Obesity among people with SMI in South Asia: Implication for research, policy and practice

Introduction: People with severe mental illness (SMI) have an increased mortality compared to general population. This mortality gap is wider in low and middle income countries and most of it can be attributed to obesity and its comorbidities. We determined the prevalence of obesity in people with SMI in South Asia and explored the association between obesity with mental and physical health comorbidities. We presented this finding to policymakers and decision makers to set research and clinical practice priorities.   

Methods: This cross-sectional Survey randomly selected 3989 people with SMI attending National Mental Health Institutes in Bangladesh, India and Pakistan. Height, weight and waist circumference were measured by trained personnel, and body mass index (BMI) categories were calculated. We used WHO STEPS approach to collect socio demographic details, physical and mental health status and health risk behaviors.  

Results: We found a high prevalence of obesity, 30% of the participants were overweight and16% were obese using the international cut-off scores while 17% were overweight and 46.3% had obesity using the ethnic-adjusted cut off scores. Obesity was associated with relative higher risk of having type 2 diabetes (RRR =1.55, 95% CI: 1.13-2.13), hypertension (RRR =1.69, 95% CI: 1.30-2.19) and higher levels of cholesterol (RRR =1.55, 95% CI: 1.11-1.56). We presented the findings to policymakers and stakeholders, and we found that the development of lifestyle interventions to prevent and treat obesity should be a priority.  

Conclusion: We found a high prevalence of obesity in people with SMI from South Asia, and we found obesity to be associated with physical and mental health conditions. This indicates the need for screening for overweight and early identification, regular monitoring of weight and integration of lifestyle modification advice into routine care of SMI patients by developing new policies.