levels of vitamin D and magnesium, and that further studies have shown simply giving multivitamins to patients can decrease obesity, it seems logical that the two are highly correlated.
Wednesday, November 24, 2010
As a dietitian working in mental health, the fact that resources and research in this area are so limited and the need is so great is very discouraging. This is a population that can have a life expectancy up to 25 years shorter. See link for more information http://professional.diabetes.org/admin/UserFiles/file/CE/AntiPsych%20Meds/Newcomer_SevereMentalIllness_RiskOfCVD_JAMA_07.pdf
Thursday, November 25, 2010
as a mental health conumer myself I can atest to the negative stero typing given all persons with mental illness and aspecially those with schizophrenia. First, if there is a problem that require the police–the police then lump all mental health consumers in the same group. Second, many who are diagnosed with a mental illness are not psychologly ready to accept the diagnosis–this leads to non-compliance with treatment. finally, if they are non-compliant there is a very good chance that they will end up self medicating with drugs or alcohol. I know of ever so many persons who were diagnosed with mental illness and thought that they were better and went off there medications because they did not know that the condition was as permanant as typ 2 diabetes–only to relapse. Then when they got onto the new age antisicatic medications they had to deal with weight gain. I even know of people who went off the New Age Anti sycotics because of the weight gain the weird vioces sights and what not were easier to deal with than the weight and stero typ of the weight. Further, one publication on diabetes put schizophrenia as a 7% probability of developing type 2 diabetes. So while there is a correlation it is not the only correlation–thank you for your insight
Thursday, November 25, 2010
While it is nice that you have expressed concern about the plight of those with mental health concerns and particularly schizophrenia where there is comorbid obesity, I’m sure you can imagine that it is not all that satisfying to suggest that solutions lie in better front-line preparation (consisting of ??? recommendations/resources?) and more research.
Thursday, November 25, 2010
For me personally, this is an amazingly interesting area of study; that atypical antipsychotics typically encourage rapid weight gain expresses the idea that the motivation to eat palatable food indicates that appetite is not necessarily a stable trait, and it is something that can be manipulated.
Interesting how the brain and feeding behaviour are linked, no?
Thanks for the post. In the meantime, I am not really sure how professionals who work with clients with mental illness can help to encourage appetite control (particularly in the initial stages of these treatments), but articles and awareness certainly helps.
Best,
M
Monday, November 29, 2010
To comment further on resources, programs such as community walking groups with healthy eating education and cooking components have shown success in reducing or preventing weight gain. There are few of these and they should be routinely available and promoted. Cognitive behavioural therapy for obesity has been proven to be helpful but is rarely available.
The antipsychotic medications often cause people to feel increased hunger, a decreased sense of feeling full, and to have increased food cravings. The resulting increase in food intake causes the weight gain.
There is usually no preventive effort with these medications. Typically clients are only told that their new medication may cause weight gain and it is only after they gain 25 + lbs that they might get a referral to see the dietitian or have the medication reassessed. In mental health the dietitian hours are significantly less than in other areas and we often don’t get to see the person more than a few times. Most clients can’t afford weight management programs except perhaps for TOPS, and many of the programs have strategies that are not sustainable.
Examples of the types of strategies a dietitian will work with people on to help reduce weight gain:
-enhancing the feeling of being satisfied or full by eating regular meals and including protein and fibre (because they digest at a slower rate)
-cutting down on liquid calories as these generally do not help you feel full
-how to include lower calorie choices such as fruit and vegetables on a tight budget
-assist with meal planning, provide easy and healthy recipes or meal ideas
-provide ideas for healthier options to help satisfy different food cravings (such as dessert flavor yogurts over ice cream)
-strategies to cut back on mindless eating such as in front of the TV
All education is customized to the individual.
Tuesday, September 20, 2011
Very interesting article. I study medicine at university of bologna (Italy). In this period we are studing the types of schizophrenia, symptomes, and treatment.