Schizophrenia | Medical Illness and Schizophrenia | Obesity in schizophrenia |

The Epidemic of Obesity

 Jun 09, 2009 Viewed: 1066

Obesity and its related sequelae represent a growing epidemic in the United States. Overweight is defined by the World Health Organization as a body mass index (BMI) of 25.0­29.9 kg/m2, and obesity as BMI ≥ 30 kg/m2. Recent data estimate that more than 50% of U.S. adults are overweight, with 31% of men and 35% of women considered obese, or at least 20% above their ideal body weight (Yanovski and Yanovski 1999).

Results of the 1999 National Health and Nutrition Examination Survey (NHANES), released in December 2000 by the National Center for Health Statistics, noted that the proportion of obese individuals in the United States in 1999 was 80% greater than the proportion measured by NHANES II in 1976­1980, and 17% greater than that measured by NHANES III in 1997 (Flegal and Troiano 2000). Similarly, the Centers for Disease Control (CDC) performed a telephone survey in 1991 that found that only 4 of the 47 states surveyed had obesity rates of 15% or greater, whereas the 2000 survey, which was repeated in all 50 states, found that every state except Colorado had an obesity rate ≥ 15% (Mokdad et al. 2000a, 2000b).

The economic burden of health care costs related to obesity has also grown dramatically in the past decade. Direct health costs of obesity in the United States were over $50 billion in 1995, or 7% of the total U.S. health care budget (Wolf and Colditz 1998), whereas both direct and indirect costs of obesity were estimated to be $98 billion in 1997 and $241 billion in 2001 (Schlosser 2001). This compares with an estimated $17.3 billion for direct health care costs of schizophrenia in the United States in 1995, with indirect costs of close to $50 billion (Knapp 2000).

A major source of the health care costs for obesity relates to the development of comorbid medical disorders, particularly diabetes mellitus, which itself accounts for approximately 60% of the health care costs attributed to obesity (Colditz 1999). Other conditions such as hypertension, coronary heart disease, cholelithiasis, arthritis, and certain cancers (e.g., breast) become increasingly prevalent as BMI increases into the overweight and obese range (Must et al. 1999).

Obesity in Schizophrenia

In addition to the health care costs of obesity, social stigma, discrimination, and low self-esteem are common problems among patients with obesity (Myers and Rosen 1999). This stigmatization can lead to psychological distress and could exacerbate illness in the vulnerable, psychotic individual.

The stigma of mental illness combined with that of being overweight or obese is a significant burden for patients suffering from both conditions.

Donna A. Wirshing, M.D.
Jonathan M. Meyer, M.D.

