Psychiatric medication-induced obesity: a review

Treatment options for heart failure in individuals with overweight or obesity: a review

Obesity and heart failure are interlaced global epidemics, each contributing to significant morbidity and mortality. Obesity is not only a risk-factor for heart failure, but also complicates its management, by distinctive pathophysiological mechanisms and cumulative comorbidities, requiring tailored treatment plan. To present current treatment options for heart failure in individuals with overweight/obesity, emphasizing available pharmacological therapies, non-pharmacological strategies, and the management of related comorbidities. We conducted a comprehensive literature review regarding the results of heart failure treatments in individuals with overweight/obesity, including cornerstone interventions as well as emerging therapeutic options. Specific drug classes, including angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors, have demonstrated consistent efficacy in heart failure irrespective of body mass index, while diuretics remain a key for fluid management. Glucagon-like peptide-1 receptor agonists have shown promising results in improving relevant outcomes and warrant further research. Non-pharmacological approaches, including weight-loss strategies and lifestyle modifications, have shown to improve symptoms, exercise tolerance and quality of life. Managing heart failure in individuals with overweight/obesity requires a multidisciplinary, individualized approach integrating pharmacological and non-pharmacological options. Emerging therapies and preventive strategies arise to address the unique challenges in this population and provide improved outcomes.

Implementation of a Budo group therapy for psychiatric in- and outpatients: a feasibility study

Introduction

Physical exercise has been shown to have numerous health benefits on co-morbid somatic conditions in psychiatry and can also enhance mental health. Thus, it is not difficult to recommend physical training programs as part of an integrated and holistic treatment approach for mental health disorders. However, getting patients to participate and keeping them engaged is a major challenge. Programs based on martial arts training could be interventions improving physical and mental health with higher attachment rates. The structured discipline, holistic approach integrating physical and mental elements, and empowering activities, may explain higher participant attachment rates.

Methods

Thus, the main objective of this feasibility study is to describe a newly established group therapy program incorporating interventions from martial arts training with its physical and philosophical parts including mindfulness and breath work.

Results

During the 14-month study period from April 2021 to May 2022, a Budo group therapy was used by 215 individual persons with a total of 725 group therapy participations. Retention in the program was good across all settings and very good for persons who participated as outpatients. The mean age of the participants was 33.5 years with a range from 14 to 69 years of age, and about 41% of the participants were female. The therapy program was able to address patients over the whole spectrum of psychiatric diagnoses. Satisfaction and motivation were uniformly self-reported as very good. Patients self-reported improved mental and physical health after participating in a Budo session compared to pre-session.

Discussion

Budo group therapy thus can be seen as a feasible, well-accepted and promising new transdiagnostic treatment approach, combining physical activation with resilience enhancement. With minimal contraindications, a broad spectrum of individuals seeking mental health support can engage in this group therapy.

Temporal Trends of Obesity Among Nebraska Adults: EMR Data Shows a More Rapid Increase Than Projected

INTRODUCTION/OBJECTIVES

Obesity data is typically obtained from national population surveys, while the use of more accurate electronic medical record (EMR) data is underutilized. The objective of this study is to calculate current obesity prevalence and weight trends using EMR data and compare the results to prior survey-based obesity prevalence projections for the state.

METHODS

This retrospective study analyzed Body Mass Index (BMI) from deidentified EMR data from 16,491 adult patients in urban midwestern primary care clinics between January 2017 and October 2021 for obesity prevalence and weight trajectories, stratified by age and gender.

RESULTS

There was a large discrepancy between the survey-based self-reported rates of obesity (35.5%) and those calculated from baseline EMR data (47.6%), along with a smaller discrepancy in females (47.9%) compared to males (47.2%). Young adults aged 20 to 29 years showed a larger increase in BMI over time compared to other age groups.

CONCLUSIONS

EMR-derived data indicates a prevalence of obesity greater than projections that have been based on self-reported survey data as well as higher weight trends than projected for this midwestern state. As evident from our study, cohorts such as at-risk young adults with a more rapid weight gain trajectory should be prioritized for enhanced obesity management.

Liposome-Derived Nanosystems for the Treatment of Behavioral and Neurodegenerative Diseases: The Promise of Niosomes, Transfersomes, and Ethosomes for Increased Brain Drug Bioavailability

Psychiatric and neurodegenerative disorders are amongst the most prevalent and debilitating diseases, but current treatments either have low success rates, greatly due to the low permeability of the blood-brain barrier, and/or are connected to severe side effects. Hence, new strategies are extremely important, and here is where liposome-derived nanosystems come in. Niosomes, transfersomes, and ethosomes are nanometric vesicular structures that allow drug encapsulation, protecting them from degradation, and increasing their solubility, permeability, brain targeting, and bioavailability. This review highlighted the great potential of these nanosystems for the treatment of Alzheimer's disease, Parkinson's disease, schizophrenia, bipolar disorder, anxiety, and depression. Studies regarding the encapsulation of synthetic and natural-derived molecules in these systems, for intravenous, oral, transdermal, or intranasal administration, have led to an increased brain bioavailability when compared to conventional pharmaceutical forms. Moreover, the developed formulations proved to have neuroprotective, anti-inflammatory, and antioxidant effects, including brain neurotransmitter level restoration and brain oxidative status improvement, and improved locomotor activity or enhancement of recognition and working memories in animal models. Hence, albeit being relatively new technologies, niosomes, transfersomes, and ethosomes have already proven to increase the brain bioavailability of psychoactive drugs, leading to increased effectiveness and decreased side effects, showing promise as future therapeutics.

Challenges in Cardiovascular Evaluation and Management of Obese Patients: JACC State-of-the-Art Review

Many unique clinical challenges accompany the diagnosis and treatment of cardiovascular disease (CVD) in people living with overweight/obesity. Similarly, physicians encounter numerous complicating factors when managing obesity among people with CVD. Diagnostic accuracy in CVD medicine can be hampered by the presence of obesity, and pharmacological treatments or cardiac procedures require careful adjustment to optimize efficacy. The obesity paradox concept remains a source of confusion within the clinical community that may cause important risk factors to go unaddressed, and body mass index is a misleading measure that cannot account for body composition (eg, lean mass). Lifestyle modifications that support weight loss require long-term commitment, but cardiac rehabilitation programs represent a potential opportunity for structured interventions, and bariatric surgery may reduce CVD risk factors in obesity and CVD. This review examines the key issues and considerations for physicians involved in the management of concurrent obesity and CVD.

Weight Gain, Mental Symptoms and Self-Esteem in Patients with Schizophrenia

The aim of this study is to examine the weight gain, mental symptoms and self-esteem in patients with schizophrenia undergoing treatment at a community mental health center (CMHC). The study is conducted with 103 schizophrenic patients between 01.08.2021 – 01.02.2022. The data was collected with Personal Information Form, Rosenberg Self-esteem Scale, and Positive and Negative Syndrome Scale (PANSS). 35% of the patients are women, 43.7% are single, and 48.5% are between the ages of 45-64. There was no significant increase between the patients’ weigh measurement value in the first month (x̄=81.185) and the measurement value at the end of six months (x̄=81.320). The decrease in the self-esteem scale mean score at the end of six months (x̄=1.317) was not found significant, when compared to the self-esteem scale mean score in the first month (x̄=1452). The PANSS General Psychopathology subscale mean score was found to be statistically lower at the end of the six-month follow-up (x̄=26.418), compared to the first month mean score (x̄=27.136). There was no significant difference between weight gain, self-esteem, and PANSS positive/negative symptoms in the six-month follow-up of patients with schizophrenia enrolled in CMHC. A significant difference was discovered between the first and sixth-month measurements in PANSS general psychopathology symptoms. It is detected that gender, working status, atypical and mixed antipsychotics use, smoking status, and changes in daytime sleeping habits affect mental symptoms.

