Weight Management and Mental Health in Wales

These monthly blog posts by the Public Mental Health Implementation Centre (PMHIC), 'Perspectives on public mental health', aim to highlight the voices of practitioners, patients, carers, and public health experts.

Welcome to this month’s blog post, in which Dr Katherine O’Mahony (Patient and Public Involvement representative) and Dr Emily Peckham (Senior Research Fellow, Bangor University) introduce our new report, Weight Management and Mental Health: A framework for action in Wales (developed in partnership with the NHS Wales Joint Commissioning Committee (JCC) and the Dyfodol Programme). They also share the eight recommendations on how to support people with mental health conditions in healthy weight management.

One of the top three reasons for the loss of healthy years in people with mental health conditions is overweight and obesity, as described by Holt and Peveler (2009). Globally, among people with severe mental illness, 25.9% are obese, compared with 16% of the general population. This is concerning because obesity is linked to many chronic illnesses, including heart disease, diabetes and cancer.

Supporting healthy weight management in people with mental health conditions is important to reduce their risk of physical health conditions.

What can be done to support people with mental health conditions in healthy weight management in Wales?

Understanding how mental health is linked to overweight and obesity

The relationship between mental health and overweight or obesity is complicated. People with overweight or obesity are more likely to have mental health conditions, and people with mental health conditions are more likely to have overweight and obesity.

Having a mental health condition can make it more difficult to take part in activities that reduce the risk of overweight and obesity, such as physical activity and preparing balanced meals. Also, some medications for mental health conditions (such as antipsychotic medication) can lead to increased appetite, which in turn leads to weight gain. People with mental health conditions are also more likely to experience poverty, which also increases the risk of weight gain due to lack of access to healthy food.

Altogether, there are several factors that increase the risk that people with mental illness will be overweight or obese.

Current strategies for weight management and their shortcomings

The current national strategies for healthy weight management in Wales, such as Healthy Weight Healthy Wales, do not include guidance for people with mental health conditions. This means that this population lacks supportive information, despite having specific needs related to weight management. There is also a lack of clear guidance on how to ensure that people with mental health conditions receive a medication review, and that people with severe mental ill health receive a physical health check.

As a result, a lack of standards to identify and support weight management in people with mental illness could lead to greater problems without the appropriate healthcare in place.

Recommendations for healthy weight management in Wales

Weight Management and Mental Health: A framework for action in Wales makes eight recommendations for actions to support people with mental health conditions to maintain a healthy weight. These recommendations are aimed at clinicians, services and policy makers when thinking about how best to support people who use mental health services with healthy weight management:

1. Provide leadership and direction to deliver healthy weight management support for people with mental health conditions.
2. Tailor weight management support for people with mental health conditions, taking into account the particular challenges faced by this population.
3. Provide physical health checks for people with mental health conditions, and monitor the weight of people who have been prescribed medication known to cause weight gain.
4. Embed weight management support in mental health services, making it clear when and how these services will be provided, and who will be delivering them.
5. Provide follow-on care after physical health checks, which should include a medication review and support to make behaviour changes that help maintain a healthy weight.
6. Address medication-related weight gain, by ensuring medication reviews take place with a mental health care provider.
7. Consider the broader context (for example, improving access to physical activity programmes).
8. Optimise the way we use data, to understand the scale of the issue and inform strategies.

These eight actions will support people with mental health conditions to achieve healthy weight management. Offering tailored support, and ensuring that people receive an annual physical health check (with a medication review if needed), will be key in reducing the risk of people developing overweight and obesity.