References

  1. Allison DB, Mentore JL, Heo M, et al: Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry 156:1686-1696, 1999a
  2. Allison D, Fontaine K, Moonseong H, et al: The distribution of body mass index among individuals with and without schizophrenia. J Clin Psychiatry 60:215- 220, 1999b
  3. Allison D, Mackell J: Healthcare resource use and body mass index among individuals with schizophrenia. Poster presented at the annual meeting of the New Clinical Drug Evaluation Unit, Boca Raton, FL, May 2000
  4. Aronne LJ: Epidemiology, morbidity, and treatment of overweight and obesity. J Clin Psychiatry 62 (suppl 23):13-22, 2001
  5. Aulakh CS, Hill JL, Yoney HT, et al: Evidence for involvement of 5-HT1C and 5-HT2 receptors in the food intake suppressant effects of 1-(2,5-dimethoxy- 4-iodophenyl)-2-aminopropane (DOI). Psychopharmacologia 109:444-448, 1992
  6. Ball MP, Coons VB, Buchanan RW: A program for treating olanzapine-related weight gain. Psychiatr Serv 52:967-969, 2001
  7. Baptista T, Hernandez L, Prieto LA, et al: Metformin in obesity associated with antipsychotic drug administration: a pilot study. J Clin Psychiatry 62:653-655, 2001
  8. Basson BR, Kinon BJ, Taylor CC, et al: Factors influencing acute weight change in patients with schizophrenia treated with olanzapine, haloperidol or risperidone. J Clin Psychiatry 62:231-238, 2001
  9. Bernstein JG: Psychotropic drug induced weight gain: mechanisms and management. Clin Neuropharmacol 11 (suppl 1):S194-S206, 1988
  10. Berry SA, Mahmoud RA: Normalization of olanzapine associated abnormalities of insulin resistance and insulin release after switch to risperidone: the risperidone rescue study. Poster presented at the 40th annual meeting of the American College of Neuropsychopharmacology, Kona, HI, December 2001
  11. Brecher M, Melvin K: Effect of long term quetiapine monotherapy on weight in schizophrenia. Poster presented at the annual meeting of the American Psychiatric Association, New Orleans, Louisiana, May 2001
  12. Bromel T, Blum W, Ziegler A, et al: Serum leptin levels increase rapidly after initiation of clozapine treatment. Mol Psychiatry 3:76-80, 1998
  13. Bustillo JR, Buchanan RW, Irish D, et al: Differential effect of clozapine on weight: a controlled study. Am J Psychiatry 153:817-819, 1996
  14. Cerulli J, Lomaestro B, Malone M: Update on the pharmacotherapy of obesity.Ann Pharmacother 32:88-102, 1998
  15. Colditz GA: Economic costs of obesity and inactivity. Med Sci Sports Exerc 31 (suppl 11):S663-S667, 1999
  16. Correa N, Opler LA, Kay SR, et al: Amantadine in the treatment of neuroendocrine side effects of neuroleptics. J Clin Psychopharmacol 7:91-95, 1987
  17. Davidson S, Judd F, Jolley D, et al: Cardiovascular risk factors for people with mental illness. Aust N Z J Psychiatry 35:196-202, 2001
  18. DeFronzo RA, Goodman AM: Multicenter Metformin Study Group: efficacy of metformin in patients with non-insulin-dependent diabetes mellitus. N Engl J Med 333:541-549, 1995
  19. Eder U, Mangweth B, Ebenbichler C, et al: Association of olanzapine-induced weight gain with an increase in body fat. Am J Psychiatry 158:1719-1722, 2001
  20. Flegal KM, Troiano RP: Changes in the distribution of body mass index of adults and children in the US population. Int J Obes Relat Metab Disord 24:807-818, 2000
  21. Fontaine KR, Heo M, Harrigan EP, et al: Estimating the consequences of antipsychotic induced weight gain on health and mortality rate. Psychiatry Res 101(3):277-288, 2001
  22. Fontbonne A, Charles MA, Juhan-Vague I, et al: The effect of metformin on the metabolic abnormalities associated with upper-body fat distribution. Diabetes Care 19:920-926, 1996
  23. Furst BA, Champion KM, Pierre JM, et al: Possible association of QTc interval prolongation with co-administration of quetiapine and lovastatin. Biol Psychiatry 51:264-265, 2002
  24. Garattini S, Mennini T, Samain R: Reduction of food intake by manipulation of central serotonin: current experimental results. Br J Psychiatry 155 (suppl 8):41-51, 1989
  25. Geodon. New York, Pfizer, 2001 [package insert]
