Abstract
Aims1) To determine the pooled prevalence of overweight and obesity in people with severe mental illness (SMI), overall and by type of SMI, geographical region, and year of data collection; and 2) to assess the likelihood of overweight and obesity, in people with SMI compared with the general population.MethodsPubMed, Medline, EMBASE, and PsycINFO databases were searched to identify observational studies assessing the prevalence of obesity in adults with SMI. Screening, data extraction and risk of bias assessments were performed independently by two co-authors. Random effect estimates for the pooled prevalence of overweight and obesity and the pooled odds of obesity in people with SMI compared with the general population were calculated. Subgroup analyses were conducted for types of SMI, setting, antipsychotic medication, region of the world, country income classification, date of data collection and sex. We assessed publication bias and performed a series of sensitivity analyses, excluding studies with high risk of bias, with low sample size and those not reporting obesity according to WHO classification.Result120 studies from 43 countries were included, the majority were from high income countries. The pooled prevalence of obesity in people with SMI was 25.9% (95% C.I. = 23.3-29.1) and the combined pooled prevalence of overweight and obesity was 60.1% (95% C.I. = 55.8-63.1). Sub-Saharan Africa (13.0%, 95%C.I. = 6.7-25.1) and South Asia (17.7%, 95%C.I. = 10.5-28.5) had the lowest prevalence of obesity whilst North Africa and the Middle East (35.8%, 95%C.I. = 23.8-44.8) reported the highest prevalence. People with SMI were 3.04 more likely (95% C.I. = 2.42-3.82) to have obesity than the general population, but there was no difference in the prevalence of overweight. Women with schizophrenia were 1.44 (95% C.I. = 1.25-1.67) times more likely than men with schizophrenia to live with obesity; however, no gender differences were found among those with bipolar disorder.ConclusionPeople with SMI have a markedly high prevalence and higher odds of obesity than the general population. This may contribute to the very high prevalence of physical health conditions and mortality in this group. People with SMI around the world would likely benefit from interventions to reduce and prevent obesity.
Highlights
Obesity is a major global public health challenge [1]
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) [18] and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines [19]
We separated the prevalence of obesity for each severe mental illness (SMI) condition in three reports that provided estimates separately for people with schizophrenia and bipolar disorders
Summary
Obesity is a major global public health challenge [1]. The prevalence has steadily risen over recent decades, with rates tripling since 1975 to the point where 30% of the world’s population has either overweight or living with obesity [1]. People with severe mental illness (SMI), (defined as those with schizophrenia and psychotic disorders, bipolar disorder and major depressive disorder with psychotic features), have been reported to be disproportionately affected by the obesity epidemic [3, 4]. Current data suggest that the prevalence of obesity among people with SMI is increasing at a faster rate than the general population [7]. The high prevalence of obesity has been attributed to a combination of side effects and increased appetite associated with psychotropic medication, clustering of health risk behaviours such as poor diet with a high content of saturated fats [8], low engagement with physical activity [9], and social determinants of poor health such as stigma and poverty [10]
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