Charlotte Lee, a research fellow and chartered psychologist at The University of Bristol, says that weight gain following diagnosis of certain mental illnesses is predictable, but healthcare systems aren’t doing enough to support people through the experience.
Lee was the lead author on a study that looked at the health records of over 100,000 people in the U.K, comparing how the weights of people with and without one of a certain set of diagnoses evolved over a period of up to 15 years. The study was focused on what it termed severe mental illness (SMI), which Lee emphasized is not a clinical term, but is often used in research to encompass diagnoses of schizophrenia spectrum and bipolar disorders.
“These are chronic and enduring diagnoses often characterized by seeing, hearing and believing things not based on reality,” she said.
Lee explained the methodology of the study.
“ I found everyone in their primary care practice who had been newly diagnosed with SMI and I paired them up with people in the same practice who had the same age, gender, and starting weight, but did not have a diagnosis of SMI,” she said.
“I then followed them up for the entire follow up period, every time they went to their doctor, they stepped on the scales and had their weight measured. I was able to pull out that data and plot it on a chart. What I found was striking – people with SMI gain about five kilograms more than people without SMI over a period of 15 to 20 years.”
Lee says one factor contributing to weight gain is antipsychotic medication.
“We know from clinical trials that they cause quite rapid weight gain over a period of weeks to months,” she said. “ We do have strong evidence that it is the antipsychotics that are interacting with other factors that are driving the weight gain.”
But Lee says her study shows that weight gain isn’t uniquely attributable to antipsychotic medication
“ In my study, I showed that people with severe mental illness who are not taking antipsychotics still gained more weight than people from the general population, just a little bit less than those with SMI and who are taking antipsychotics. So in other words, there is something else going on,” she said.
“We believe that the additional drivers of weight gain in this patient group might be behavioral or social, and that’s actually good news because that’s amenable to change and it gives us an area to focus on.”
Lee says she feels its important that when a patient is prescribed antipsychotic medication, the healthcare provider speaks with them about expected side effects, including sedation and weight gain.
“Very often the patients with whom I speak with tell me that no such chat was ever initiated, and it is so important to patients, in order to feel that they have some autonomy and expectation around where their health might go.”
On a population level, Lee says people are slightly more likely to be told to lose weight, but aren’t getting support to lose it. She says weight loss groups exist and have been shown to be successful for the general population and people with SMI, but access is a problem.
“These programs exist for a general population across Europe, the United States and Canada. They are commissioned for anyone who meets the eligibility criteria to access them, but what we see is that people with SMI are less likely to be referred to them despite pretty good robust evidence that when referred, people with SMI can lose the same amount of weight commensurate with the general population when they access them,” she said.
“What might be going on is a fatalistic or nihilistic view among practitioners that weight gain is inevitable in this population and not amenable to change,” she said. “It might be the case that patients with SMI need a little bit of extra support going to these groups – imagine you’ve just had a mental health crisis where your entire world has been flipped upside down. Then imagine trying to get onto the bus and go into a room of strangers in a weight loss group – that can feel incredibly daunting and overwhelming, and it’s understandable why some patients with SMI might avoid it altogether.”
Lee says extra support like linking people with peer support workers, or designing a service specifically geared towards people with mental illness diagnoses could address the situation.
Lee says the stigma around both weight gain and mental illness complicate the issue.
“ Both mental illness and obesity separately carry an enormous amount of stigma, both public structural as well as self or internalized stigma. But when the two overlap, it can render a person feeling completely invisible and indefensible,” she said. “I think we have come a long way from seeing either mental illness or obesity as a matter of personal failure or lack of personal resolve.”
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