Relationships between food-related behaviors, obesity, and medication use in individuals with Smith-Magenis syndrome

BACKGROUND

Smith-Magenis syndrome (SMS) is a complex neurodevelopmental disorder that includes obesity and food-seeking/satiety-related behaviors.

AIMS

This study examined associations between food-related/hyperphagic behaviors, weight, and medication use in individuals with SMS.

METHODS/PROCEDURES

Caregivers of individuals with SMS in the Parents and Researchers Interested in SMS (PRISMS) Patient Registry completed a demographic/medication questionnaire, the Hyperphagia Questionnaire for Clinical Trials, and the Food Related Problems Questionnaire.

OUTCOMES/RESULTS

Among 49 participants (M_age = 16.41 ± 12.73 years, range = 4-69 years, 55% girls/women), individuals with SMS with overweight/obesity (n = 22) had worse overall food-related problems including greater impaired satiety (p < 0.05), maladaptive eating behaviors (p < 0.05), inappropriate response (p < 0.01), and hyperphagia (p < 0.01) compared to individuals of normal/underweight (n = 27). Those taking anti-depressants/anxiolytics (n = 16) had greater maladaptive eating behaviors (p < 0.05), hyperphagic behaviors (p < 0.05), and hyperphagic severity (p < 0.05) than those not taking anti-depressants/anxiolytics (n = 33). Boys/men with SMS had greater maladaptive eating behaviors (p < 0.05), inappropriate response (p < 0.05), and hyperphagic drive (p < 0.01) than girls/women with SMS.

CONCLUSIONS/IMPLICATIONS

Maladaptive food-related behaviors were higher in individuals with SMS with overweight/obesity, taking anti-depressants/anxiolytics, or who were male. Medications in this population should be chosen with weight-related side effects in mind.

Long-term treatment of antipsychotics and combined therapy with other psychotropic medications inducing weight gain in patients with non-affective psychotic disorder: Evidence from GROUP, a longitudinal study

INTRODUCTION

Antipsychotics (APs) can cause weight gain. Little is known about changes in weight when APs are combined with other psychotropics. This study examines the weight change in patients undergoing long-term treatment with APs or with AP combined with other psychotropics.

METHODS

Patients with non-affective psychotic disorder from the GROUP study were divided into three groups: AP medication group (APm) (n = 100), AP in combination with other psychotropics (APc) (n = 73), and medication-free (Meds-free) (n = 100). Weight change was examined at inclusion and after three years using a paired-sample t-test. An Independent-sample t-test was performed to evaluate weight change among patients taking clozapine, olanzapine, and quetiapine and individuals not taking these medications. Linear regression was performed to evaluate the association between covariates and weight.

RESULTS

Patients in the APm group [mean = 1.800 kg, t(99)=2.849, 95% CI(0.546, 3.054), p = 0.005] and the APc group [mean = 1.877 kg, t(72)=2.688, 95% CI(0.485, 3.268), p = 0.009] showed significant weight gain. Patients taking clozapine, olanzapine or quetiapine showed significant weight gain compared to those not taking these medications [mean difference=1.707 kg, t(271)= 2.061, 95% CI(0.077, 3.337), p = 0.040)].

CONCLUSION

Patients receiving APs and APs with other psychotropics gain weight during long-term treatment. It is possible that weight gain is mainly driven by APs.

Allostasis, Action, and Affect in Depression: Insights from the Theory of Constructed Emotion

The theory of constructed emotion is a systems neuroscience approach to understanding the nature of emotion. It is also a general theoretical framework to guide hypothesis generation for how actions and experiences are constructed as the brain continually anticipates metabolic needs and attempts to meet those needs before they arise (termed allostasis). In this review, we introduce this framework and hypothesize that allostatic dysregulation is a trans-disorder vulnerability for mental and physical illness. We then review published findings consistent with the hypothesis that several symptoms in major depressive disorder (MDD), such as fatigue, distress, context insensitivity, reward insensitivity, and motor retardation, are associated with persistent problems in energy regulation. Our approach transforms the current understanding of MDD as resulting from enhanced emotional reactivity combined with reduced cognitive control and, in doing so, offers novel hypotheses regarding the development, progression, treatment, and prevention of MDD.

Superwoman's kryptonite: The superwoman schema and perceived barriers to weight management among U.S. Black women

The role that the superwoman schema (SWS) plays in U.S. Black women's perceptions of barriers (biological, psychological, and sociological) to healthy weight management is unknown. This exploratory study examined whether 122 women classified as normal weight, overweight or obese differed in their perceptions of types of barriers and if the SWS predicted perceived barriers to weight management. Women classified as obese reported more barriers than those classified as normal weight. The SWS uniquely positively predicted perceived psychological and sociological barriers. Our findings suggest that the SWS may play a vital role in the self-management of weight in U.S. Black women.

Orexin, serotonin, and energy balance

The lateral hypothalamus is critical for the control of ingestive behavior and spontaneous physical activity (SPA), as lesion or stimulation of this region alters these behaviors. Evidence points to lateral hypothalamic orexin neurons as modulators of feeding and SPA. These neurons affect a broad range of systems, and project to multiple brain regions such as the dorsal raphe nucleus, which contains serotoninergic neurons (DRN) important to energy homeostasis. Physical activity is comprised of intentional exercise and SPA. These are opposite ends of a continuum of physical activity intensity and structure. Non‐goal‐oriented behaviors, such as fidgeting, standing, and ambulating, constitute SPA in humans, and reflect a propensity for activity separate from intentional activity, such as high‐intensity voluntary exercise. In animals, SPA is activity not influenced by rewards such as food or a running wheel. Spontaneous physical activity in humans and animals burns calories and could theoretically be manipulated pharmacologically to expend calories and protect against obesity. The DRN neurons receive orexin inputs, and project heavily onto cortical and subcortical areas involved in movement, feeding and energy expenditure (EE). This review discusses the function of hypothalamic orexin in energy‐homeostasis, the interaction with DRN serotonin neurons, and the role of this orexin‐serotonin axis in regulating food intake, SPA, and EE. In addition, we discuss possible brain areas involved in orexin–serotonin cross‐talk; the role of serotonin receptors, transporters and uptake‐inhibitors in the pathogenesis and treatment of obesity; animal models of obesity with impaired serotonin‐function; single‐nucleotide polymorphisms in the serotonin system and obesity; and future directions in the orexin–serotonin field.

This article is categorized under:

Metabolic Diseases > Molecular and Cellular Physiology

Psychotropic Medications in Metabolic and Bariatric Surgery: Research Updates and Clinical Considerations

PURPOSE OF REVIEW

We review evidence for assessing and monitoring psychotropic medications in metabolic and bariatric surgery (MBS) patients. We describe weight gain side effects, potential perioperative risks, pharmacokinetic changes that occur after MBS, and conclude with clinical recommendations.

