Chronic Obesity in Deinstitutionalized Mentally Ill Adults Receiving Rehabilitative Services in Rhode Island

Abstract

There is little published literature regarding the nutritional status of the mentally ill, except for limited data on the institutionalized mentally ill. The rate of deinstitutionalization in Rhode Island is over 98%, the highest in the nation. For every 100 Rhode Island residents in public mental health hospitals in 1955, fewer than 2 are there today. A pilot study was conducted to determine the nutrititional status of a population of mentally ill adults in Rhode Island residing in both community based group homes and independent settings receiving rehabilitative services. Fifteen males and 15 females (n = 30) were included in the study. Ages ranged from 35 to 73 years (mean = 50 years). Body mass index (BMI) ranged from 15 to 41kg/m2 (mean=31kg/m2). The prevalence of obesity was determined to be §7% which is more than double that of the general population. Review of past medical history revealed that the obesity was chronic as the obesity and the trend for increasing weight was documented for a minimum of two years. The severity of obesity was found to be variable from 33% with mild obesity, BMI = 27–29kg/m2; 43% with moderate obesity, BMI = 30–39kg/m2; to 13% with severe obesity, BMI ≥ 40kg/m2. Activity was sedentary to mildly active without evidence of physical limitation. Medication review revealed extensive polypharmacy with nutritional implications for altered appetite (n=28), weight (n=28), gastrointestinal function (n=30), and dental health (n=30). Poor motivational and cognitive functioning in this population present a challenge for obesity management, however close association between the members and case workers present a unique opportunity for dietitians to increase fitness and nutrition knowledge to accomplish a modest weight reduction.