Obesity in patients with severe mental illness: overview and management

Severe mental illness and obesity are each serious public health problems that overlap to a clinically significant extent. Unfortunately, some of the most effective medications for severe mental illness are associated with the greatest weight gain, and the most effective strategy for severe obesity, bariatric surgery, is a treatment of last resort. First-line medication choices for patients with severe mental illness and obesity should be effective for treating the mental disorder, safe, well-tolerated, and, if possible, weight-neutral or associated with weight loss. If drugs with weight-inducing effects must be used, emerging data indicate that behavioral weight management, if not already in place, should be implemented and that adjunctive pharmacotherapeutic strategies should be considered. Severe mental illness with obesity must be viewed as 2 chronic illnesses that each require long-term management.