RECENT FINDINGS

Research on psychiatric medication use and post-MBS weight outcomes is lacking and inconsistent; however, there is consistent evidence that, though variable, psychiatric medication use is associated with weight gain. Several meta-analyses and reviews provide guidance on lowering risk when appropriate. Perioperative lithium toxicity and SSRI discontinuation syndrome also warrant consideration, as do potential post-operative pharmacokinetic changes. In the absence of data for each psychiatric drug classification, close symptom monitoring and, where appropriate, serum concentration monitoring are recommended. MBS patients are a psychiatrically vulnerable population, and many are on psychiatric medications. Given potential weight/metabolic side effects, perioperative complications, and post-operative pharmacokinetic changes that occur with psychotropic medication use, providers should stay well informed on psychiatric medication management considerations.

Severe Maternal Morbidity and Maternal Mortality in Women With Intellectual and Developmental Disabilities

INTRODUCTION

Despite increased attention on severe maternal morbidity and maternal mortality, scant research exists on adverse maternal outcomes in women with disabilities. This study compares the rates of severe maternal morbidity and maternal mortality in women with and without intellectual and developmental disabilities.

METHODS

This study used 2004-2017 Healthcare Cost and Utilization Project Nationwide Inpatient Sample data. Analyses were conducted in 2019‒2020. The risk of severe maternal morbidity with and without blood transfusion and maternal mortality during delivery among women with and without intellectual and developmental disabilities were compared using modified Poisson regression analysis.

RESULTS

This study identified 32,324 deliveries to women with intellectual and developmental disabilities. Per 10,000 deliveries, 566 deliveries with severe maternal morbidity occurred in women with intellectual and developmental disabilities compared with 239 in women without intellectual and developmental disabilities. Women with intellectual and developmental disabilities had greater risk of both severe maternal morbidity (risk ratio=2.36, 95% CI=2.06, 2.69) and nontransfusion severe maternal morbidity (risk ratio=2.95, 95% CI=2.42, 3.61) in unadjusted analyses, which was mitigated in adjusted analyses for sociodemographic characteristics (risk ratio=1.74, 95% CI=1.47, 2.06; risk ratio=1.85, 95% CI=1.42, 2.41) and the expanded obstetric comorbidity index (risk ratio=1.23, 95% CI=1.04, 1.44; risk ratio=1.31, 95% CI=1.02, 1.68). The unadjusted incidence of maternal mortality in women with intellectual and developmental disabilities was 284 per 100,000 deliveries, nearly 4-fold higher than in women without intellectual and developmental disabilities (69 per 100,000 deliveries; risk ratio=4.07, 95% CI=2.04, 8.12), and the risk remained almost 3-fold higher after adjustment for sociodemographic characteristics (risk ratio=2.86, 95% CI=1.30, 6.29) and the expanded obstetric comorbidity index (risk ratio=2.30, 95% CI=1.05, 5.29).

CONCLUSIONS

Women with intellectual and developmental disabilities are at increased risk of severe maternal morbidity and maternal mortality. These findings underscore the need for enhanced monitoring of the needs and maternal outcomes of women with intellectual and developmental disabilities in efforts to improve maternal health.

Specific Changes in the Mammalian Gut Microbiome as a Biomarker for Oxytocin-Induced Behavioral Changes

Prolonged exposure to psychiatric pharmacological agents is often associated with marked gastrointestinal phenomena, including changes in food intake, bowel motility, gastric emptying, and transit time. Those changes are reflected in the gut microbiota composition of the patient and can, therefore, be objectively measured. This is in contrast to the standard psychiatric evaluation of patients, which includes symptoms that are subjectively assessed (i.e., mood, anxiety level, perception, thought disorders, etc.). The association between a drug’s effect on the microbiota and psychiatric symptoms may allow for quantifiable surrogate markers of treatment effectiveness. Changes in the levels of specific drug-sensitive bacterial species can, thus, potentially serve as biomarkers for the intake and effectiveness of psychiatric drugs. Here, we show substantial microbiota changes that were associated with oxytocin administration and the decreased anxiety/depression-like behaviors it conferred in a rat model of corticosterone-induced stress. Compared with oxytocin, citalopram produced more minor effects on the rats’ microbiota. Alterations in the gut microbiota may, therefore, reflect the consumption and effectiveness of some psychiatric drugs.

From population to neuron: exploring common mediators for metabolic problems and mental illnesses

Major mental illnesses such as schizophrenia (SZ) and bipolar disorder (BP) frequently accompany metabolic conditions, but their relationship is still unclear, in particular at the mechanistic level. We implemented an approach of "from population to neuron", combining population-based epidemiological analysis with neurobiological experiments using cell and animal models based on a hypothesis built from the epidemiological study. We characterized high-quality population data, olfactory neuronal cells biopsied from patients with SZ or BP, and healthy subjects, as well as mice genetically modified for insulin signaling. We accessed the Danish Registry and observed (1) a higher incidence of diabetes in people with SZ or BP and (2) higher incidence of major mental illnesses in people with diabetes in the same large cohort. These epidemiological data suggest the existence of common pathophysiological mediators in both diabetes and major mental illnesses. We hypothesized that molecules associated with insulin resistance might be such common mediators, and then validated the hypothesis by using two independent sets of olfactory neuronal cells biopsied from patients and healthy controls. In the first set, we confirmed an enrichment of insulin signaling-associated molecules among the genes that were significantly different between SZ patients and controls in unbiased expression profiling data. In the second set, olfactory neuronal cells from SZ and BP patients who were not pre-diabetic or diabetic showed reduced IRS2 tyrosine phosphorylation upon insulin stimulation, indicative of insulin resistance. These cells also displayed an upregulation of IRS1 protein phosphorylation at serine-312 at baseline (without insulin stimulation), further supporting the concept of insulin resistance in olfactory neuronal cells from SZ patients. Finally, Irs2 knockout mice showed an aberrant response to amphetamine, which is also observed in some patients with major mental illnesses. The bi-directional relationships between major mental illnesses and diabetes suggest that there may be common pathophysiological mediators associated with insulin resistance underlying these mental and physical conditions.

Medical Weight-Loss Outcomes in Patients Receiving Concomitant Psychotropic Medication: A Retrospective Cohort Study

OBJECTIVE

This study aimed to elucidate medical weight-loss outcomes in patients unexposed or exposed to psychotropic medication(s).

METHODS

This retrospective cohort study evaluated weight-loss outcomes of completers treated at an academic weight-management center between April 1, 2014, and April 1, 2016. Patients were classified as either unexposed (not prescribed psychotropic medication) or exposed (prescribed psychotropic medication) based on use of antidepressants, mood stabilizers, or antipsychotics during the study.

RESULTS

Of 1,932 patients seen during the study period, 885 were eligible for inclusion, of whom 619 (70.0%) were unexposed and 266 (30.0%) were exposed to psychotropic medications. In the unexposed and exposed groups, the mean age, sex distribution, proportion with type 2 diabetes, initial BMI, and number of weight-loss medications prescribed were similar. At 12 months, the unexposed group lost 1.6% more weight on average than the exposed group (9.1% [SD 7.6%] vs. 7.5% [SD 8.1%], respectively; P = 0.02); 71.0% and 41.2% of the unexposed group achieved ≥ 5% and ≥ 10% weight loss at 12 months, respectively, compared with 63.1% and 31.8% in the exposed group at 12 months (P = 0.04 at 5%; P = 0.02 at 10%).

CONCLUSIONS

Exposure to psychotropic medications was associated with diminished weight loss in patients with medically managed overweight and obesity.

Changes in weight and weight-related quality of life in a multicentre, randomized trial of aripiprazole versus standard of care

Background

This is a secondary analysis of clinical trial data collected in 12 European countries. We examined changes in weight and weight-related quality of life among community patients with schizophrenia treated with aripiprazole (ARI) versus standard of care (SOC), consisting of other marketed atypical antipsychotics (olanzapine, quetiapine, and risperidone).

