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R R R S S S S J" d J" Weight gain
Over half (54%) of the adult Australian population are overweight or obese ADDIN EN.CITE Australian Bureau of Statistics20071127Australian Bureau of Statistics,Overweight and obesityAustralian Social Trends2007Canberra4102.0http://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/4DE3C28315518DCECA25732C002074E4?opendocumenthttp://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/2586A287F0EE3016CA25732F001C96BF/$File/41020_overweight%20and%20obesity_2007.pdf(Australian Bureau of Statistics, 2007), up from 45% a decade ago. People with low incomes and education levels, from rural areas and male are more likely to be overweight and obese ADDIN EN.CITE Australian Bureau of Statistics20071127Australian Bureau of Statistics,Overweight and obesityAustralian Social Trends2007Canberra4102.0http://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/4DE3C28315518DCECA25732C002074E4?opendocumenthttp://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/2586A287F0EE3016CA25732F001C96BF/$File/41020_overweight%20and%20obesity_2007.pdf(Australian Bureau of Statistics, 2007). Catapano and Castle ADDIN EN.CITE Catapano20042217Catapano, L.Castle, D.Obesity in schizophrenia: What can be done about it?Australasian PsychiatryAustralasian Psychiatry23-5121Adult*Antipsychotic Agents/ae [Adverse Effects]Antipsychotic Agents/tu [Therapeutic Use]Appetite Depressants/tu [Therapeutic Use]Cognitive TherapyCombined Modality TherapyDrug InteractionsExerciseFollow-Up StudiesHumans*Obesity/ci [Chemically Induced]Obesity/th [Therapy]Risk Factors*Schizophrenia/dt [Drug Therapy]*Schizophrenic PsychologySelf ConceptSocial AdjustmentTreatment Outcome2004(2004) report that individuals with schizophrenia are three times more likely to be obese than the general population. Being overweight or obese poses a major risk to the long term health of people with a mental illness by increasing their risk of chronic illness ADDIN EN.CITE Marder20048817Marder, S. R.Essock, S. M.Miller, A. L.Buchanan, R. W.Casey, D. E.Davis, J. M.Kane, J. M.Lieberman, J. A.Schooler, N. R.Covell, N.Stroup, S.Weissman, E. M.Wirshing, D. A.Hall, C. S.Pogach, L.Pi-Sunyer, X.Bigger, J. T., Jr.Friedman, A.Kleinberg, D.Yevich, S. J.Davis, B.Shon, S.Physical health monitoring of patients with schizophreniaAmerican Journal of PsychiatryAmerican Journal of Psychiatry1334-491618Adult*Antipsychotic Agents/ae [Adverse Effects]Antipsychotic Agents/tu [Therapeutic Use]Basal Ganglia Diseases/ci [Chemically Induced]Basal Ganglia Diseases/di [Diagnosis]Cataract/ci [Chemically Induced]Cataract/di [Diagnosis]Clozapine/ae [Adverse Effects]Clozapine/tu [Therapeutic Use]Diabetes Mellitus, Type 2/ci [Chemically Induced]Diabetes Mellitus, Type 2/di [Diagnosis]*Health StatusHumansHyperlipidemias/ci [Chemically Induced]Hyperlipidemias/di [Diagnosis]Hyperprolactinemia/ci [Chemically Induced]Hyperprolactinemia/di [Diagnosis]Long QT Syndrome/ci [Chemically Induced]Long QT Syndrome/di [Diagnosis]*Monitoring, Physiologic/mt [Methods]Myocarditis/ci [Chemically Induced]Myocarditis/di [Diagnosis]Obesity/di [Diagnosis]Practice Guidelines*Schizophrenia/di [Diagnosis]*Schizophrenia/dt [Drug Therapy]Sexual Dysfunctions, Psychological/ci [Chemically Induced]Sexual Dysfunctions, Psychological/di [Diagnosis]Weight Gain2004(Marder et al., 2004) and appears to lessen life expectancy markedly, especially among younger adults ADDIN EN.CITE Fontaine2003131317Fontaine, K. R.Redden, D. T.Wang, C.Westfall, A. O.Allison, D. B.Years of life lost due to obesityJAMAJAMA187-932892AdultAfrican Americans/sn [Statistics & Numerical Data]AgedAged, 80 and overBody Mass Index*Cost of IllnessEuropean Continental Ancestry Group/sn [Statistics & Numerical Data]FemaleHumans*Life ExpectancyLife TablesMaleMiddle AgedNutrition Surveys*Obesity/ep [Epidemiology]Proportional Hazards ModelsQuality-Adjusted Life YearsUnited States/ep [Epidemiology]2003(Fontaine, Redden, Wang, Westfall, & Allison, 2003).
