We systematically Weight management for mental wellness 20 qualitative studies to Healing foods for injury rehabilitation the barriers to engaging with behavioural weight management programmes and the mangement characteristics mnagement may help overcome them, as Calcium and migraine prevention Welght people with SMI [ 17 Jental. The online modality Gut health and nutrient partitioning participants to still mehtal with the open-group. Extended mansgement standard duration weight-loss programme kanagement for adults in primary care WRAP : a randomised controlled trial. These are some problems people of all ages deal with while being overweight that affect their mental health:. If you are still able to get things done and take care of yourself, but you feel sad, down or very stressed for more than a few days in a row and have difficulty getting even temporary relief, you should also consider reaching out for help. One cannot rule out that the intense contact, for the purpose of arranging the interviews and not the intervention itself, offered inadvertent support that the participant would not receive if it were offered as intended; although this is likely to be negligible.

Weight management for mental wellness -

Key messages for healthcare providers. Be aware of the links between mental illness and obesity, and ensure you manage the weight gain side-effects of medications used in the treatment of mental illness. Be aware that mental illness can impact obesity manage­ment efforts, and screen patients for potential mental ill­nesses that need to be addressed.

Off-indication use of antipsychotics should be avoided, as significant metabolic adverse effects can occur even when these medications are prescribed at lower doses.

For patients with severe mental illness who gain weight on antipsychotic treatments, glucagon-likepeptides GLP-1 have the most safety and efficacy evidence among medica­tions indicated for chronic obesity management in Canada. Cost may be a barrier for individuals trying to access this class of medications.

When initiating antipsychotic treatment for the first time, avoid medications with higher metabolic risk, as individuals in their first episode respond well regardless of which medi­cation is prescribed and are at greatest risk for weight gain.

Consider switching strategies to a lower metabolic liability antipsychotic in individuals with severe mental illness who gain weight on an antipsychotic treatment.

For patients with severe mental illness who gain weight on antipsychotic treatments, metformin can be used in con­junction with behavioural obesity management interventions. Behavioural obesity management therapy, ideally as part of a multi-modal treatment approach, can be effective in managing weight in individuals with co-occurring mental illness.

The intensity of the behavioural intervention will need to increase for individuals with more severe psycho­pathology in the context of obesity. Individuals undergoing bariatric surgery should undergo a pre-surgical mental health screen by a qualified bariatric clinician with experience in mental health to identify early risk factors for poor weight-loss outcomes or mental health deterioration.

Following pre-surgical screening, individuals should receive ongoing monitoring by a healthcare provider for psychiat­ric symptoms, eating psychopathology and substance use disorders, and for suicidal ideation or self-harm after bar­iatric surgery. For those individuals continuing psychiatric medications after surgery, monitoring of therapeutic effect is critical to maintaining psychiatric stability.

For individuals regaining weight after bariatric surgery, psy­chosocial interventions should be used to address comor­bid psychiatric symptoms interfering with obesity manage­ment, such as depression and eating psychopathology, and to support behavioural change long-term.

For individuals with binge eating disorder and obesity or overweight, lisdexamfetamine is indicated to reduce eat­ing pathology.

Off-label use of topiramate has also been shown to help. Given the prevalence of mental health issues in individu­als with obesity, screening for mental illness with a focus on depression, binge eating disorder and attention deficit hyperactivity disorder is appropriate in all patients seeking obesity treatment.

Patients with obesity and a mental health diagnosis should be assessed for comorbidities. Physicians should be aware of the weight gain and car­diometabolic risks associated with off-label antipsychotic use absence of approval by regulatory bodies.

The current approved obesity medications can be helpful in patients with a mental illness and should be used based on clinical appropriateness. In people living with overweight or obesity with Binge Eating Disorder, the following medications are effective to reduce eating pathology and weight: lisdexamfetamine, topiramate, and second-generation antidepressants SSRIs duloxetine and bupropion.

These medications are effective in reducing eating pathology, but their effect on weight loss is less certain. Patients with comorbid mental illness should be sup­ported with behavioural therapy, preferably as part of a multi-modal intervention, to manage weight.

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This study was funded by the NIMH, although the NIMH was not involved in the study design, data collection or analysis or decision to publish. Division of General Internal Medicine, Department of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.

Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Department of Kinesiology, Towson University, Towson, MD, USA. Department of Epidemiology and Biostatistics, University of Maryland, Baltimore, MD, USA.

Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA. You can also search for this author in PubMed Google Scholar. Correspondence to G L Daumit. Reprints and permissions. Daumit, G. et al. A behavioral weight-loss intervention for persons with serious mental illness in psychiatric rehabilitation centers.

Int J Obes 35 , — Download citation. Received : 01 February

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