Method

Five-hundred and fifty-five patients whose clinical symptoms were not optimally controlled and/or experienced tolerability problems with current medication were randomized to ARI (10–30 mg/day) or SOC. Weight and weight-related quality of life (using the IWQOL-Lite) were assessed at baseline, and weeks 8, 18 and 26. Random regression analysis across all time points using all available data was used to compare groups on changes in weight and IWQOL-Lite. Meaningful change from baseline was also assessed.

Results

Participants were 59.7% male, with a mean age of 38.5 years (SD 10.9) and mean baseline body mass index of 27.2 (SD 5.1). ARI participants lost an average of 1.7% of baseline weight in comparison to a gain of 2.1% by SOC participants (p < 0.0001) at 26 weeks. ARI participants experienced significantly greater increases in physical function, self-esteem, sexual life, and IWQOL-Lite total score. At 26 weeks, 20.7% of ARI participants experienced meaningful improvements in IWQOL-Lite score, versus 13.5% of SOC participants. A clinically meaningful change in weight was also associated with a meaningful change in quality of life (p < 0.001). A potential limitation of this study was its funding by a pharmaceutical company.

Conclusions

Compared to standard of care, patients with schizophrenia treated with aripiprazole experienced decreased weight and improved weight-related quality of life over 26 weeks. These changes were both statistically and clinically significant.

The impact of binge eating behavior on lithium- and quetiapine-associated changes in body weight, body mass index, and waist circumference during 6 months of treatment: Findings from the bipolar CHOICE study

BACKGROUND

Lithium and quetiapine can cause weight gain, but their comparative longer term anthropometric effects are unknown, as are the potential moderating effects of baseline binge-eating (BE) behavior.

METHODS

We assessed 6 month changes in body weight, body mass index (BMI) and waist circumference in 482 adults with DSM-IV bipolar disorders who participated in a comparative effectiveness study of lithium and quetiapine with evidence-based adjunctive treatment (Bipolar CHOICE). Anthropometric measurements were obtained at baseline, and at 2, 4, 6, 8, 12, 16, 20, and 24 weeks. BE behavior was defined as affirmative responses to MINI items M1 and M3 at baseline. Data were analyzed using a mixed model repeated measures approach, adjusted for baseline values of dependent measures.

RESULTS

On average, body weight and BMI increased over 6 months with lithium and quetiapine. However, those treated with quetiapine experienced greater increases from baseline in body weight (peak change, + 3.6 lbs. vs. + 1.4 lbs.) and BMI (peak change, + 0.6 kg/m² vs. + 0.3 kg/m²), starting at 2 weeks (group x time, F_8,3052= 2.9, p = 0.003 for body weight, F_8,3052= 3.0, p = 0.002 for BMI). Significant increases in waist circumference were observed only with quetiapine. The relationship between drug treatment and changes in body weight (group x time x binge eating status, F_1,2770= 2.0, p = 0.002), BMI (F_1,2767= 2.0, p = 0.002), and waist circumference (women only, F_25,1621= 2.9, p < 0.0001) were moderated by BE behavior. The largest increases over 24 weeks in body weight and BMI, and waist circumference in women, occurred for quetiapine-treated patients with baseline binge-eating, relative to quetiapine-treated patients without binge eating and lithium-treated patients with or without baseline binge-eating.

LIMITATIONS

Bipolar CHOICE was not designed to study anthropometric outcomes.

CONCLUSIONS

Greater changes in body weight, BMI, and waist circumference occurred with quetiapine- versus lithium-based treatment over 6 months of treatment. The effects of study drugs on these anthropometric measures were moderated by BE behavior at baseline.

Evaluating Prevalence and Patterns of Prescribing Medications for Depression for Patients With Obesity Using Large Primary Care Data (Canadian Primary Care Sentinel Surveillance Network)

Introduction: Depression is a serious disorder that brings a tremendous health and economic burden. Many antidepressants (AD) have obesogenic effects, increasing the population of obese patients at increased risk for a more severe disease course and poor treatment response. In addition, obese patients with depression may not be receiving the recommended standard of care due to "obesity bias." It is important to evaluate prescribing pharmacological treatment of depression in patients with obesity. Objectives: To describe the prevalence and patterns of AD prescribing for patients with depression and comorbid obesity compared with normal weight patients, and to examine the association of prescribing prevalence with obesity class. Methods: Study sample of adult patients (>18 years old) with depression was extracted from the national Canadian Primary Care Sentinel Surveillance Network (CPCSSN) Electronic Medical Records database for 2011-2016. Measures were prescribing of at least one AD (outcome) and body mass index (BMI) to categorize patients into weight categories (exposure). Data were analyzed cross-sectionally using descriptive statistics and mixed effects logistic regression model with clustering on CPCSSN networks and adjusting for age, sex, and the comorbidities. Results: Of 120,381 patients with depression, 63,830 patients had complete data on studied variables (complete cases analysis). Compared with normal weight patients, obese patients were more likely to receive an AD prescription (adjusted Odds Ratio [aOR] = 1.17; 95% Confidence Interval [CI]: 1.12-1.22). Patients with obesity classes II and III were 8% (95% CI: 1.00, 1.16) and 6% (95% CI: 0.98, 1.16) more likely, respectively, to receive AD. After imputing missing data using Multiple Imputations by Chained Equations, the results remained unchanged. The prevalence of prescribing >3 AD types was higher in obese category (7.27%, [95% CI: 6.84, 7.73]) than in normal weight category (5.6%; [95% CI: 5.24, 5.99]). Conclusion: The association between obesity and high prevalence of AD prescribing and prescribing high number of different AD to obese patients, consistent across geographical regions, raises a public health concern. Study results warrant qualitative studies to explore reasons behind the difference in prescribing, and quantitative longitudinal studies evaluating the association of AD prescribing patterns for obese patients with health outcomes.

Meaning and Management of Multiple Medications Among Public Mental Health Service Users

Public mental health service users frequently manage multiple health conditions, and are often prescribed multiple medications. While medications are useful tools in treating diagnosed mental illnesses, they bring management challenges and also can carry complex meanings for the individuals taking them. This study utilized a qualitative methodological approach to examine the experience and meaning of polypharmacy among public mental health services users. This sample of service users (n = 26) who were prescribed multiple medications described three distinct types of challenges they faced in managing medications: related to information, material tasks, and self-stigma. Nevertheless, respondents reported creative and resilient strategies to manage these challenges. Findings build on previous literature and reflect the increasing need to focus on challenges related to polypharmacy. Furthermore, findings indicate that low levels of literacy and high levels of material disadvantage, which are common among public mental health service users, complicate the management and meaning of multiple medications.

Food cue reactivity in food addiction: A functional magnetic resonance imaging study

BACKGROUND

While neuroimaging studies have revealed that reward dysfunction may similarly contribute to obesity and addiction, no prior studies have examined neural responses in individuals who meet the "clinical" food addiction phenotype.

METHODS

Women (n = 44) with overweight and obesity, nearly half of whom (n = 20) met criteria for moderate-to-severe Yale Food Addiction Scale 2.0 (YFAS 2.0) food addiction, participated in a functional magnetic resonance imaging cue reactivity task. Participants viewed images of highly processed foods, minimally processed foods, and household objects while thinking about how much they wanted each item. Differences in neural responses by YFAS 2.0 food addiction to highly processed and minimally processed food cues were investigated.

