Conflict of interest: R. I. G. H. has received educational grants and fees for lecturing and consultancy work from Eli-Lilly and Company, Bristol Myers Squibb, GlaxoSmithKline and AstraZeneca. R. C. P. has received hospitality, fees for speaking or consultancy from makers of antipsychotics, including Eli-Lilly, Bristol Myers Squibb, Sanofi, AstraZeneca, Lundbeck, Janssen and Pfizer.
Obesity, serious mental illness and antipsychotic drugs
Article first published online: 19 MAY 2009
© 2009 Blackwell Publishing Ltd
Diabetes, Obesity and Metabolism
Volume 11, Issue 7, pages 665–679, July 2009
How to Cite
Holt, R. I. G. and Peveler, R. C. (2009), Obesity, serious mental illness and antipsychotic drugs. Diabetes, Obesity and Metabolism, 11: 665–679. doi: 10.1111/j.1463-1326.2009.01038.x
- Issue published online: 28 MAY 2009
- Article first published online: 19 MAY 2009
- Received 7 October 2008; returned for revises 9 December 2008; revised version accepted 23 December 2008
- bipolar illness;
The prevalence of overweight and obesity is higher in people with mental illness than in the general population. Body weight is tightly regulated by a complex system involving the cortex and limbic system, the hypothalamus and the gastrointestinal tract. While there are justifiable concerns about the weight gain associated with antipsychotic medication, it is too simplistic to ascribe all obesity in people with serious mental illness (SMI) to their drug treatment. The development of obesity in SMI results from the complex interaction of the genotype and environment of the person with mental illness, the mental illness itself and antipsychotic medication. There are dysfunctional reward mechanisms in SMI that may contribute to poor food choices and overeating. While it is clear that antipsychotics have profound effects to stimulate appetite, no one receptor interaction provides an adequate explanation for this effect, and many mechanisms are likely to be involved. The complexity of the system regulating body weight allows us to start to understand why some individuals appear much more prone to weight gain and obesity than others.