Aims1) To determine the pooled prevalence of overweight and obesity in people with severe mental illness (SMI), overall and by type of SMI, geographical region, and year of data collection; and 2) to assess the likelihood of overweight and obesity, in people with SMI compared with the general population.MethodsPubMed, Medline, EMBASE, and PsycINFO databases were searched to identify observational studies assessing the prevalence of obesity in adults with SMI. Screening, data extraction and risk of bias assessments were performed independently by two co-authors. Random effect estimates for the pooled prevalence of overweight and obesity and the pooled odds of obesity in people with SMI compared with the general population were calculated. Subgroup analyses were conducted for types of SMI, setting, antipsychotic medication, region of the world, country income classification, date of data collection and sex. We assessed publication bias and performed a series of sensitivity analyses, excluding studies with high risk of bias, with low sample size and those not reporting obesity according to WHO classification.Result120 studies from 43 countries were included, the majority were from high income countries. The pooled prevalence of obesity in people with SMI was 25.9% (95% C.I. = 23.3-29.1) and the combined pooled prevalence of overweight and obesity was 60.1% (95% C.I. = 55.8-63.1). Sub-Saharan Africa (13.0%, 95%C.I. = 6.7-25.1) and South Asia (17.7%, 95%C.I. = 10.5-28.5) had the lowest prevalence of obesity whilst North Africa and the Middle East (35.8%, 95%C.I. = 23.8-44.8) reported the highest prevalence. People with SMI were 3.04 more likely (95% C.I. = 2.42-3.82) to have obesity than the general population, but there was no difference in the prevalence of overweight. Women with schizophrenia were 1.44 (95% C.I. = 1.25-1.67) times more likely than men with schizophrenia to live with obesity; however, no gender differences were found among those with bipolar disorder.ConclusionPeople with SMI have a markedly high prevalence and higher odds of obesity than the general population. This may contribute to the very high prevalence of physical health conditions and mortality in this group. People with SMI around the world would likely benefit from interventions to reduce and prevent obesity.

People with severe mental illness (SMI) have a higher prevalence of obesity as compared with the general population, however, there is mixed evidence about the prevalence of underweight. Thus, the aim of this study is to determine the pooled prevalence of underweight in people with SMI and its association with socio-demographic factors; and to compare the prevalence of underweight between SMI and the general population. MEDLINE, PsycINFO, and EMBASE databases were searched to identify observational studies assessing the prevalence of underweight in adults with SMI (schizophrenia, major depressive disorder with psychotic features, and bipolar disorders). Screening, data extraction, and risk of bias assessments were performed independently by two co-authors, with disagreements resolved by consensus. Random effect estimates for the pooled prevalence of underweight and the pooled odds of underweight in people with SMI compared with the general population were calculated. Subgroup analyses were conducted for the type of SMI, setting, antipsychotic medication, region of the world, World Bank country income classification, data collection, and sex. Forty estimates from 22 countries were included. The pooled prevalence of underweight in people with SMI was 3.8% (95% confidence interval[CI] = 2.9-5.0). People with SMI were less likely to be underweight than the general population (odds ratio [OR] 0.65; 95% CI = 0.4-1.0). The pooled prevalence of underweight in SMI in South Asia was 7.5% (95% CI = 5.8-14.1) followed by Europe and Central Asia at 5.2% (95% CI = 3.2-8.1) and North America at 1.8% (95% CI = 1.2-2.6). People with SMI have lower odds of being underweight compared to the general population. People with schizophrenia had the highest prevalence of underweight compared to other types of SMI. Japan and South Asia have the highest prevalence of underweight in people with SMI.