RESULTS

There was a significant interaction between participant group and neural response in the right superior frontal gyrus to highly versus minimally processed food cues (r = 0.57). Individuals with YFAS 2.0 food addiction exhibited modest, elevated responses in the superior frontal gyrus for highly processed food images and more robust, decreased activations for minimally processed food cues, whereas participants in the control group showed the opposite responses in this region. Across all participants, the household items elicited greater activation than the food cues in regions associated with interoceptive awareness and visuospatial attention (e.g., insula, inferior frontal gyrus, inferior parietal lobe).

CONCLUSIONS

Women with overweight or obesity and YFAS 2.0 food addiction, compared to those with only overweight or obesity, exhibited differential responses to highly and minimally processed food cues in a region previously associated with cue-induced craving in persons with a substance-use disorder. Overall, the present work provides further support for the utility of the food addiction phenotype within overweight and obesity.

Emerging Roles for Serotonin in Regulating Metabolism: New Implications for an Ancient Molecule

Serotonin is a phylogenetically ancient biogenic amine that has played an integral role in maintaining energy homeostasis for billions of years. In mammals, serotonin produced within the central nervous system regulates behavior, suppresses appetite, and promotes energy expenditure by increasing sympathetic drive to brown adipose tissue. In addition to these central circuits, emerging evidence also suggests an important role for peripheral serotonin as a factor that enhances nutrient absorption and storage. Specifically, glucose and fatty acids stimulate the release of serotonin from the duodenum, promoting gut peristalsis and nutrient absorption. Serotonin also enters the bloodstream and interacts with multiple organs, priming the body for energy storage by promoting insulin secretion and de novo lipogenesis in the liver and white adipose tissue, while reducing lipolysis and the metabolic activity of brown and beige adipose tissue. Collectively, peripheral serotonin acts as an endocrine factor to promote the efficient storage of energy by upregulating lipid anabolism. Pharmacological inhibition of serotonin synthesis or signaling in key metabolic tissues are potential drug targets for obesity, type 2 diabetes, and nonalcoholic fatty liver disease (NAFLD).

Environmental and Nutritional Effects Regulating Adipose Tissue Function and Metabolism Across Generations

The unabated rise in obesity prevalence during the last 40 years has spurred substantial interest in understanding the reasons for this epidemic. Studies in mice and humans have demonstrated that obesity is a highly heritable disease; however genetic variations within specific populations have so far not been able to explain this phenomenon to its full extent. Recent work has demonstrated that environmental cues can be sensed by an organism to elicit lasting changes, which in turn can affect systemic energy metabolism by different epigenetic mechanisms such as changes in small noncoding RNA expression, DNA methylation patterns, as well as histone modifications. These changes can directly modulate cellular function in response to environmental cues, however research during the last decade has demonstrated that some of these modifications might be transmitted to subsequent generations, thus modulating energy metabolism of the progeny in an inter- as well as transgenerational manner. In this context, adipose tissue has become a focus of research due to its plasticity, which allows the formation of energy storing (white) as well as energy wasting (brown/brite/beige) cells within the same depot. In this Review, the effects of environmental induced obesity with a particular focus on adipose tissue are discussed.

Quality of Life One Year After Bariatric Surgery: the Moderator Role of Spirituality

BACKGROUND

This study aimed to assess quality of life in obese patients 1 year after bariatric surgery taking into consideration the influence of socio-demographic, clinical, and psychological variables.

METHODS

A sample of 90 patients undergoing bariatric surgery was assessed in two moments: before surgery and 1 year after surgery.

RESULTS

Social support, problem-focused coping strategies, and quality of life increased after surgery, while eating disorder behaviour and impulsiveness decreased. The presence of eating disorder behaviour predicted worse physical and mental quality of life and higher satisfaction with social support predicted better physical and mental quality of life. In addition, higher impulsiveness predicted worse mental quality of life. Spirituality moderated the relationship between impulsiveness and mental/physical quality of life.

CONCLUSIONS

Interventions should focus on promoting social support and coping strategies particularly spirituality since it played an important role in quality of life.

Cardiometabolic effects of psychotropic medications

Background Many psychiatric disorders including schizophrenia, bipolar disorder and major depression convey an excess burden of cardiovascular morbidity and mortality. The medications used to treat these conditions may further adversely affect cardiovascular risk and exacerbate health disparities for vulnerable populations. There is a clinical need to appreciate the cardiometabolic adverse effects of psychotropic medications. Methods This paper reviews the most relevant cardiometabolic effects of psychotropic medications, organized around the components of metabolic syndrome. When known, the molecular and physiological mechanisms underlying any adverse cardiometabolic effects are detailed. Results Many commonly used psychotropic medications, particularly antipsychotics, mood stabilizers and some antidepressants, have been independently associated with cardiometabolic risk factors such as insulin resistance, obesity and dyslipidemia. Stimulants, antidepressants that inhibit reuptake of norepinephrine, some antipsychotics and valproic acid derivatives may also increase blood pressure. Conclusion Understanding, assessing and subsequently managing cardiometabolic complications of psychotropic medications are important to mitigate the excess cardiovascular morbidity and mortality in the clinical populations prescribed psychotropic medications. There is considerable variability in risk between medications and individuals. Timely management of iatrogenic cardiometabolic effects is critical.

The Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update

Bipolar disorders, including bipolar I disorder (BP-I) and bipolar II disorder (BP-II), are common, potentially disabling, and, in some cases, life-threatening conditions. Bipolar disorders are characterized by alternating episodes of mania or hypomania and depression, or mixtures of manic and depressive features. Bipolar disorders present many diagnostic and therapeutic challenges for busy clinicians. Adequate management of bipolar disorders requires pharmacotherapy and psychosocial interventions targeted to the specific phases of illness. Effective treatments are available for each illness phase, but mood episode relapses and incomplete responses to treatment are common, especially for the depressive phase. Mood symptoms, psychosocial functioning, and suicide risk must, therefore, be continually reevaluated, and, when necessary, the plan of care must be adjusted during long-term treatment. Many patients will require additional treatment of comorbid psychiatric and substance use disorders and management of a variety of commonly co-occurring chronic general medical conditions.

Depression, its comorbidities and treatment, and childhood body mass index trajectories

OBJECTIVE

No prior studies have evaluated depression diagnoses and cumulative antidepressant use in relation to longitudinal body mass index (BMI) trajectories in a population-representative sample.

METHODS

Electronic health record data from 105,163 children ages 8 to 18 years with 314,648 BMI values were used. Depression diagnoses were evaluated as ever versus never, cumulative number of encounters with diagnoses, and total duration of diagnoses. Antidepressants were evaluated as months of use. Associations were evaluated with diagnoses alone, antidepressants alone, and then together, adjusting for covariates.

RESULTS

A total of 6,172 (5.9%) and 10,628 (10.1%) children had a diagnosis of depression or received antidepressant treatment, respectively. At all ages, children receiving Medical Assistance (30.9%) were more likely to be treated with antidepressants. Depression diagnosis and antidepressant use were each independently and positively associated with BMI trajectories; associations were stronger with longer durations of diagnosis and treatment. Among children who received 12 or more months of antidepressants (vs. none), the mean (95% CI) weight gain at 18 years associated with antidepressant use (all classes) was 2.10 (1.76-2.45) kg.

CONCLUSIONS

Depression and antidepressant use were both independently associated with increasing BMIs over time, suggesting an important unintended consequence of healthcare to the obesity epidemic.

