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Schwartz et al. (1) revealed, in a recent study, that people of all weight groups exhibited significant anti-fat bias, with thinner people being more likely to automatically associate negative attributes with people who are fat. Of even greater concern was the substantial proportion of individuals who indicated that they would be willing to endure various aversive life events rather than experience obesity. Up to 46% of the total sample indicated that they would rather give up 1 year of life than be obese, and 30% reported that they would rather be divorced than be obese.

As a psychiatrist, I encounter many patients who refuse treatment because of concerns about the problem of weight gain associated with the use of atypical antipsychotic drugs (2). In our Early Psychosis Treatment Service, we have documented non-adherence rates of up to 39% (3), while non-adherence rates of 74% have been found to occur within the first 18 months of antipsychotic treatment in recent reports (4). A recent survey of people with schizophrenia looked at antipsychotic medication adherence, objective weight status, and subjective distress over weight gain and found that both BMI and subjective distress from weight gain were significant predictors of non-adherence to antipsychotic medication (5). Obese individuals were more than twice as likely as those with normal BMI to report skipping their medication. This suggests that distress over weight gain may predispose people with schizophrenia to choose aversive life circumstances (i.e., psychosis) over the option of effective antipsychotic treatment and its associated risk of weight gain.

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