Abstract

BackgroundObesity is a significant problem for people with serious mental illness. We aimed to consider body size from the perspective of long-stay psychiatric inpatients, focussing on: weight gain and its causes and impacts; diet and physical activity; and the perceived ability to make meaningful change in these domains.MethodA mixed methods study with 51 long-term psychiatric forensic and rehabilitation inpatients using semi-structured interviews combined with biometric and demographic data.Results94% of participants were overweight or obese (mean BMI 35.3, SD 8.1). They were concerned about their weight, with 75% of them attempting to lose weight. Qualitative responses indicated low personal effectiveness and self-stigmatisation. Participants viewed their weight gain as something ‘done to them’ through medication, hospitalisation and leave restrictions. A prevailing theme was that institutional constraints made it difficult to live a healthy life (just the way the system is). Many had an external locus of control, viewing weight loss as desirable but unachievable, inhibited by environmental factors and requiring a quantum of motivation they found hard to muster. Despite this, participants were thoughtful and interested, had sound ideas for weight loss, and wished to be engaged in a shared endeavour to achieve better health outcomes. Consulting people as experts on their experiences, preferences, and goals may help develop new solutions, remove unidentified barriers, and improve motivation.ConclusionsThe importance of an individualised, multifactorial approach in weight loss programmes for this group was clear. Patient-led ideas and co-design should be key principles in programme and environmental design.

Highlights

  • Obesity is a significant problem for people with serious mental illness

  • People with serious mental illnesses (SMI) such as schizophrenia, bipolar disorder and major depressive disorder, have poorer physical health and significantly reduced life expectancy compared with the general population [1]

  • This review found that in general, both mental health patients and nurses held positive views about health promotion but patients felt the ability to improve their physical health was beyond their control

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Summary

Introduction

Obesity is a significant problem for people with serious mental illness. People with serious mental illnesses (SMI) such as schizophrenia, bipolar disorder and major depressive disorder, have poorer physical health and significantly reduced life expectancy compared with the general population [1]. Those with schizophrenia have a 2–3 fold increased standardised mortality ratio [1,2,3,4], a sobering fact aptly described as “the scandal of premature mortality” [5]. Amongst all the research on obesity and its correlates in SMI, very little traverses the experiences of those personally affected. The parlous physical health outcomes are well quantified, but what about effects of weight on self-esteem, confidence and stigma, and beliefs about causes, barriers and ideas for improved health and weight loss?

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