by Dr Liz Newbronner
Obesity is a major health concern in the UK population as a whole. However, some groups within society are at greater risk of becoming obese. People with severe mental illness (SMI) are one of these groups. Obesity is a common comorbidity experienced by people with SMI and can be prevented and treated.
There are a number of factors that contribute to people with SMI being more at risk of becoming obese. They are disproportionately affected by food insecurity – a recent systematic review showed that 40% of people with SMI experience food insecurity. Food insecurity is a major barrier to eating healthily, in part because of the price disparity between health and unhealthy food products but also because it is associated with lack of access to fresh foods, inadequate food storage and poor cooking facilities. More generally people with mental ill health face a significant income gap compared to people without such conditions. People with SMI in particular are also likely to engage in substantially lower levels of physical activity and higher levels of sedentary behaviour than those without SMI. In addition, some antipsychotic and antidepressant medications have metabolic side effects such as weight gain. This is a major concern for people with SMI and their families.
The Working Group for Improving the Physical Health of People with SMI, published in 2016 made a number of recommendations aimed at improving the standard of care for obesity prevention and treatment. These include better assessment and diagnosis of the causes of obesity; the targeting of interventions on those with a BMI over 30; promotion of physical activity; and for people taking psychotropic medication, regular weight and waist measurements checks, especially where they experience rapid weight gain.
More recently, a collaborative event hosted by Equally Well and the Closing the Gap network (a YH ARC supported initiative), has led to a renewed call to support people with SMI to achieve or maintain a healthy weight, allowing them to experience improved physical health and quality of life, as well as contributing to better mental health.
This blog was written by Dr Liz Newbronner, Mental and Physical Multimorbidity theme, Yorkshire and Humber ARC. Sincere thanks to Jo Smith and colleagues for permission to use material from their recent paper:
Smith, J., Ker, S., Archer, D., Gilbody, S., Peckham, E., & Hardman, C. (2022). Food insecurity and severe mental illness: Understanding the hidden problem and how to ask about food access during routine healthcare. BJPsych Advances, 1-9. doi: 10.1192/bja.2022.33