Psychotropic medications contributing to weight gain
Anti-psychotics
Atypical
Highest risk
Clozapine
Olanzapine
Moderate risk
Risperidone
Minimal risk
Ziprasidone
Typicals
Chlorpromazine dose dependent
Mood stabilisers
Lithium (more than half on long term treatment gain weight) Chen and Silverstone (1990) cited in Malhi, Mitchell and Caterson ADDIN EN.CITE Malhi20014417Malhi, G. S.Mitchell, P. B.Caterson, I.'Why getting fat, Doc?' Weight gain and psychotropic medicationsAustralian & New Zealand Journal of PsychiatryAustralian & New Zealand Journal of Psychiatry315-21353Humans*Mental Disorders/dt [Drug Therapy]*Obesity/ci [Chemically Induced]Obesity/pc [Prevention & Control]*Psychotropic Drugs/ae [Adverse Effects]Psychotropic Drugs/tu [Therapeutic Use]Risk Factors*Weight Gain/de [Drug Effects]2001(2001).
Sodium valproate
Antidepressants
Tricyclic
Amitriptyline
Imipramine
MAOI
phenelzine
Other factors contributing to weight gain in individuals with a mental illness
Diet high in fat and low in fibre ADDIN EN.CITE Brown1999111117Brown, S.Birtwistle, J.Roe, L.Thompson, C.The unhealthy lifestyle of people with schizophreniaPsychological MedicinePsychological Medicine697-701293Energy IntakeFemaleFollow-Up StudiesHealth StatusHumans*Life StyleMaleMiddle AgedObesity/co [Complications]Psychiatric Status Rating ScalesSchizophrenia/co [Complications]Schizophrenia/di [Diagnosis]*SchizophreniaSchizophrenic Psychology1999(Brown, Birtwistle, Roe, & Thompson, 1999)
Lack of exercise ADDIN EN.CITE Brown1999111117Brown, S.Birtwistle, J.Roe, L.Thompson, C.The unhealthy lifestyle of people with schizophreniaPsychological MedicinePsychological Medicine697-701293Energy IntakeFemaleFollow-Up StudiesHealth StatusHumans*Life StyleMaleMiddle AgedObesity/co [Complications]Psychiatric Status Rating ScalesSchizophrenia/co [Complications]Schizophrenia/di [Diagnosis]*SchizophreniaSchizophrenic Psychology1999(Brown, Birtwistle, Roe, & Thompson, 1999) sedentary lifestyle, may have to stop work due to symptoms, restricted activity due to hospitalisation or pharmacotherapy
Hypothyroidism (mood stabilisers can produce thyroid dysfunction)
Family history of obesity or diabetes ADDIN EN.CITE Marder20048817Marder, S. R.Essock, S. M.Miller, A. L.Buchanan, R. W.Casey, D. E.Davis, J. M.Kane, J. M.Lieberman, J. A.Schooler, N. R.Covell, N.Stroup, S.Weissman, E. M.Wirshing, D. A.Hall, C. S.Pogach, L.Pi-Sunyer, X.Bigger, J. T., Jr.Friedman, A.Kleinberg, D.Yevich, S. J.Davis, B.Shon, S.Physical health monitoring of patients with schizophreniaAmerican Journal of PsychiatryAmerican Journal of Psychiatry1334-491618Adult*Antipsychotic Agents/ae [Adverse Effects]Antipsychotic Agents/tu [Therapeutic Use]Basal Ganglia Diseases/ci [Chemically Induced]Basal Ganglia Diseases/di [Diagnosis]Cataract/ci [Chemically Induced]Cataract/di [Diagnosis]Clozapine/ae [Adverse Effects]Clozapine/tu [Therapeutic Use]Diabetes Mellitus, Type 2/ci [Chemically Induced]Diabetes Mellitus, Type 2/di [Diagnosis]*Health StatusHumansHyperlipidemias/ci [Chemically Induced]Hyperlipidemias/di [Diagnosis]Hyperprolactinemia/ci [Chemically Induced]Hyperprolactinemia/di [Diagnosis]Long QT Syndrome/ci [Chemically Induced]Long QT Syndrome/di [Diagnosis]*Monitoring, Physiologic/mt [Methods]Myocarditis/ci [Chemically Induced]Myocarditis/di [Diagnosis]Obesity/di [Diagnosis]Practice Guidelines*Schizophrenia/di [Diagnosis]*Schizophrenia/dt [Drug Therapy]Sexual Dysfunctions, Psychological/ci [Chemically Induced]Sexual Dysfunctions, Psychological/di [Diagnosis]Weight Gain2004(Marder et al., 2004)
Patho-physiology of weight gain
Obesity is caused by a calorie intake which exceeds energy output. Saturated fats and high sugar levels in food are high calorie while a sedentary life style will not burn up the high calorie intake thus the excess is stored as adipose tissue or fat. In addition a family history of obesity, impaired endocrine function (hormones), fluid retention and psychotropic medication all contribute to weight gain see figure 1.