Impact of major depressive disorder, distinct subtypes, and symptom severity on lifestyle in the BiDirect Study

The aim of this study was to examine associations of major depressive disorder (MDD), its distinct subtypes, and symptom severity with the individual lifestyle factors smoking, diet quality, physical activity, and body mass index as well as with a combined lifestyle index measuring the co-occurrence of these lifestyle factors. A sample of 823 patients with MDD and 597 non-depressed controls was examined. The psychiatric assessment was based on a clinical interview including the Mini International Neuropsychiatric Interview and the Hamilton Depression Rating Scale. Each lifestyle factor was scored as either healthy or unhealthy, and the number of unhealthy lifestyle factors was added up in a combined lifestyle index. Cross-sectional analyses were performed using alternating logistic regression and ordinal logistic regression, adjusted for socio-demographic characteristics. After adjustment, MDD was significantly associated with smoking, low physical activity, and overweight. Likewise, MDD was significantly related to the overall lifestyle index. When stratifying for subtypes, all subtypes showed higher odds for an overall unhealthier lifestyle than controls, but the associations with the individual lifestyle factors were partly different. Symptom severity was associated with the lifestyle index in a dose-response manner. In conclusion, patients with MDD represent an important target group for lifestyle interventions.

The utility of weight loss medications after bariatric surgery for weight regain or inadequate weight loss: A multi-center study

BACKGROUND

Patients who undergo bariatric surgery often have inadequate weight loss or weight regain.

OBJECTIVES

We sought to discern the utility of weight loss pharmacotherapy as an adjunct to bariatric surgery in patients with inadequate weight loss or weight regain.

SETTING

Two academic medical centers.

METHODS

We completed a retrospective study to identify patients who had undergone bariatric surgery in the form of a Roux-en-Y gastric bypass (RYGB) or a sleeve gastrectomy from 2000-2014. From this cohort, we identified patients who were placed on weight loss pharmacotherapy postoperatively for inadequate weight loss or weight regain. We extracted key demographic data, medical history, and examined weight loss in response to surgery and after the initiation of weight loss pharmacotherapy.

RESULTS

A total of 319 patients (RYGB = 258; sleeve gastrectomy = 61) met inclusion criteria for analysis. More than half (54%; n = 172) of all study patients lost≥5% (7.2 to 195.2 lbs) of their total weight with medications after surgery. There were several high responders with 30.3% of patients (n = 96) and 15% (n = 49) losing≥10% (16.7 to 195.2 lbs) and≥15% (25 to 195.2 lbs) of their total weight, respectively, Topiramate was the only medication that demonstrated a statistically significant response for weight loss with patients being twice as likely to lose at least 10% of their weight when placed on this medication (odds ratio = 1.9; P = .018). Regardless of the postoperative body mass index, patients who underwent RYGB were significantly more likely to lose≥5% of their total weight with the aid of weight loss medications.

CONCLUSIONS

Weight loss pharmacotherapy serves as a useful adjunct to bariatric surgery in patients with inadequate weight loss or weight regain.

A General Framework for Considering Selection Bias in EHR-Based Studies: What Data Are Observed and Why?

Electronic health records (EHR) data are increasingly seen as a resource for cost-effective comparative effectiveness research (CER). Since EHR data are collected primarily for clinical and/or billing purposes, their use for CER requires consideration of numerous methodologic challenges including the potential for confounding bias, due to a lack of randomization, and for selection bias, due to missing data. In contrast to the recent literature on confounding bias in EHR-based CER, virtually no attention has been paid to selection bias possibly due to the belief that standard methods for missing data can be readily-applied. Such methods, however, hinge on an overly simplistic view of the available/missing EHR data, so that their application in the EHR setting will often fail to completely control selection bias. Motivated by challenges we face in an on-going EHR-based comparative effectiveness study of choice of antidepressant treatment and long-term weight change, we propose a new general framework for selection bias in EHR-based CER. Crucially, the framework provides structure within which researchers can consider the complex interplay between numerous decisions, made by patients and health care providers, which give rise to health-related information being recorded in the EHR system, as well as the wide variability across EHR systems themselves. This, in turn, provides structure within which: (i) the transparency of assumptions regarding missing data can be enhanced, (ii) factors relevant to each decision can be elicited, and (iii) statistical methods can be better aligned with the complexity of the data.

Prospective Associations between Depression and Obesity for Adolescent Males and Females- A Systematic Review and Meta-Analysis of Longitudinal Studies

Adolescent obesity and depression are increasingly prevalent and are currently recognised as major public health concerns worldwide. The aim of this study is to evaluate the bi-directional associations between obesity and depression in adolescents using longitudinal studies. A systematic literature search was conducted using Pubmed (including Medline), PsycINFO, Embase, CINAHL, BIOSIS Preview and the Cochrane Library databases. According to the inclusion criteria, 13 studies were found where seven studies evaluated depression leading to obesity and six other studies examined obesity leading to depression. Using a bias-adjusted quality effects model for the meta-analysis, we found that adolescents who were depressed had a 70% (RR 1.70, 95% CI: 1.40, 2.07) increased risk of being obese, conversely obese adolescents had an increased risk of 40% (RR 1.40, 95% CI: 1.16, 1.70) of being depressed. The risk difference (RD) of early adolescent depression leading to obesity is 3% higher risk than it is for obesity leading to depression. In sensitivity analysis, the association between depression leading to obesity was greater than that of obesity leading to depression for females in early adulthood compared with females in late adolescence. Overall, the findings of this study suggest a bi-directional association between depression and obesity that was stronger for female adolescents. However, this finding also underscores the importance of early detection and treatment strategies to inhibit the development of reciprocal disorders.

The Healthy Weights Initiative: a community-based obesity reduction program with positive impact on depressed mood scores

Objectives

The risk for many chronic diseases increases with obesity. In addition to these, the risk for depression also increases. Exercise interventions for weight loss among those who are not overweight or obese have shown a moderate effect on depression, but few studies have looked at those with obesity. The objectives of this study were to determine 1) the prevalence of depressed mood in obese participants as determined by the Beck Depression Inventory II at baseline and follow-up; 2) the change in depressed mood between those who completed the program and those who did not; and 3) the differences between those whose depressed mood was alleviated after the program and those who continued to have depressed mood.

Methods

Depressed mood scores were calculated at baseline and follow-up for those who completed the program and for those who quit. Among those who completed the program, chi-squares were used to determine the differences between those who no longer had depressed mood and those who still had depressed mood at the end of the program, and regression analysis was used to determine the independent risk factors for still having depressed mood at program completion.

Results

Depressed mood prevalence decreased from 45.7% to 11.7% (P<0.000) from baseline to follow-up among those who completed the program and increased from 44.8% to 55.6% (P<0.000) among those who quit. After logistic regression, a score of <40 in general health increased the risk of still having depressed mood upon program completion (odds ratio [OR] 3.39; 95% CI 1.18–9.72; P=0.023).

Conclusion

Treating depressed mood among obese adults through a community-based, weight-loss program based on evidence may be an adjunct to medical treatment. More research is needed.

