More than a number

31 March 2020

Experiences of weight management among people with severe mental illness

Jo Wilton

People living with severe mental illness in the UK are more likely to have common risk factors for being overweight, such as reduced access to healthy food, lower incomes and health conditions that limit their mobility. In addition, they have risk factors not typically faced by the general population, such as weight gain related to psychiatric medication and admission to inpatient wards with few opportunities to be physically active.

Weight management is complex, and this is especially true for people with severe mental illness, yet, until relatively recently, little guidance had been tailored to their needs. Based on the first-hand experiences of service users and published research, this report brings into focus some of the challenges and complexities of this subject, and it provides a starting point for those looking to understand what is important to people with severe mental illness in terms of weight management support in the community.

The report is produced by Centre for Mental Health, Rethink Mental Illness and the Association of Mental Health Providers. It was commissioned by the VCSE Health and Wellbeing Alliance (HWA), a partnership between the Department of Health, NHS England, and Public Health England, and 20 national voluntary sector organisations and consortia.

Service users shared their experiences of weight management, which included: the difficulties of remaining motivated during fluctuations in their mental health; the complicated ways in which their eating was related to their emotions; and the lack of long-term support. We also heard from practitioners and commissioners about some of the challenges of providing weight management support to people with severe mental illness.

These included: competing priorities, with attention being focused on the psychiatric side of care often at the expense of issues such as weight; and lack of clarity about who is responsible for coordinating physical health care of people with severe mental illness.

Even without these additional challenges, sustained weight loss is hard to achieve. Our research suggests that, if this is the only criterion of success, services are setting people up for failure which, in turn, can lead them to become discouraged and feel a sense of hopelessness about weight management. More promising, however, are efforts that take the emphasis off numbers (e.g. kilograms lost or reductions in BMI) and instead prioritise weight gain prevention, setting achievable goals, and building people’s intrinsic motivation to adopt healthier behaviours.

Additional resources

We have worked with the above partners to produce a suite of resources to support individuals and teams wanting to learn more about severe mental illness and weight management. You can download a quick guide for service users, a quick guide for practitioners, and a PowerPoint outlining the key issues.

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