Twenty‐year progression of body mass index in a county‐wide cohort of people with schizophrenia and bipolar disorder identified at their first episode of psychosis

Abstract

Objective There is increased prevalence of obesity in schizophrenia and bipolar disorder, leading to disproportionate risk of adverse health conditions. Prospective, long-term weight gain data, however, are scarce. Methods We analyzed data from the Suffolk County Mental Health Project cohort of consecutive first admissions with psychosis recruited from September 1989 to December 1995 and subsequently followed for 20 years, focusing on people with schizophrenia (n=146) and bipolar disorder (n=87). The time course of weight gain was examined using a 2 (group) × 5 (time) mixed-model repeated measures ANOVA, and body mass index (BMI) scores at the first (6 months) and second (2 years) assessments were compared to examine whether early overweight predicted later obesity. Results There was a statistically significant effect of time, F(1,210)=68.06, p<.001, and diagnosis on BMI, F(1,210)= 29.18, p<.001, but not the interaction of time × diagnosis, F(1,210)=0.88, p=.48. Most participants had normal BMIs at the first two assessments. Early overweight was a predictor of eventual obesity for both groups. At the 20 year follow-ups, approximately 50% of the bipolar and 62% of the schizophrenia sample were obese, with greater prevalence of obesity in schizophrenia at each assessment (all p<.02), except for years 4 (p=.12) and 20 (p=.27). Conclusions Nearly two thirds of the participants with schizophrenia and over half with bipolar disorder were obese 20 years after first hospitalization for psychosis, considerably higher than the rate for adults in New York State (27%). Early intervention may be required to prevent long-term consequences of obesity-related morbidity and mortality.

Cognition and disability in schizophrenia: cognition‐related skills deficits and decision‐making challenges add to morbidity

“…In analyses of data from the Suffolk County Mental Health Project, we examined the 20‐year course of weight gain and its impact on everyday functioning at the 20‐year follow‐up. We found that weight gain was progressive over the entire period, leading to over 50% of bipolar patients and 60% of schizophrenia patients having a body mass index in the obese range 20 years after diagnosis, a striking change from 8% and 20%, respectively, at the time of first diagnosis.…”

Cardiovascular risk remains high in schizophrenia with modest improvements in bipolar disorder during past decade

“…Consistent with this, after adjusting for symptom level, functioning level and use of antipsychotics with adverse metabolic side effects, several differences in CVD risk factors between the diagnostic groups disappeared, while obesity, waist, LDL‐C and diastolic BP remained significantly higher in the SCZ group. Some recent studies also suggest greater risk levels among patients with SCZ compared to BD . Other studies report mixed findings, including similar rates of MetS and greater prevalence of smoking and central adiposity in SCZ, but lower levels of TC and LDL‐C .…”

Re-evaluating classical body type theories: genetic correlation between psychiatric disorders and body mass index

“…influenced by fewer confounding ‘environmental factors’). In a real clinical setting, the major and defining problem of the patients with SCZ and BD is obesity (Manu et al 2015 ; Strassnig et al 2017 ). Therefore, we speculate, on the basis of our current results, that obesity in SCZ or BD may not be attributable entirely to genetic factors but might be greatly influenced by several environmental factors, such as medications (e.g.…”