Long-Term Weight Change after Initiating Second-Generation Antidepressants

(1) Objective: To examine the relationship between the choice of second-generation antidepressant drug treatment and long-term weight change; (2) Methods: We conducted a retrospective cohort study to investigate the relationship between choice of antidepressant medication and weight change at two years among adult patients with a new antidepressant treatment episode between January, 2006 and October, 2009 in a large health system in Washington State. Medication use, encounters, diagnoses, height, and weight were collected from electronic databases. We modeled change in weight and BMI at two years after initiation of treatment using inverse probability weighted linear regression models that adjusted for potential confounders. Fluoxetine was the reference treatment; (3) Results: In intent-to-treat analyses, non-smokers who initiated bupropion treatment on average lost 7.1 lbs compared to fluoxetine users who were non-smokers (95% CI: −11.3, −2.8; p-value < 0.01); smokers who initiated bupropion treatment gained on average 2.2 lbs compared to fluoxetine users who were smokers (95% CI: −2.3, 6.8; p-value = 0.33). Changes in weight associated with all other antidepressant medications were not significantly different than fluoxetine, except for sertraline users, who gained an average of 5.9 lbs compared to fluoxetine users (95% CI: 0.8, 10.9; p-value = 0.02); (4) Conclusion: Antidepressant drug therapy is significantly associated with long-term weight change at two years. Bupropion may be considered as the first-line drug of choice for overweight and obese patients unless there are other existing contraindications.

Antidepressant Use is Associated with Increased Energy Intake and Similar Levels of Physical Activity

Antidepressants have been associated with weight gain, but the causes are unclear. The aims of this study were to assess the association of antidepressant use with energy intake, macronutrient diet composition, and physical activity. We used data on medication use, energy intake, diet composition, and physical activity for 3073 eligible adults from the 2005–2006 National Health and Nutrition Examination Survey (NHANES). Potential confounding variables, including depression symptoms, were included in the models assessing energy intake, physical activity, and sedentary behavior. Antidepressant users reported consuming an additional (mean ± S.E.) 215 ± 73 kcal/day compared to non-users (p = 0.01). There were no differences in percent calories from sugar, fat, or alcohol between the two groups. Antidepressant users had similar frequencies of walking or biking, engaging in muscle-strengthening activities, and engaging in moderate or vigorous physical activity. Antidepressant users were more likely to use a computer for ≥2 h/day (OR 1.77; 95% CI: 1.09–2.90), but TV watching was similar between the two groups. These results suggest increased energy intake and sedentary behavior may contribute to weight gain associated with antidepressant use. Focusing on limiting food intake and sedentary behaviors may be important in mitigating the weight gain associated with antidepressant use.

A record linkage study of antidepressant medication use and weight change in Australian adults

OBJECTIVE

Antidepressant use is widespread. While weight gain is a commonly reported side-effect of antidepressant use and has the potential to affect population health, there is little large-scale population-based evidence on the issue, particularly for long-term use (⩾12 months). The aim of this study is to investigate the association between antidepressant use and weight change, including whether this relationship varies according to antidepressant class, recency of use, duration of use and dose.

METHODS

Annual percentage weight change was calculated from self-reported weight at two time-points from 20,751 participants aged ⩾45 years from the 45 and Up Study - a population-based cohort study from New South Wales, Australia. Antidepressant use, ascertained from linked pharmaceutical data, from 19 months before baseline until end of follow-up (mean = 3.3 years of follow-up), was categorised as current, past-only, non-persistent or non-use. The association between antidepressant use and weight change was modelled using linear and multinomial logistic regressions and according to antidepressant class, recency, duration and dose.

RESULTS

Antidepressants were dispensed to 23% of participants (n = 4748) during the study period. Current antidepressant users were significantly more likely to gain >3% of their body weight annually than non-users (adjusted relative risk ratio = 1.19; 95% confidence interval: [1.03, 1.38]); the risk increased with increasing dose among current users (p[trend] = 0.003). Risk of weight gain did not vary significantly according to antidepressant class, recency or duration of use; however, statistical power was limited. No significant associations were found between antidepressant use and weight loss.

CONCLUSION

Current antidepressant use was associated with modest but statistically significant annual gains in weight, with similar effects observed across the different classes of antidepressants used.

Psychological distress as a determinant of changes in body mass index over a period of 10years

OBJECTIVE

To examine the longitudinal relationship between psychological distress and body mass index (BMI) changes over a period of five and ten years.

METHOD

Data were used from the Dutch, prospective, population based Doetinchem Cohort study over the period 1995/1999 until 2005/2009 (N=5504). Psychological distress was assessed using the Mental Health Inventory (MHI-5). BMI (kg/m(2)) was calculated from measured body height and body weight. GEE analyses were used to examine the relationship between psychological distress at baseline and BMI change, and the development of overweight over five years. Linear and logistic regression analyses were used to examine these relations over ten years.

RESULTS

Psychological distress predicted an extra overall increase in BMI of 0.14kg/m(2) (95% CI 0.03-0.25) over five years and an increase of 0.18kg/m(2) (95% CI 0.01-0.35) over ten years, when comparing psychologically distressed participants to psychologically healthy participants. This was especially the case among persons with normal weight (five years; B=0.26kg/m(2), 95% CI=0.12-0.40/ten years; B=0.32kg/m(2) 95% CI=0.11-0.53) and moderate overweight (five years: B=0.18kg/m(2), 95% CI=0.02-0.35) at baseline. Psychological distress did not predict the development of overweight five and ten years later.

CONCLUSION

The results in this study indicated that psychological distress predicted an increased risk in gaining weight, but did not result in an increased risk for developing overweight.

Tricyclic and SSRI usage influences the association between BMI and health risk factors

To determine if selective-serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) influence the association between obesity and cardiovascular disease risk, participants from the Third National Health and Nutrition Examination Survey (NHANES III; 1988-1992) and continuous NHANES (1999-2009, n = 18 274) were used. For a given body mass index (BMI), individuals taking SSRIs (n = 219) tended to have significantly better health risk profiles with lower systolic blood pressure (P = 0.002) and higher high-density lipoprotein (P = 0.003) compared with non-users. Conversely, those who used TCAs (n = 116) had significantly worse health risk profiles with higher diastolic blood pressure (P ≤ 0.0001) and triglycerides (P = 0.023) as compared with non-users for a given BMI. Insulin resistance (HOMA-IR) was higher in TCA users and those with larger BMIs, whereby the differences in insulin resistance between TCA users and non-users was greater with higher BMIs (interaction effect: P = 0.013). Furthermore, individuals taking SSRIs were less likely to have cardiovascular disease than non-users (odds ratio, 95% confidence interval = 0.50, 0.33-0.75) for a given BMI, with no differences by TCA use (odds ratio = 0.74, 0.44-1.24). SSRI and TCA use may alter how body weight relates with cardiovascular risk. When prescribing antidepressant medications, it may be necessary to monitor and consider body weight and cardiovascular risk profile of individual patients.

A 12-week weight reduction intervention for overweight individuals taking antipsychotic medications

People taking antipsychotic medications are at increased risk for obesity, diabetes, and early mortality. Few weight loss interventions have targeted this population. Thirty-six individuals were randomized to an evidence-based 12-week weight loss intervention (PREMIER with DASH diet, n = 18) or to usual care (n = 18) in this feasibility trial. Average attendance was 8.6 of 12 sessions. Intent-to-treat analyses of covariance, adjusted for baseline weight, showed significant changes in weight: Mean weight in intervention participants declined from 213.3 to 206.6 pounds, while control participants' weight was unchanged. It is possible to recruit, assess, intervene with, and retain participants taking antipsychotic medications in a dietary and exercise lifestyle change trial. Participants reported high levels of satisfaction with the intervention.

