Purpose -Obesity is an important contributory factor to premature mortality and morbidity. The purpose of this study was to survey inpatients at a secure psychiatric hospital in order to determine the proportion that was overweight and obese. Further aims were to identify variables associated with obesity and the proportion of patients being treated for diabetes mellitus, hypertension, and hyperlipidaemia.Design/methodology/approach -A cross-sectional survey of 234 adult male and female forensic and rehabilitation patients was carried out using routinely collected data.Findings -Of the 144 males, 33.3 per cent were overweight and 47.2 per cent were obese. Of the 90 females, 20.0 per cent were overweight and 63.3 per cent were obese. More patients had gained weight in the last three months than had lost it. Being overweight or obese was associated with the prescription of antipsychotic medication and valproate. A total of 30.3 per cent of patients were being treated for hyperlipidaemia, 14.1 per cent for hypertension and 8.5 per cent for type II diabetes mellitus.Research limitations/implications -The survey was conducted in an independent hospital, thus the results are not readily generalisable to the wider NHS. The authors were unable to report on the prevalence of metabolic syndrome. This is a subject that merits further research.Practical implications -Obesity is a major challenge in this patient population and requires active management to try and prevent complications. Patients need continuing education about healthy eating and encouragement to take exercise.Originality/value -There is a paucity of published surveys of obesity and its complications in forensic populations.

Purpose -The purpose of this paper is to explore the incidence of obesity and its complications in secure psychiatric settings; and to assess changes in body mass index (BMI). Design/methodology/approach -Electronic patient records were used to determine levels of obesity and weight change over a three-year period. BMI levels were related to status, medication and patient characteristics.Findings -The incidence of obesity (34 per cent) in the sample (n ¼ 351) was higher than in the general population. One-third of patients were on medication for hyperlipidaemia and 10 per cent were diagnosed with type II diabetes. Patients on regular antipsychotic drugs and sodium valproate and who were less active had higher BMIs. Gender differences over a three-year period showed a tendency for women's weight to continue to increase which may be linked to lower levels of engagement in activities of moderate or vigorous intensity. Originality/value -Previous surveys using secure psychiatric populations have been point in time reviews. The current study tracks changes over a three-year time period and related this to a range of interventions.

SUMMARY The delivery of good nutritional care is a fundamental element of the management of individuals with Huntington’s disease and all patients with Huntington’s disease will, at some time, need dietary intervention because of the sequela of the disease; yet there are no European nutritional guidelines. The European Huntington’s Disease Network Standards of Care Dietitians Group has brought together expert dietitians from across Europe to produce nutritional guidelines to improve the nutritional management of individuals with Huntington’s disease. The guidelines were developed to promote optimal nutritional screening, assessment and management of individuals throughout all stages of the disease, with the aim of improving the standard of nutritional care delivered. Literature was systematically searched in an attempt to ensure that the recommendations are based on sound evidence and where evidence is lacking, specific guidance is based on consensus expert dietetic opinion. The provision of nutritional care varies widely between countries. Implementation of these nutritional guidelines across Europe should improve the quality of nutritional care delivered to individuals with Huntington’s disease.

Purpose – The purpose of this paper is to describe healthy lifestyle initiatives in a secure psychiatric facility and the evidence base for these interventions. Design/methodology/approach – Following a detailed review of the literature on the physical health of psychiatric inpatients, a trans-diagnostic approach to behaviour change is advocated in selected areas. Findings – Lifestyle strategy proposals were produced that incorporate the principle of “libertarian paternalism” in making changes to eating and exercise behaviour; a programme of motivational and reinforcement strategies; and facility-specific environmental restructuring to include maximising the therapeutic use of green space. Practical implications – Instituting described changes needs to be accompanied by a programme of evaluation to assess intervention-specific physical health changes. Originality/value – This paper provides a synthesis of findings in key areas of behaviour change relevant to improving the physical health of psychiatric patients in secure settings. It is a co-ordinated and interlinked lifestyle strategy that has applicability to similar services.

Nutrition screening is the first-line approach to addressing the nutritional needs of service users and has been recommended as best practice by several authoritative and regulatory bodies. A simple and comprehensive screening tool, the St Andrew's Nutrition Screening Instrument (SANSI), was developed for use in an inpatient secure psychiatric setting. The aim of this study was to test the screening tool for reliability and validity. This study identified SANSI as reliable and valid for use in secure psychiatric settings for adolescents and adults. This should give confidence to regulatory and commissioning organizations, that the nutritional risk for patients in an organization which serves a diverse mental health population is being correctly identified, raising staff awareness and allowing appropriate action to be planned.