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Management of obesity in the psychiatrist's office

Obesity is an epidemic in the developed countries, and the rest of the world is quickly catching up. Patients with severe mental illness (SMI) suffer from two to three times higher rates of obesity 1, and this has translated into much higher rates of obesity-related morbidity and premature mortality in this population 2. This raises the question if obesity management should be added to the expanding responsibilities of psychiatrists. Our answer to this question is a resounding “Yes”. 
 
First, obesity is a behavioral problem that involves eating too much and moving too little. The most robust evidence for effective management of obesity is for behavioral interventions, usually referred to as lifestyle interventions. These are typically based on principles of cognitive behavioral therapy and social cognitive change. Psychiatrists are experts of behavioral change and are equipped with the tools to employ against this disease. 
 
Second, it has become abundantly clear that psychiatric medications, especially antipsychotics, play an important role in the increased rates of obesity among patients with SMI 3. While it is preferable to prevent the excess weight gain due to psychotropic medications, this is not always possible. Many patients will already be overweight or obese at the initial visit to a psychiatrist. Management of overweight and obesity is therefore as much a part of psychiatrists' duty as the management of other medication side effects, ranging from movement disorders to impaired sexual function. Obesity is also associated with increased rates of depression, decreased quality of life, and increased stigma in this population. Obesity is a calamity that needs to be managed in the psychiatrist's office.