An overview of treatments for obesity in a population with mental illness

Eating cognitions, emotions and behaviour under treatment with second generation antipsychotics: A systematic review and meta-analysis

Weight gain and metabolic disturbances are frequent in people treated with second generation antipsychotics (SGA). We aimed to investigate the effect of SGAs on eating behaviors, cognitions and emotions, as a possible contributor to this adverse effect. A systematic review and a meta-analysis were conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Original articles measuring outcomes relating to eating cognitions, behaviours and emotions, during treatment with SGAs were included in this review. A total of 92 papers with 11,274 participants were included from three scientific databases (PubMed, Web of Science and PsycInfo). Results were synthesized descriptively except for the continuous data where meta-analyses were performed and for the binary data where odds ratios were calculated. Hunger was increased in participants treated with SGAs with an odds ratio for appetite increase of 1.51 (95% CI [1.04, 1.97]; z = 6.40; p < 0.001). Compared to controls, our results showed that craving for fat and carbohydrates are the highest among other craving subscales. There was a small increase in dietary disinhibition (SMD = 0.40) and restrained eating (SMD = 0.43) in participants treated with SGAs compared to controls and substantial heterogeneity across studies reporting these eating traits. There were few studies examining other eating-related outcomes such as food addiction, satiety, fullness, caloric intake and dietary quality and habits. Understanding the mechanisms associated with appetite and eating-related psychopathology changes in patients treated with antipsychotics is needed to reliably inform the development of effective preventative strategies.

Weight Gain and Mental Health in the Canadian Prison Population

Most inmates gain excessive bodyweight during incarceration in Canadian federal penitentiaries. It is currently unknown if the weight gain is related to participants' higher prevalence of mental illness and/or psychotropic medication use. This study examined how weight change (kg) and body mass index (BMI) change (kg/m²) of 1,420 participants were associated with mental health status and psychotropic medication use. Participants who took psychotropic medications did not gain more weight during incarceration compared to their counterparts who were not taking psychotropic medications (6.5 kg vs. 6.0 kg, p = 0.87, respectively). However, participants taking psychotropic medications were more likely to be overweight or obese, which means they already had higher BMI at the beginning of their incarceration as opposed to gaining more weight during incarceration. Weight gain of participants observed during incarceration in Canadian federal penitentiaries was not related to the higher prevalence of mental illness or psychotropic medication use.

An exploration of reported food intake among inmates who gained body weight during incarceration in Canadian federal penitentiaries

Background

Canadian penitentiaries have recently been shown to be obesogenic. However, little is known about the eating habits of inmates who gained weight while living in the prison environment.

Methods

This retrospective cohort study examined the reported food intake of inmates during incarceration in federal penitentiaries. During a face to face interview, anthropometric measures (2016–2017) were taken and compared to anthropometric data at the beginning of incarceration (mean follow-up of 5.0 ± 8.3 years). Self-reported data on food intake were collected via a food frequency questionnaire.

Results

Inmates who gained the most weight (15.7 kg) during incarceration reported not eating vegetables. They were followed by inmates who gained 14.3 kg and reported not eating fruit. Other inmates who gained a significant amount of weight reported not eating cereal, dairy or legumes. Moreover, inmates’ weight gain was also assessed by special diets: inmates following a religious diet (4.5 kg) or a diet of conscience (-0.3 kg) gained less weight than inmates not following a diet (5.8 kg). In comparison to other types of diets, inmates on a medical diet gained the most weight (7.5 kg). Furthermore, inmates who gained significant weight (8.0 kg) also reported not purchasing healthy foods from the commissary store (or “canteen”), whereas inmates who gained less weight (4.8 kg) reported purchasing healthy foods from the commissary store (or “canteen”). The observed weight gain was positively associated with food purchased from the commissary store (or “canteen”), but was not associated with the feeding system of the penitentiary (tray, cafeteria or meal plan).

Discussion

Food intake during incarceration is a modifiable risk factor that could be the target of weight management interventions with inmates. Our findings suggest that inmates who gained the most weight also reported having low intake of foods deemed healthy (vegetables, fruit, cereal, dairy and legumes) from food services and from the commissary store (or “canteen”) purchases.

Fructose consumption reduces hippocampal synaptic plasticity underlying cognitive performance

Metabolic syndrome (MetS) is a global epidemic, which involves a spectrum of metabolic disorders comprising diabetes and obesity. The impact of MetS on the brain is becoming to be a concern, however, the poor understanding of mechanisms involved has limited the development of therapeutic strategies. We induced a MetS-like condition by exposing mice to fructose feeding for 7weeks. There was a dramatic deterioration in the capacity of the hippocampus to sustain synaptic plasticity in the forms of long-term potentiation (LTP) and long-term depression (LTD). Mice exposed to fructose showed a reduction in the number of contact zones and the size of postsynaptic densities (PSDs) in the hippocampus, as well as a decrease in hippocampal neurogenesis. There was an increase in lipid peroxidation likely associated with a deficiency in plasma membrane excitability. Consistent with an overall hippocampal dysfunction, there was a subsequent decrease in hippocampal dependent learning and memory performance, i.e., spatial learning and episodic memory. Most of the pathological sequel of MetS in the brain was reversed three month after discontinue fructose feeding. These results are novel to show that MetS triggers a cascade of molecular events, which disrupt hippocampal functional plasticity, and specific aspects of learning and memory function. The overall information raises concerns about the risk imposed by excessive fructose consumption on the pathology of neurological disorders.

Association of depression & health related quality of life with body composition in children and youth with obesity

BACKGROUND

There is an increasing recognition of the relationship between mental illness and obesity in the pediatric population. Our objective was to explore the individual, biological and family determinants of depressive symptoms and HRQOL in youth with obesity in a clinical setting.

METHODS

We studied 244 youth aged 8-17 years at the time of entry to a weight management program. Depressive symptoms were evaluated using the Center for Epidemiological Studies Depression Scale for Children questionnaire, with a score of ≥15 or antidepressant use indicating depression. HRQOL was examined using the PedsQL4.0. We considered the influence of age, sex, health history, anthropometry, body fat, family health and socioeconomic status (SES) on depression and HRQOL.

RESULTS

Depression was common in this population (36.4%). In multivariate analysis, the extent of obesity (body fat) predicted both depression (OR 1.1 (1.0-1.2); p=0.05) and low HRQOL scores (β -0.63 (p<0.001)). Family SES was an important predictor of depression but not of HRQOL. In contrast to population-based studies, sex, age, pubertal status and family history of depression did not predict depressive symptoms.

LIMITATIONS

As this study included children and adolescents seeking obesity treatment, results may not be generalizable to the general population of obese youth.

CONCLUSIONS

Depression and low HRQOL are common in youth entering weight management programs. Extent of obesity predicted depressive symptoms and low HRQOL. Predictors of depression in this population differ from non-obese populations studied. It is important to consider these characteristics to assist clinicians in identifying these children.

The impact of obesity on quality of life

An important association exists between obesity and mental illness that impacts all aspects of an individual's quality of life. This association can begin early in the developmental trajectory and we do not yet completely understand all the mechanisms linking obesity and mental illness. What we e do know is that physical health factors that often occur secondary to obesity, combined with societal attitudes toward those that are obese coupled with iatrogenic treatment factors linked to psychiatric pharmacotherapy and a number of biologic mediators result in an important and increasing common comorbidity. Recognizing this association is essential for the proper management of both conditions. The following review addresses this issue and provides clinical pearls to help deal with this issue.