Obesity and Severe Mental Illness: A Disturbing Correlation

Obese individuals in the severely mentally ill population are “poster children” for the numerous problems that can be associated with multiple and chronic medical conditions. That’s according to researchers exploring what turns out to be a strong correlation between obesity and severe mental illness.

Recently, researchers at the mental health information and advocacy organization Mental Health America (MHA) conducted a review of the available literature on both obesity and mental illness and found a disturbing connection between obesity and severe mental illness. The research team found that the severely mentally ill were at much greater risk for obesity, partly as a result of medication side effects, but also because of various neurobiological factors thought to play a common role in addiction, severe mental illness, and obesity.

The enormity of the impact of obesity on individual health and society in general has become increasingly clear in recent years. And although it has long been known that obesity plays a role in a wide variety of illnesses, the relationship between obesity and mental illness has been relatively poorly understood. For this reason, the researchers sought to carefully survey the known literature on obesity and mental illness. Further, because certain social, behavioral, cultural, physiological, metabolic and genetic factors are known to play key roles in obesity, and because many of these same factors play critical roles in the development of mental illness, it was hoped that more closely examining any correlation between obesity and severe mental illness might yield some information useful in the prevention and treatment of both conditions.

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Obesity has been historically measured in terms of Body Mass Index (BMI: body mass divided by the square of height), and as a population, 65 percent of Americans are overweight (having a BMI of between 25 and 29 kg/m²) or obese (having a BMI equal to or greater than 30 kg/m²). But more recently, the concept of “Metabolic Syndrome” has been used to study the relationship between obesity and other health problems. The Metabolic Syndrome is characterized by:

• Excess fat in the stomach area
• High blood triglyceride levels
• Low High Density Lipoprotein (“HDL” or the “good cholesterol”) levels in the blood
• High blood pressure (chronic hypertension)
• High fasting blood sugar levels

This metabolic syndrome is becoming increasingly prevalent and many think it will soon surpass smoking as the greatest risk factor for heart disease. And childhood obesity rates have nearly tripled over the last 30 years, increasing the risk for the development of metabolic syndrome in adulthood.

The survey conducted by MHA reviewers could not conclude that a causal relationship exists between obesity and severe mental illness. Rather, it noted the abundant evidence that having and being treated for a severe mental illness increases one’s risk of obesity, and that many of the factors known to play a role in mental illness also play key roles in obesity. And inasmuch as prevention is the most desirable form of treatment for either condition, the authors of the study advocate for taking strong preventative action as the best way of minimizing the overall health risks, both physiological and mental.

To minimize the risks associated with obesity (especially metabolic syndrome), and its impact on co-morbid conditions among the mentally ill population, the researchers recommended:

• Treating professionals should try to prescribe medications least likely to foster undesirable weight gain and to encourage their patients to engage in key primary prevention behaviors, including increased physical activity and exercise, and greater conscientiousness about the quality and quantity of foods they consume;
• A stronger emphasis on early detection of the warning signs of obesity or metabolic syndrome and ongoing monitoring of metabolic functions for patients being treated for mental illness;
• Collateral intervention programs for those mentally ill individuals who become obese, including multimodal and structured weight loss therapies, pharmacologically-assisted weight loss treatment, weight control surgical procedures when deemed necessary, and supportive therapies and behavioral interventions that promote changes to a healthier lifestyle.

The authors of this study conclude that obese individuals in the severely mentally ill population are inherently the “poster children” for the numerous problems that can be associated with multiple and chronic medical conditions. And the authors also assert that the financial, personal, and social cost of these problems (as well as the burden placed on the health care system) simply cannot be overstated. Accordingly, they encourage all providers of services within the mental health care system to be more mindful of and attentive to the relationship between obesity and mental illness.

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