  26. Goodall E, Oxtoby C, Richards R, et al: A clinical trial of the efficacy and acceptability of D-fenfluramine in the treatment of neuroleptic-induced obesity. Br J Psychiatry 153:208-213, 1988
  27. Green AI, Patel JK, Goisman RM, et al: Weight gain from novel antipsychotic drugs: need for action. Gen Hosp Psychiatry 22:224-235, 2000
  28. Groop L, Orho-Melander M: The dysmetabolic syndrome. J Intern Med 250:105- 120, 2001
  29. Gupta S, Droney T, Al-Samarrai S, et al: Olanzapine: weight gain and therapeutic efficacy. J Clin Psychopharmacol 19:273-275, 1999
  30. Henderson DC, Cagliero E, Gray C, et al: Clozapine, diabetes mellitus, weight gain, and lipid abnormalities: a five-year naturalistic study. Am J Psychiatry 157:975-981, 2000
  31. Hilgar E, Quiner S, Ginzel I, et al: The effect of orlistat on plasma levels of psychotropic drugs in patients with long-term psychopharmacotherapy. J Clin Psychopharmacol 22:68-70, 2002
  32. Jones AM, Rak IW, Raniwalla J, et al: Weight changes in patients treated with quetiapine. Poster presented at the annual meeting of the American Psychiatric Association, Chicago, IL, May 2000
  33. Kingsbury SJ, Fayek M, Trufasiu D, et al: The apparent effects of ziprasidone on plasma lipids and glucose. J Clin Psychiatry 62:347-349, 2001
  34. Kinon BJ, Basson BR, Gilmore JA, et al: Long-term olanzapine treatment: weight change and weight-related health factors in schizophrenia. J Clin Psychiatry 62:92-100, 2001
  35. Knapp M: Schizophrenia costs and treatment cost-effectiveness. Acta Psychiatrica Scand Suppl 102:15-18, 2000
  36. Knight A: Astemizole: a new, non-sedating antihistamine for hay fever. J Otolaryngol 14:85-88, 1985
  37. Kolokowska T, Gadhvi H, Molyneux S: An open clinical trial of fenfluramine in chronic schizophrenia: a pilot study. Int Clin Psychopharmacol 2:83-88, 1987
  38. Kraepelin E: Dementia Praecox and Paraphrenia. Edinburgh, E & S Livingstone, 1919
  39. Kraus T, Haack M, Schuld A, et al: Body weight and leptin plasma levels during treatment with antipsychotic drugs. Am J Psychiatry 156:312-314, 1999
  40. Leadbetter R, Shutty M, Pavalonis D, et al: Clozapine-induced weight gain: prevalence and clinical relevance. Am J Psychiatry 149:68-72, 1992
  41. Luque C, Rey J: Sibutramine: a serotonin-norepinephrine reuptake-inhibitor for the treatment of obesity. Ann Pharmacother 33:968-978, 1999
  42. Marder S, Davis JM, Chouinard G, et al: The effects of risperidone on the five dimensions of schizophrenia. J Clin Psychiatry 58:538-546, 1997
  43. McElroy S, Suppes T, Keck P, et al: Open-label adjunctive topiramate in the treatment of bipolar disorders. Biol Psychiatry 47:1025-1033, 2000
  44. McIntyre RS, Trakas K, Lin D, et al: Risk of adverse events associated with antipsychotic treatment: results from the Canadian National Outcomes Measurement Study in Schizophrenia (CNOMSS). Abstract presented at the 40th annual meeting of the American College of Neuropsychopharmacology, Kona, HI, December 2001
  45. Meyer JM: Novel antipsychotics and severe hyperlipidemia. J Clin Psychopharmacol 21:369-374, 2001
  46. Meyer JM: A retrospective comparison of lipid, glucose and weight changes at one year between olanzapine and risperidone treated inpatients. J Clin Psychiatry 63: 425-433, 2002
  47. Mokdad AH, Ford ES, Bowman BA, et al: Diabetes trends in the U.S.: 1990-1998. Diabetes Care 23:1278-1283, 2000a
  48. Mokdad AH, Serdula MK, Dietz WH, et al: The continuing epidemic of obesity in the United States. JAMA 284:1650-1651, 2000b
  49. Morrison JA, Cottingham EM, Barton BA: Metformin for weight loss in pediatric patients taking psychotropic drugs. Am J Psychiatry 159:655-657, 2002
  50. Must A, Spadano J, Coakley EH, et al: The disease burden associated with overweight and obesity. JAMA 282:1523-1529, 1999
  51. Myers A, Rosen JC: Obesity stigmatizationa and coping: relation to mental health symptoms, body image, and self-esteem. Int J Obes Relat Metab Disord 23:221-230, 1999
  52. National Heart, Lung and Blood Institute (NHLBI): Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Available at: http://www.nhlbi.nih.gov/guidelines/obesity/practgd_c.pdf. November 2000
