The management of obesity in people with severe mental illness an unresolved conundrum

Abstract

There can be little doubt in anyone’s mind that obesity is a major global public health challenge. The prevalence has steadily risen over recent decades to the point where overweight and obesity now affect more than two billion people or 30% of the world’s population, a rate that has tripled since 1975 [1]. Obesity comes at a huge personal cost through a range of medical illnesses from metabolic conditions such as diabetes, through musculoskeletal disorders to cardiovascular disease and various cancers as well as impaired mental well-being and reduced life chances. In terms of the societal cost, the economic impact of obesity was estimated at USD 2 trillion in 2014, through increased health expenditure, lost productivity and disability [2].

At its core, the cause of obesity appears simple, namely, consuming more calories than are expended but experience dictates that the causes are much more complex and include both individual and societal factors. Dietary patterns have changed with an increased intake of energy-dense foods that are rich in fat and refined sugars, while physical activity has dropped both at work and leisure. Although, some might view these as personal responsibility, the observation that obesity affects the most socially disadvantaged people, at least in high-income countries, would argue that a lack of governmental policy has contributed to the epidemic by failing to create a healthy environment through transport and urban planning and support for healthy food choices.

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ORCID for Richard Holt: orcid.org/0000-0001-8911-6744

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