In the largest study of its kind in the UK, drawing on a sample of more than 400 outpatients with psychosis at the South London and Maudsley NHS Foundation Trust and King’s College London, researchers found central obesity evident in more than 80% of participants.
Nearly half of the sample were obese (48%), with a body mass index (BMI) of 30 or more. Additionally, nearly all women and most men had a waist circumference above the International Diabetes Federation’s (IDF) threshold for central obesity.
Dr Fiona Gaughran, senior author from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), said: "We already know that diagnosis of a psychotic illness such as schizophrenia or bipolar disorder is associated with a reduced life expectancy of between 10 to 25 years. This mortality gap is largely due to natural causes, including cardiac disease. The worryingly high levels of cardiovascular risk shown in our study indicate that a much greater emphasis on physical activity is needed for those with severe mental illnesses, as well as a more significant focus on supporting attempts to quit smoking.
"While previous research has demonstrated that people gain weight on starting antipsychotics, our study of people who have had psychosis for nearly 16 years on average found no difference in the rates of cardiovascular risk between the various different antipsychotic medications. Research is urgently needed into the best ways to reduce existing cardiovascular risk in people with psychosis, prevent weight gain and promote healthy lifestyles in the early stages of the illness."
According to the IDF obesity threshold measure, 83% of patients were centrally obese: 95% of females and 74% of males. Central obesity refers to excessive fat around the stomach and abdomen, to the extent that it is likely to have a negative impact on health.
Although cardiovascular risk factors are common in psychosis, this UK study reports some of the highest rates worldwide, reinforcing the need to incorporate weight and cardiovascular risk assessment and management into the routine care of people with psychosis.
Data was collected as part of the National Institute for Health Research (NIHR)-funded IMPaCT trial and the study took place within community mental health teams in five mental health NHS trusts in urban and rural locations across England.
The study also identified lifestyle choices likely to add to cardiovascular risk, with 62% of the sample reported to be smokers, greatly in excess of the general UK population smoking rates of 20%. Lack of exercise was also commonplace, with only 12% of participants engaging in high intensity physical activity.
The research paper summarises independent research funded by the NIHR under its IMPaCT Programme Grant (Reference Number RP-PG-0606-1049).