Psychotic disorders and obesity: New report shows big waistlines are to blame

August 23, 2017

Obesity is a major public health problem in the United States, as an estimated 35 percent of Americans are obese and have a body mass index (BMI) of 30 or more. For the 2.2 million Americans with schizophrenia and the 5.7 million Americans with bipolar disorder, the increased prevalence of obesity and its related diseases such as type 2 diabetes and cardiovascular disease is particularly disconcerting.

Because of a number of factors, including obesity, the lifespan for those with is 20 years shorter than the general population and 10 years shorter for those with bipolar disorder. But in a first-of-its-kind study, researchers from Florida Atlantic University show that expanding waistlines and the way body fat is distributed are largely to blame.

The study, published in the international journal Bipolar Disorders, is the first to compare the long-term course of weight across different psychotic disorders. Researchers from FAU's Charles E. Schmidt College of Medicine provide the most comprehensive trajectory for schizophrenia and bipolar disorder available to date, based on data carefully collected by Evelyn Bromet, Ph.D., distinguished professor of psychiatry at Stony Brook University in New York, and colleagues at Stony Brook University. Their findings will provide vital information to fill the gap that exists today for clinicians to pinpoint the critical time periods that would lend themselves to prevention and intervention.

"Most clinical trials for psychotic disorders are limited to cross-sectional or short-term studies that typically last one year or less," said Martin T. Strassnig, M.D., lead author of the study and associate professor of Integrated Medical Science in FAU's College of Medicine. "These trials are not long enough to determine the best timing for intervention. Moreover, if there are weight differences in schizophrenia and bipolar disorder patients, we need to tailor prevention and intervention efforts specific to their needs."

Strassnig and his collaborators obtained data for their study from a carefully conducted 20-year study in a well-controlled epidemiological setting of a countywide sample of first-admission patients hospitalized with a psychotic condition in the early 1990s. Study participants ranged in age from 15 to 60 years, and excluded those with a psychosis related to depression, substance use and other psychoses. The study included in-person follow-ups, which occurred at six months, and at 2, 4, 10, and 20 years after their first admission.

For the FAU report, the researchers looked at weight and height measurements as well as biomarkers such as blood pressure, cholesterol, triglycerides, hemoglobin A1C, body fat percentage and waist circumference. Weight gain was defined by a standard measure of BMI.

Key findings from the study revealed that cholesterol, triglycerides, hemoglobin A1C, and blood pressure were not correlated with BMI in the group as a whole. However, body fat and waist circumference were substantially correlated, with waist circumference sharing 74 percent of the variance with BMI, and body fat sharing 40 percent of the variance. Waist circumference at year 20 was significantly higher in schizophrenia than in bipolar disorder and women with schizophrenia had higher waist circumferences than men or women with bipolar disorder. In both bipolar disorder and schizophrenia, BMI was more strongly correlated with waist circumference than with percent body fat, suggesting a central obesity pattern in addition to waist circumference, representing a reasonably accurate proxy measure for distribution.

Results also show that nearly two-thirds of those with schizophrenia and more than half of those with bipolar disorder were obese 20 years after their first hospitalization for psychosis. Early overweight predicted future weight gain: a large majority of people who were overweight at year two turned out to be obese at the 20-year mark. Similar weight gain trajectories also were observed in schizophrenia and bipolar disorder with slightly different start points. The schizophrenia group gained twice as much weight within the first 10 years, while those with experienced less weight gain during the initial 10-year period compared to the subsequent 10 years.

"Interestingly, the use of antipsychotic medication was not associated with longitudinal differences in the course of weight gain, nor was the type or availability of antipsychotics," said Strassnig. "In fact, during years 10 to 20, when the likelihood of being exposed to the group of weight gain-causing second-generation drugs was greatest, there is evidence of plateauing of weight gain. Moreover, neither gender nor race was associated with the rate of weight gain post baseline."

The researchers stress that because weight gain continues for 20 years, interventions can be effective in mitigating further weight gain even many years into treatment. Finally, another important conclusion they draw from their data is that should be measured frequently, especially in women with schizophrenia.

Explore further: Review links flaxseed consumption to weight reduction

Related Stories

Review links flaxseed consumption to weight reduction

June 30, 2017
(HealthDay)—Whole flaxseed consumption is associated with significant reductions in body weight, body mass index (BMI), and waist circumference, according to a review published online June 21 in Obesity Reviews.

Poor metabolic health in some normal-weight women may increase risk for colorectal cancer

February 1, 2017
Even though poor metabolic health is usually associated with obesity, 30 percent of normal-weight adults are believed to be metabolically unhealthy worldwide, according to Liang.

Severe mental illness linked to much higher risk for cardiovascular disease

May 12, 2017
An international study of more than 3.2 million people with severe mental illness reveals a substantially increased risk for developing cardiovascular disease compared to the general population.

Obesity among adolescents with bipolar disorder is linked to increased illness severity

December 1, 2016
Bipolar disorder is one of the most disabling medical conditions among adolescents worldwide. Similarly, being overweight or obese is common in adolescents and is known to confer risk for cardiovascular disease and other ...

Risperidone can cause increased appetite, weight gain in children treated for autism

April 21, 2016
The drug risperidone has been successful in reducing serious behavioral problems in children with autism spectrum disorder (ASD), but researchers have discovered that increased appetite, followed by weight gain, can be a ...

Online tools better for treating obesity in those who have serious mental illness

March 9, 2017
Online weight management tools and weekly peer coaching resulted in greater weight loss for people with serious mental illness than when they visited health professionals in person in clinics, according to a new study led ...

Recommended for you

Self-harm, suicide attempts climb among US girls, study says

November 21, 2017
Attempted suicides, drug overdoses, cutting and other types of self-injury have increased substantially in U.S. girls, a 15-year study of emergency room visits found.

Car, stroller, juice: Babies understand when words are related

November 20, 2017
The meaning behind infants' screeches, squeals and wails may frustrate and confound sleep-deprived new parents. But at an age when babies cannot yet speak to us in words, they are already avid students of language.

Simple EKG can determine whether patient has depression or bipolar disorder

November 20, 2017
A groundbreaking Loyola Medicine study suggests that a simple 15-minute electrocardiogram could help a physician determine whether a patient has major depression or bipolar disorder.

Non-fearful social withdrawal linked positively to creativity

November 20, 2017
Everyone needs an occasional break from the social ramble, though spending too much time alone can be unhealthy and there is growing evidence that the psychosocial effects of too much solitude can last a lifetime.

Cultural values can be a strong predictor of alcohol consumption

November 20, 2017
Countries with populations that value autonomy and harmony tend to have higher average levels of alcohol consumption than countries with more traditional values, such as hierarchy and being part of a collective. This new ...

A walk at the mall or the park? New study shows, for moms and daughters, a walk in the park is best

November 17, 2017
Spending time together with family may help strengthen the family bond, but new research from the University of Illinois shows that specifically spending time outside in nature—even just a 20-minute walk—together can ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.