Overweight and obesity in youth with developmental disabilities: a call to action

Elevated weight status has become a leading problem for adults and children around the world, regardless of the presence or lack of disability. Youth with intellectual and developmental disabilities are more vulnerable than the typical population to overweight in recent decades, and these individuals often experience overweight and obesity at higher rates than their typically developing peers. Young people with disabilities have many circumstances, beyond those of typically developing children, which increase their risk for greater body mass. These include greater medication use, having syndromes with obesity as an associated symptom, and possessing altered eating habits related to their disability. We discuss obesity-related health risks, possible weight management options, recommendations for weight maintenance or loss, and future research. Although most professionals who work with youth having developmental disabilities do not have great expertise in nutrition and weight management, we must collectively recognise the importance of weight issues for quality of life of these individuals and work with them in maintaining healthy lifestyles. Intervention options, both for caregivers and for health professionals, are discussed.

Changes in body weight and health-related quality of life: 2 cohorts of US women

Studies have shown that body weight is a determinant of health-related quality of life (HRQoL). However, few studies have examined long-term weight change with changes in HRQoL. We followed 52,682 women aged 46-71 years in the Nurses' Health Study (in 1992-2000) and 52,587 women aged 29-46 years in the Nurses' Health Study II (in 1993-2001). Body weight was self-reported, HRQoL was measured by the Medical Outcomes Study's 36-Item Short Form Health Survey, and both were updated every 4 years. The relationship between changes in weight and HRQoL scores was evaluated at 4-year intervals by using a generalized linear regression model with multivariate adjustment for baseline age, ethnicity, menopausal status, and changes in comorbidities and lifestyle factors. Weight gain of 15 lbs (1 lb = 0.45 kg) or more over a 4-year period was associated with 2.05-point lower (95% confidence interval: 2.14, 1.95) physical component scores, whereas weight loss of 15 lbs or more was associated with 0.89-point higher (95% confidence interval: 0.75, 1.03) physical component scores. Inverse associations were also found between weight change and physical function, role limitations due to physical problems, bodily pain, general health, and vitality. However, the relations of weight change with mental component scores, social functioning, mental health, and role limitations due to emotional problems were small.

Associations between anxiety, depression, antidepressant medication, obesity and weight gain among Canadian women

Purpose

Some mental illnesses have been suggested to be associated with obesity, although results are somewhat inconsistent and research has focused mainly on depression.

Methods

Associations between anxiety, depression, medications for these illnesses, and obesity were investigated cross-sectionally among women aged 25–74 (n = 3004) who participated as population controls in a cancer case-control study. Participants self-reported information on anxiety, depression, height, current weight and weight at age 25.

Results

No association was observed between either anxiety or depression and either current overweight or obesity status. However, depressed women taking antidepressants were more likely to be obese [OR = 1.71 (95%CI  =  1.16–2.52) daily antidepressant use; OR = 1.89 (95%CI = 1.21–2.96) ever tricyclic antidepressant use]. In the full study sample consistent positive associations between anxiety, depression and obesity among women with a history of antidepressant use, and generally negative associations among women without, were suggested. Finally, weight gain was associated with history of anxiety [5–19 kg OR = 1.29 (95% CI = 1.06–1.57); ≥20 kg OR = 1.43 (95% CI = 1.08–1.88)] and depression [≥20 kg OR = 1.28 (95% CI = 0.99–1.65)].

Conclusions

These results suggest depression and anxiety may be associated with weight gain and antidepressant use may be associated with obesity.

Obesity and liver disease: the epidemic of the twenty-first century

Obesity is a rapidly growing health problem that is associated with more than 65 comorbidities and results in substantially increased all-cause mortality. The increase of obesity has played an important role in the increasing prevalence of nonalcoholic fatty liver disease (NAFLD), the most common cause of liver disease in the United States. Understanding the prevalence, comorbidities, and pathogenesis of obesity provides an essential foundation for clinicians who care for individuals with NAFLD.

Racial/Ethnic Differences in the Relationship between Obesity and Depression Treatment

Using data from the 2004 to 2008 Medical Expenditure Panel Survey (MEPS), this study examined the relationship between obesity and the treatment of depression across racial/ethnic subgroups, controlling for depressive symptoms, self-rated mental health, health status, and socioeconomic characteristics. The association between obesity and depression-related medication was significant for white women but not for black or Hispanic women. Similarly, the association between obesity and depression-related ambulatory visits was significant for white women but not for black or Hispanic women. The results for men were, in general, mixed and inconsistent. The significant racial/ethnic differences found in the relationship between obesity and depression treatment among women suggest that social and cultural factors might play important roles in depression treatment among women.

Chronic clomipramine treatment reverses core symptom of depression in subordinate tree shrews

Chronic stress is the major cause of clinical depression. The behavioral signs of depression, including anhedonia, learning and memory deficits, and sleep disruption, result from the damaging effects of stress hormones on specific neural pathways. The Chinese tree shrew (Tupaia belangeri chinensis) is an aggressive non-human primate with a hierarchical social structure that has become a well-established model of the behavioral, endocrine, and neurobiological changes associated with stress-induced depression. The tricyclic antidepressant clomipramine treats many of the core symptoms of depression in humans. To further test the validity of the tree shrew model of depression, we examined the effects of clomipramine on depression-like behaviors and physiological stress responses induced by social defeat in subordinate tree shrews. Social defeat led to weight loss, anhedonia (as measured by sucrose preference), unstable fluctuations in locomotor activity, sustained urinary cortisol elevation, irregular cortisol rhythms, and deficient hippocampal long-term potentiation (LTP). Clomipramine ameliorated anhedonia and irregular locomotor activity, and partially rescued the irregular cortisol rhythm. In contrast, weight loss increased, cortisol levels were even higher, and in vitro LTP was still impaired in the clomipramine treatment group. These results demonstrate the unique advantage of the tree shrew social defeat model of depression.

Proposed nurse-led initiatives in improving physical health of people with serious mental illness: a survey of nurses in mental health

AIMS AND OBJECTIVES

To identify nurse perceptions on the potential value of general and specific nursing approaches to improving physical health outcomes of people with serious mental illness.

BACKGROUND

People diagnosed with serious mental illnesses experience heightened rates of physical illnesses and can be supported better via healthcare system prevention and management. Nurses working in mental health are a critical part of a system-wide approach to improving physical health care, but there is little known on their views on specific approaches within Australia (e.g. screening for risks, stigma reduction).

DESIGN

A national, cross-sectional and nonrandom survey study delivered online.

METHODS

Members of the Australian College of Mental Health Nurses (n = 643), representing nurses employed in mental healthcare services across Australia (71·6% from public mental health services). Participants were asked to rate the potential of nine nurse-based strategies for improving physical health (options: 'yes', 'no', 'not sure') and the potential value of 10 nursing and general strategies for improving physical health (rating from 'negative value' to 'significant value').

RESULTS

There was a high endorsement of all nine nurse-based strategies for physical health (e.g. lifestyle programmes, screening, linking services), although there was less support for reducing antipsychotics or advocating for fewer side effects. Participants mainly viewed all strategies as of moderate to significant value, with the most promising value attached to colocation of primary and mental care services, lifestyle programmes and improving primary care services (reduce stigma, train GPs).

CONCLUSIONS

Australian nurses working in mental health services view a range of nurse-based strategies for improving physical healthcare services and standards as important.

RELEVANCE TO CLINICAL PRACTICE

Nurses collectively need to work with consumers, health agencies and the general public to further define how to organise and implement physical health integration strategies, towards more comprehensive health care of people with serious mental illness.