Psychological Well-Being Comes Before Physical Fitness

In our clinical observations, we see people driven by an urgent desire for a slim body to take appetite-suppressing medications, sometimes without consulting a specialist physician. We also notice higher rates of depression and mania, while young people who take stimulants to build muscle may experience psychotic episodes and sexual dysfunction as side effects of these medications. Even natural weight-loss regimens may negatively affect a person's mental state, as clinical research confirms. In a study tracking depressive symptoms among 194 participants in a weight-loss program, 13.9% reported notable increases in depressive symptoms, while the prevalence of suicidal ideation was 3.6%.

On the other hand, medication-related weight gain is a common side effect when medications are used in psychiatric treatment. Some may consider it a positive outcome if they are underweight, and gaining a few kilograms may be acceptable for those of moderate weight. However, it can pose a challenge for people who are already overweight: they may hesitate to take the medication despite needing it, or stop taking it without even consulting the psychiatrist overseeing their care after noticing weight gain.

According to a 2014 review of eight studies, up to 55% of psychiatric patients taking modern antipsychotics experience weight gain, a side effect that appears to result from disruption of the chemical signals that control appetite.

After reviewing the medications commonly used to treat the condition and ruling out those that do not cause weight gain because they are unsuitable for that condition, the psychiatrist may have to prescribe medications that increase weight. However, a psychiatrist prescribing them and a patient adhering to them do not mean that obesity is inevitable, nor do they mean surrendering to the weight gain and doing nothing about this unwanted side effect. According to a 2015 study of 200 people with severe mental illness who had been taking antipsychotics for at least one month and were overweight or obese, behavioral interventions helped people maintain their weight while taking these medications. The study found that a personalized diet and exercise plan benefited 40% of participants, who lost at least 5% of their body weight after six months.

We should also remember that these medications were prescribed by a psychiatrist to treat an illness or control a symptom. If we compare their benefits in improving the patient's mental health with the side effect of weight gain, the balance will inevitably favor the benefit. Better mental health spares a person many of the difficulties caused by mental illness. For example, for a person with psychosis to gain weight is less harmful than responding to a voice whispering in their ear, "Kill your father," or jumping from a height and ending their life!

Finally, monitoring body weight and choosing medications wisely are among the best ways to prevent weight gain in patients taking psychiatric medications. We also encourage people receiving mental health treatment to adhere to their prescribed treatment and remain in contact with their psychiatrist so they can reach a shared decision about medications that suit the condition and have side effects the patient finds more acceptable.

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