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Obesity in adults with serious and persistent mental illness: A review of postulated mechanisms and current interventions

James L. Megna, MD, PhD

Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA

Thomas L. Schwartz, MD

Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA

Umar A. Siddiqui, MD

Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA

Mariela Herrera Rojas, MD

Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA

BACKGROUND: An epidemic of overweight and obesity in the United States has had profound effects on the health of the general population, with consequent development of metabolic syndrome and related morbidity and mortality. However, these effects have been more widespread among adults with serious and persistent mental illness.

METHODS: A literature search was conducted using the PubMed and Ovid databases. Terms used, in varying combinations, were schizophrenia, schizoaffective disorder, bipolar disorder, obesity, atypical antipsychotic, diabetes mellitus, hyperlipidemia, and metabolic syndrome. Of 103 articles generated, 71 were deemed pertinent to the current study. One reference was decided upon based on personal communication.

RESULTS: Both nonpharmacologic and pharmacologic factors contribute to obesity development in adults with serious and persistent mental illness. Consequently, similarly targeted nonpharmacologic and pharmacologic interventions have been used to mitigate against body weight gain. Although the results obtained thus far are promising, effect sizes only in the low to medium range have been realized, with nonpharmacologic interventions demonstrating slight superiority.

CONCLUSIONS: Improved therapeutic methods are needed to address the effects of obesity on individuals with serious and persistent mental illness. Factors that will likely contribute to such advancement are a better understanding of the mechanisms involved, earlier intervention, and adequately powered, randomized controlled trials of sufficient duration, with baseline body weight as a covariate.

KEYWORDS: obesity, serious and persistent mental illness, morbidity and mortality, nonpharmacologic and pharmacologic mechanisms/interventions

ANNALS OF CLINICAL PSYCHIATRY 2011;23(2):131-140

CORRESPONDENCE: James L. Megna, MD, PhD Department of Psychiatry SUNY Upstate Medical University 750 E. Adams Street Syracuse, NY 13210 USA E-MAIL: MegnaJ@upstate.edu
Annals of Clinical Psychiatry ©2011 Quadrant HealthCom Inc.

 
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