Obesity and Mental Illness

Obesity is one of the most common physical health care problems among persons with severe and
persistent mental illness. Obesity is a complex multifactorial chronic disease that develops from the
interaction between genotype and the environment. Among individuals with serious mental illnesses, an unhealthy lifestyle, as well as the effects of psychotropic medications, such as secondgeneration antipsychotics, can contribute to the development of this problem. Excess body weight
increases the risk for many medical problems, including type 2 diabetes mellitus, coronary heart
disease, osteoarthritis, hypertension, and gallbladder disease. Monitoring body weight is essential,
and weight gain early in treatment can help predict those at high risk for substantial weight gain.
Children, adolescents, and first-episode patients are at higher risk for weight gain. Lifestyle therapies
and other non-pharmacological interventions have been shown to be effective in controlled clinical
trials, but the evidence base for adjunctive medication strategies such as with orlistat, sibutramine,
amantadine, nizatidine, metformin, topiramate, and others, is conflicting. Switching antipsychotic
medication may or may not be clinically feasible, but can lead to a reduction in body weight. At the
very least, a ‘small steps approach’ to managing weight should be offered to all patients who are
started on second generation antipsychotics.

Thakore J, Leonard BE (eds): Metabolic Effects of Psychotropic Drugs.
Mod Trends Pharmacopsychiatry. Basel, Karger, 2009, vol 26, pp 25–46