Self-reported body weight perception and dieting practices in community-dwelling patients with schizophrenia

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Abstract

Introduction

Many patients with schizophrenia are exposed to serious health risks associated with their excess body weight. Evidence exists that even a moderate amount of weight loss may have significant health benefits. Thus, weight control in schizophrenia patients has become an important treatment goal. Although studies in the general population show that satisfaction with body weight is an important predictor for engagement in various weight loss measures, the perspective of schizophrenia patients has not been assessed.

Method

Information on self-reported weight perception, desire to lose weight as well as weight loss attempts was obtained according to methods employed in the National Health and Nutrition Examination Survey, Cycle III (NHANES III). Body weight and height were measured and body mass index (BMI) was calculated.

Results

Perception of body weight and desire to lose weight were correlated to BMI. Both obese female and male subjects (BMI⩾30) were aware of their weight status. However, whereas overweight females (BMI>25≤29.9) accurately perceived themselves so, males in this category had difficulties perceiving themselves overweight, and consequently neither wanted to lose weight, nor tried to lose weight. As means of weight loss, caloric restriction (diet) was most frequently employed (by more than 80% of study subjects); yet only a third of study subjects (34.4%) engaged in the recommended combination of diet and exercise to lose weight. Questionable weight loss practices were also frequently employed, especially among women.

Conclusions

Obese patients (BMI≥30) were generally aware of their excess body weight and wanted to lose weight. Only non-obese, yet overweight males (BMI>25≤29.9) did not perceive themselves as overweight and consequently did not try to lose weight. Weight loss practices did not always follow established recommendations. Especially women were likely to approach weight loss with questionably appropriate and unsafe methods.

Introduction

There is evidence that the increasing prevalence of obesity seen over the past decade is continuing at a rapid pace. Data from the recent 1999–2000 National Health and Nutrition Examination Survey (NHANES; available online) show that nearly 65% of the adult US population are overweight, as defined by a body mass index (BMI) greater than 25 kg/m2, as compared to 56% seen in NHANES III, which was conducted between 1988 and 1994 (Flegal et al., 2000). Serious health risks can be associated with excess body weight (National Task Force on the Prevention and Treatment of Obesity, 2000). Enormous public health implications derive from these facts, with almost 7% of the US health care budget spent on medical treatment of obesity-related conditions (Colditz, 1999).

Most studies state that schizophrenic patients tend to be overweight (Gopalaswamy and Morgan, 1985, Strassnig et al., 2003a). However, Allison et al. (1999) found this to be true primarily in women. It appears even more worrisome that adolescent and young adult patients with schizophrenia already carry more body weight than their corresponding healthy peers (Theisen et al., 2001). Weight gain in schizophrenia patients may well be attributed to medication effects (Ganguli, 1999), such as through appetite increase, sedation, or hormonal effects (Baptista, 1999, Taylor and McAskill, 2000). Lifestyle factors, e.g. poor diet, also contribute (Strassnig et al., 2003a, Strassnig et al., 2003b, Brown et al., 1999). There is also some evidence that obesity is an independent risk factor for antipsychotic noncompliance (Weiden et al., 2003), leaving the individual more vulnerable to relapse (Weiden and Olfson, 1995).

Even a moderate degree of weight reduction is beneficial to the overweight person (Blackburn, 1995) and significantly decreases health risks (Ross et al., 2000, Willet et al., 1999). Overweight schizophrenia patients may also benefit from weight loss, as they usually carry numerous additional risk factors for medical diseases, including a higher prevalence of smoking and diabetes (Brown et al., 2000).

A disturbed body size and body weight perception has long been noted in psychiatric patients, especially in patients with eating disorders (Becker et al., 1999, Warah, 1989, Birtchnell et al., 1985). Some evidence exists that patients with schizophrenia also mispercept their body size, but findings have been controversial (Fischer, 1986, Priebe and Röhricht, 2001) and may rather represent a specific feature of acute psychopathology in a distinct subset of patients (Rohricht and Priebe, 2002). Apart from the latter trials, it is notable that outside of the literature focusing on eating disorders, few studies have examined the relationship of weight perception and dieting behaviors in the psychiatric population.

In mentally healthy persons, there is a relationship between satisfaction with body size and engagement in weight loss efforts. Indeed, the strongest predictor of engagement in weight loss efforts in a healthy population has been the perceived body size (Anderson et al., 2002). It seems important to assess whether this is true for schizophrenia patients as well. We therefore decided to examine the relations, if any, between measured BMI, self-reported weight perception, expressed desire to lose weight and dieting behavior of schizophrenia patients.

Section snippets

Subjects

Patients with a DSM-IV diagnosis (APA, 1994) of Schizophrenia, Schizoaffective Disorder and Psychotic Disorder NOS were recruited from the outpatient clinic and partial hospital at the Comprehensive Care Services at the Western Psychiatric Institute and Clinic, Pittsburgh, PA. Patients were approached by one of the investigators during regular clinic hours, either before or after their scheduled therapist or psychiatrist appointment, and asked whether they were interested in participating in a

Results

We studied 143 patients with a diagnosis of schizophrenia, schizoaffective disorder, and psychotic disorder NOS. Average age in the study sample was 43.3 (±8.6) years. Seventy-seven patients (53.8%) were male, and 66 (46.2%) were female. Regarding ethnicity, 77 (53.8%) were Caucasian and 66 (46.2%) were African-American. Sixty-seven study subjects (46.9%) carried a diagnosis of DSM IV Schizophrenia, 52 (36.3%) of Schizoaffective Disorder, and 24 (16.8%) a diagnosis of Psychotic Disorder NOS.

Discussion

The perception of body weight was a function of body mass index. In contrast to popular belief, weight perception of obese schizophrenia patients enrolled in the study (those with a BMI≥30) was fairly accurate. Meyer (2002) found a similar pattern among inpatients who suffer from schizophrenia; obese inpatients understood that they weighted too much. They were also aware of the fact that something needed to be done about their body weight.

Only non-obese males (BMI category ≤29.9) had trouble

Acknowledgement

Funding for this study was provided by the Trunzo Family Fund at the University of Pittsburgh. The authors wish to acknowledge the assistance of Robert Wirth, RN with recruitment of research subjects. We also thank the staff of the Comprehensive Care Program and the Schizophrenia Treatment and Research Center at Western Psychiatric Institute and Clinic for their assistance with recruitment.

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