Narrator: Welcome to the E-View Series “Strategies to Integrate Physical Health Care Into Mental Health,” chaired by John W. Newcomer, MD, from the Department of Psychiatry, Washington University School of Medicine in St. Louis, Missouri. This E-View, entitled “Monitoring and Managing Weight Gain in the Mentally Ill,” includes presentations by Rohan Ganguli, MD, and Betty Vreeland MSN, APRN, NP-C, BC.
Narrator: Dr. Ganguli, from the Department of Psychiatry at the University of Pittsburgh Medical Center and the Western Psychiatric Institute and Clinic in Pittsburgh, Pennsylvania, will now present “Weight Reduction and Prevention of Weight Gain in Patients With Schizophrenia.” Dr. Ganguli: I will talk about interventions with patients, focusing primarily on lifestyle. I'll also talk about both weight reduction and preventing weight gain because clearly the latter is the direction in which we want to point people and give them some tools.
Narrator: Think about your answer.
Dr. Ganguli: I've been treating really overweight people for many, many years without paying much attention to it at all. Then, one of my research fellows did a survey, and, as you can see, only about 20% of our patients are actually in the normal weight range. 80% of them are overweight or obese, and actually the majority of them, 60%, are obese. So this is a serious problem for the population of people with schizophrenia that we were treating. I think that among the various excuses that were made for why we were neglecting this problem was that people with schizophrenia—and this is unfortunately a very pejorative and stigmatizing attitude—do not care. I often heard clinicians and families state that obesity is the least of these patients’ problems. I also heard that patients have negative symptoms and poor insight, leading them to be unaware of their own weight problems. In other words, it has been assumed that people with schizophrenia are socially unaware and that, unlike the rest of us, this really does not matter to them.
Dr. Ganguli: Dr. Strassnig actually asked patients with schizophrenia, "Do you believe that you're overweight? Do you want to weigh less? Have you tried to lose weight?" We found that the majority of people in fact believed that they were overweight and would like to lose weight and had tried to lose weight. When we divided the sample by how badly they needed to lose weight, for health reasons—so you had the obese people here who urgently need to lose weight, the overweight people who should lose weight, and the normal weight people who do not really need to lose weight for health reasons—we found that, just like in the general population, you had people who do not necessarily need to lose weight for health reasons, but who wanted to and were trying to lose weight. At the other end, we found that almost everybody believed that they were overweight, and a surprisingly large number claimed that they had actually tried to lose weight.
Dr. Ganguli: The next question, of course, was what do patients themselves attribute their weight gain to. As most people would guess, many patients attribute their weight gain to the effects of medication. This was reinforced by this survey of community dwelling patients, conducted in the U.K. The respondents were asked about the 5 worst things about taking medicine, and weight gain came out as the most frequently cited “worst thing”.
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Abbreviations
BID = twice a day
BMI = body weight index
FDA = Food and Drug Administration
LDL = low density lipoprotein
NHLBI = National Heart, Lung, and Blood Institute
USDA = United States Department of Agriculture