A common reason that those suffering from serious mental illness are “noncompliant” with medication is the side effect of weight gain. Of those who stay on their medication, weight gain can be the most distressing side effect. According to the National Institutes of Health, mentally ill people are 50% more likely to be overweight/obese than the general population. Weight gain has significant negative health implications and is one reason why on average mentally ill people die younger than non-mentally ill people.
Some doctors dismiss this side effect as minor compared to the good the medication does. But it is not felt as minor to many of the people who suffer from its myriad effects on health, self-esteem, and social acceptance. This may be particularly true for women, as they tend to be judged more harshly by both themselves and others for even a few excess pounds. Other doctors while not dismissing the side effect, see it as regrettable but necessary. The conventional view is that there is little or nothing that can be done about the weight gain associated with psychiatric medications.
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The physical and mental health benefits reaped from programs designed to assist and support weight loss and increase fitness in those suffering from mental illness is likely to result in long term savings to the healthcare system, thereby offsetting the costs associated with providing the support, and greatly improve the lives of the mentally ill.
It is interesting that the subject of weight loss and mental illness are put together in this article. After all, a definition of INSANITY is doing the same thing over and over again and expecting different results. That is what weight loss dieting is, insanity. 95% of those who lose weight gain it back. Why on earth would you prescribe this insanity to those who are already coping with mental illness.
Instead all people of all sizes should be supported in healthful eating, fun fitness, stress reduction, better sleep, and other health BEHAVIORS, independent of weight and body size. These actions may or may not make people lean, but they will always improve health. People of all sizes need support in appreciating the bodies they have. After all this is the only place we have to live!
Please do not bring the “WOO” (War on Obesity), scare tactics and size discrimination to those who are already challenged in so many ways. Instead encourage a new peace movement that puts the focus on HEALTH AT EVERY SIZE. That would be a sane response to weight concerns.
Thank you for this reply, you put it perfectly.
Decades of research that show the weight cycling (loss and regain) period to be 2-5 years should teach us that focusing on weight loss is foolish for any population, let alone people who are in groups already stigmatized for other reasons. The study cited was only 18 months, showed a negligible difference in weight between the two groups, and showed most people regaining weight (as usual). We seem to stubbornly refuse to acknowledge that weight cycling is the result of pursuing weight loss. This is not a benign process – there is clear evidence of psychological and physiological harm with repetitive weight cycles, and this may in fact be the true source of some of the conditions correlated with higher weight.
The real stigma that you note that higher-weight people face is a terrible reality, but changing people’s weight rather than eliminating that stigma is not going to work. If you are a healthcare provider who can’t imagine someone at a higher weight having a good life, you need to get out more and meet some more fat people. In the meantime may I respectfully suggest you try hard not to impose your anti-fat attitudes on people who are depending on you while you think this over.
Thankfully, a weight-neutral focus on social support and access to pleasurable food and movement are much more important to long-term health. As healthcare providers and as feminists we need to support people who belong to stigmatized groups in seeing that their bodies are not to blame for the meanness/ignorance of other people. Our bodies need care and nurturing, at whatever size.
I applaud extra support and infrastructure for the mentally ill, and I encourage support for healthy behaviours. But, this focus on weight in our culture is not healthy for anyone – whether you are mentally ill or not. Yes, women are especially judged for the ‘extra few pounds’, and it affects their self-esteem and levels of social acceptance, but in what world does a social justice movement turn that back on the person and tell them to change? As feminists, we need to send the message that every body is a good body and deserves love, not judgment and stigma. It is that message that can encourage people to care for, nurture and love their body, not the message ‘you are not OK, lose weight, fit with the dominant ideal weight’, which women often read as ‘you are disgusting and your body is no good’ – how can those messages encourage us to exercise in public spaces, or feel good about ourselves? Research shows that long term dieting is not sustainable, but aiming for healthy behaviours, with support, is sustainable (and I suspect it is the healthy behaviours that sometimes lead to 5% weight loss, and it is the behaviours that result in good health outcomes).
I’ve noticed this in my mother, who suffers from schizophrenia. Among others, one of the most prevalent reasons for her noncompliance is weight gain. Admittedly, I haven’t given it much thought until this article; and certainly I hadn’t considered what a wide-spread problem this could be. Unfortunately, the medications also can make it difficult for the patient to exercise in the first place, since many times they cause muscle spasms, vertigo, and lethargy. It is certainly clear to me now why so many health problems may befall the medicated patient.
Why do we never talk about the effects on mental illness of dieting, of being discriminated against and excluded based on weight and of being made to feel like your body is your enemy instead of a treasured part of yourself? Why not provide body-positive support and reinforce the value of fat bodies as a way to lessen the impact of the fear of getting fat from meds? Besides, studies show that when your “slightly overweight” (according to the problematic scale of the BMI) you actually live longer!
Some of the comments here challenging the idea of dieting and weight loss seem to me to have the potential to perpetuate not taking seriously the distress of mentally ill people who experience significant rapid weight gain due to the effects of medication. Such a sudden change in one’s body can contribute to the feelings of self-loss and mourning for the lost self felt by many suffering from serious mental illness. Investing in support for improving physical health and giving people hope that the bodily change does not have to be inevitable seems like a good thing. Clearly the kinds of support that would benefit people should not focus on unhealthy “dieting,” but rather on supporting healthy habits, including healthy dietary habits. If the rapid weight gain associated with medication causes significant distress to people who are already feeling considerable distress, and if providing support and assistance (not judgment and blame) can help to reverse this weight gain, wouldn’t we want to support adding such support and assistance to the services available to the mentally ill?
Why wouldn’t we want to support trying to get those with mental illness to lose weight? If we work on challenging fat stigma, then the issue of non-compliance because of the fear of weight gain would be moot. As previous posters have mentioned, weight loss has a 95% failure rate, and that is without drugs that increase weight gain, so what would the failure rate be WITH those drugs? Again, encouraging stress reduction, movement for pleasure, healthy eating would be beneficial for anyone, and certainly for those who are suffering from mental illness, which is often exacerbated by stress and unhealthy behaviors. Promoting failure does not benefit anyone, and especially not those living with mental illnesses.
Because the problem is that “supporting healthy habits, including healthy dietary habits” doesn’t usually lead to weight loss, and certainly not significant weight loss (and that’s not just my own experience talking, there are also studies that support this). There is no real way to combat this weight gain, other than a) starvation or b) not taking the meds. Of course neither of those are valid solutions, which is why we have to change the entire ‘problem’… from ‘weight is bad’ to ‘weight is neutral’.
Actually there are at least two recent programs in Sydney and Melbourne which claim to be getting good results by providing gym and sporting facilities along with ‘personal trainers’ to people on antipsychotics right from the start of prescription to *prevent* rather than try to reverse weight gain, though they are yet to publish evidence for the results they are claiming.
But if you ask me, given the limited effectiveness of antipsychotic medication and the raft of other side effects (including increased risk of diabetes *regardless* of weight change and the dreaded extrapyramidal effects, which, contrary to marketing claims, are just as common with atypicals as they were with phenothiozines) your option (b), not taking the meds, is the best one.
Reference for my previous comment.
http://www.abc.net.au/radionational/programs/allinthemind/new-document/4689134