  53. Nemeroff CB: Dosing the antipsychotic medication olanzapine. J Clin Psychiatry 58 (suppl 10):45-49, 1997
  54. Norton J, Potter D, Edward K: Sustained weight loss associated with topiramate. Epilepsia 38 (suppl 3):S60, 1997
  55. Park YW, Allison DB, Heymsfield SB, et al: Larger amounts of visceral adipose tissue in Asian Americans. Obes Res 9:381-387, 2001
  56. Pelleymounter M, Cullen M, Baker M, et al: Effects of the obese gene production body weight regulation in ob/ob mice. Science 269:240-243, 1995
  57. Petrie J, Saha A, McEvoy J: Aripiprazole, a new atypical antipsychotic: phase II clinical trial result. Eur Neuropsychopharmacol 7 (suppl 2):S227, 1997
  58. Pfizer: Briefing document for ziprasidone HCl presented at the FDA Psychopharmacological Drugs Advisory Committee, July 19, 2000
  59. Reinstein M, Sirotovskaya L, Jonas L, et al: Effect of clozapine-quetiapine combination therapy on weight and glycaemic control. Clin Drug Invest 18:99-104, 1999
  60. Risperdal. Titusville, NJ, Janssen Pharmaceutica, 1999 [package insert]
  61. Rockwell WJ, Ellinwood EH, Trader DW: Psychotropic drugs promoting weight gain: health risks and treatment implications. South Med J 76:1407-1412, 1983
  62. Rosenfeld W, Schaefer P, Pace K: Weight loss patterns with topiramate therapy. Epilepsia 38 (suppl 3):S58, 1997
  63. Rotatori AF, Fox R, Wicks A: Weight loss with psychiatric residents in a behavioral self-control program. Psychol Rep 46:483-486, 1980
  64. Samanin R, Garattini S: The pharmacology of serotonergic drugs affecting appetite, in Nutrition and the Brain, Vol 8. Edited by Wurtman RJ, Wurtman JJ. New York, Raven, 1990, pp 163-192
  65. Sacchetti E, Guarner L, Bravi D: H2 antagonist nizatidine may control olanzapine-associated weight gain in schizophrenic patients. Biol Psychiatry 48:167-168, 2000
  66. Schlosser E: Fast Food Nation: The Dark Side of the All-American Meal. Boston, Houghton Mifflin, 2001
  67. Schotte A, Janssen PF, Megens AA, et al: Occupancy of central neurotransmitter receptors by risperidone, clozapine, and haloperidol measured ex vivo by quantitative autoradiography. Brain Res 631:191-202, 1993
  68. Seroquel. Wilmington, DE, AstraZeneca, 2000 [package insert]
  69. Silverstone T, Smith G, Goodall E: Prevalence of obesity in patients receiving depot antipsychotics. Br J Psychiatry 153:214-217, 1988
  70. Taylor DM, McAskill R: Atypical antipsychotics and weight gain: a systematic review. Acta Psychiatr Scand 101:416-432, 2000
  71. Tecott L, Sun L, Arkana S: Eating disorder and epilepsy in mice lacking 5-HT2C serotonin receptors. Nature 374:542-546, 1995
  72. Theisen FM, Linden A, Geller F, et al: Prevalence of obesity in adolescent and young adult patients with and without schizophrenia and in relationship to antipsychotic medication. J Psychiatr Res 35:339-345, 2001
  73. Umbricht DS, Pollack S, Kane JM: Clozapine and weight gain. J Clin Psychiatry 55 (suppl B):157-160, 1994
  74. Weiden PJ, Allison DB, Mackell JA, et al: Obesity as a risk factor for antipsychotic noncompliance. Poster presented at the annual meeting of the American Psychiatric Association, Chicago, IL, May 2000
  75. Werneke U, Taylor D, Sanders TA: Options for pharmacological treatment of obesity in patients treated with atypical antipsychotics. Int Clin Psychopharmacol 17:145-160, 2002
  76. Wirshing D, Wirshing W, Kysar L, et al: Novel antipsychotics:comparison of weight gain liabilities. J Clin Psychiatry 60:358-363, 1999
  77. Wirshing DA, Pierre JM, Eyeler J, et al: Risperidone associated new-onset diabetes. Biol Psychiatry 50:1489-1489, 2001a
  78. Wirshing D, Boyd J, Meng L, et al: Antipsychotic medication: impact on coronary artery disease risk factors. Biol Psychiatry 49:175S, 2001b
  79. Wolf A, Colditz G: Current estimates of the economic cost of obesity in the United States. Obes Res 6:97-106, 1998
  80. Yanovski J, Yanovski S: Recent advances in basic obesity research. JAMA 282:1504-1506, 1999
  81. Yanovski S, Yanovski J: Obesity. N Engl J Med 346:591-602, 2002
  82. Zyprexa. Indianapolis, IN, Eli Lilly, 2000 [package insert]

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