Figure 1. Factors important in maintaining weight and the effects of psychotropic medications.
ADDIN EN.CITE Malhi20013316317Malhi, G. S.Mitchell, P. B.Caterson, I.'Why getting fat, Doc?' Weight gain and psychotropic medicationsAustralian & New Zealand Journal of PsychiatryAustralian & New Zealand Journal of Psychiatry315-21353Humans*Mental Disorders/dt [Drug Therapy]*Obesity/ci [Chemically Induced]Obesity/pc [Prevention & Control]*Psychotropic Drugs/ae [Adverse Effects]Psychotropic Drugs/tu [Therapeutic Use]Risk Factors*Weight Gain/de [Drug Effects]2001(Malhi, Mitchell, & Caterson, 2001, p. 316)
MAOIs, monoamine oxidase inhibitors; SSRIs, selective serotonin reuptake inhibitors; TCAs, tricyclic antidepressants. + facilitation; - inhibition
Physical health risks of obesity
Obesity is associated with increased rates of:
Osteoarthritis (increased weight on weight bearing joints exacerbates arthritis resulting in pain which in turn leads to reduced activity)
Sleep apnoea (increased risk with BMI of 30 or greater)
Gallbladder disease
Liver disease
Polycystic ovarian disease
Cancer (oesophageal, colon, endometrial, kidney, breast)
Coronary Heart Disease (CHD)
Cardiovascular disease (CVD)
Hypertension
Stroke
Hyperlipidemia
Type 2 Diabetes Mellitus (T2DM) and
Metabolic syndrome
Metabolic syndrome is a collection of factors (excess abdominal fat, high blood pressure, abnormal blood cholesterol and fats, abnormal blood sugar metabolism) which combine to increase the risk of T2DM and CVD ADDIN EN.CITE Lumby20075517Lumby, BrendaGuide schizophrenia patients to better physical health The Nurse PractitionerThe Nurse Practitioner30-73272007Lumby20075517Lumby, BrendaGuide schizophrenia patients to better physical health The Nurse PractitionerThe Nurse Practitioner30-73272007Lumby20075517Lumby, BrendaGuide schizophrenia patients to better physical health The Nurse PractitionerThe Nurse Practitioner30-73272007(Lumby, 2007).
Weight related illnesses are also increased in those who smoke
Psychological health risks of obesity
Altered body image
Depression
Restricted lifestyle and quality of life
Significant factor in non compliance with psychotropic medication thus increasing the risk of relapse
Assessment
There are 3 main measures including the Body Mass Index (BMI), waist circumference and the waist to hip ratio (WHR).
Measuring the Body Mass Index (BMI)
Weight (kilograms) Height (metres) squared or
Weight (pounds) Height (inches) squared X 704.5
SHAPE \* MERGEFORMAT Online BMI Calculator: Better Heath Channel Victoria
http://www.betterhealth.vic.gov.au/bhcv2/bhcsite.nsf/pages/bmijs
The BMI is more reliable than scales because weight varies with height
Classification of body fatness based on BMI
BMIClassification d" 1 8 . 5 U n d e r w e i g h t 1 8 . 5 2 4 . 9 H e a l t h y 2 5 . 0 2 9 . 9 O v e r w e i g h t 3 0 3 9 . 9 O b e s e e" 4 0 . 0 M o r b i d l y o b e s e A D D I N E N . C I T E <