Obesity in a forensic and rehabilitation psychiatric service: a missed opportunity?

The purpose of this paper is to study weight changes during psychiatric hospitalization, so as to identify “obesogenic” features in a mixed (forensic and rehabilitation) inpatient service.

An observational study of psychiatric inpatients, gathering sociodemographic, clinical, weight, dietary and sleep information and an actigraphic assessment.

A total of 51 patients, aged 19-68, 40 males, participated at a median of 13 months after their admission. When studied, only 6 percent had a healthy weight, 20 percent were overweight and three quarters (74 percent) were obese. The mean Body Mass Index (BMI) was 35.3 (SD: 8.1). At admission, only three patients (8.3 percent) had healthy BMIs and over the course of their hospital stay, 47 percent gained further weight. A high proportion was physically inactive and half slept more than nine hours a day. Participants received high calorie diets and half (53 percent) smoked cigarettes.

Although antipsychotic medication is known to cause weight gain, this should not be seen in isolation when attempting to explain psychiatric inpatient obesity. An inpatient admission is an opportunity to provide a healthier eating environment, health education and assertively promote less sedentary behavior and healthier sleep habits.

Obesity adds to the burden of this already significantly disadvantaged group of patients.

The results confirm earlier research showing that forensic and rehabilitation psychiatric inpatients as a group are obese, gain weight while in hospital and often smoke. The authors add data demonstrating that they are often physically inactive, sleep excessively and consume an unhealthy diet despite the provision of health focused interventions as an integral part of their inpatient program.