James H. Rimmer, Ph.D., Director

The prevalence of obesity among people with disabilities is significantly higher than in the general population. People with mental illness are particularly vulnerable to weight gain. Individuals who have schizophrenia, bipolar disorder, and major depression, for example, have a significantly higher rate of obesity compared to the general population, which some experts believe is related to the types of medications they are taking along with poor lifestyle choices such as high consumption of fats and lack of physical activity. In one study by Hoffman and coworkers published in the Journal of Clinical Psychiatry in December 2005, researchers reported an 83% rate of overweight (21%) or obesity (62%) among 7,188 individuals with severe and persistent mental illness.

The health risks associated with obesity among people with mental illness leads to higher rates of other health problems such as hypertension and type 2 diabetes, as well as decreased adherence to medication. Thus, it is extremely important for researchers to find innovative ways to reduce obesity among people with mental illness to avoid the deleterious effects of excess weight, which, when added to the multiple effects of various psychotropic medications, creates significant health risks in this population.

Only a handful of studies have examined weight reduction in people with mental illness. Findings from these studies provide early evidence that nutritional counseling is somewhat effective in helping individuals manage their weight better in combination with antipsychotic therapy. In one study by Nguyen and coworkers, a brief intervention consisting of nutritional education combined with teaching the person how to use certain types of mood-controlling medications reduced weight gain during antipsychotic therapy. The intervention consisted of a 5-minute discussion of healthy lifestyle choices, including choosing water or diet soda as beverages; avoiding high-calorie "junk food," sugars, and starches; eating smaller portions; and engaging in physical activity a few times per week. Follow-up visits to check appropriate use of medications prescribed by the person's doctor included a brief intervention emphasizing healthy behaviors. When the participants were provided with this brief education, they gained an average of 5 pounds. When they were not given any education in the physician's office, weight gain was between 9 and 13 pounds.

In another study by a group of researchers from the Lilly Research Laboratories in Indianapolis, Indiana, participants with severe and persistent mental illness were provided with a health promotion program referred to as "Solutions for Wellness." Participants were provided with a 1-hour-per-week health promotion program that involved personalized menu planning, a personalized exercise plan, and information on stress reduction and proper sleep habits. Mental health clinicians and registered dietitians developed the nutrition component, and a public health clinician and a health fitness instructor developed the personalized exercise plan. Participants received regular mailings on how they could improve their health along with monthly motivational progress updates and motivational gifts such as exercise videos. The researchers reported that the participants made positive changes in diet, exercise, sleep, and managing stress. These results are encouraging, although the researchers noted that over half the subjects did not complete the study. While the high dropout rate is a serious limitation of the study, given the small amount of health promotion research involving people with severe and mental illness, this is a good start and justifies the need to further examine why the participants dropped out of the study and what other types of health promotion programs might work for them.