Adolescent Inpatients Gain Weight in Mental Health Facilities

Mental disorders predispose patients to weight gain, regardless of age. Psychiatric patients are more likely to develop metabolic syndrome and the poor health consequences that follow. For the most part, older patients develop metabolic syndrome, but adolescents with mental illness do, too. Health care practitioners do not completely understand why adolescents tend to gain weight during inpatient mental care. How do socio-demographic, clinical, and pharmacological risk factors contribute to weight gain?

An article published in the March 2015 issue of Journal of Child and Adolescent Psychopharmacology reported on a prospective study of 120 Israeli day-clinic patients hospitalized more than 30 days and fewer than 365 days. The patients were 52.7% male, between 11 and 20 years old, and admitted between 30 and 365 days. The researchers excluded patients with restrictive eating disorders (ie, bulimia) from the study. Patients attended the day program 6 days a week for 7 hours daily (08:00—15:00) and engaged in various clinical and educational activities. They participated in 4 hours of physical activity weekly. The clinic provided breakfast and lunch.

Psychotropic polypharmacy is common in youth treated in a psychiatric day care and inpatient settings. It conveys a potentially high cardiometabolic side effect burden in young patients, and in this study, 13% of patients were taking 3 or more drugs.

Over the study period, patients’ BMI increased by a mean of 0.5. However, only 26 of the 120 patients gained weight. Males were 3.5 times more likely to gain weight, and lighter patients were more likely to gain weight. A surprisingly high number of the weight-gaining patients (24) were admitted at normal weights. At the study’s end, the distribution of normal weight, overweight, and obese patients was unchanged.

Factors protective against weight gain included lower antipsychotic use, well structured inpatient setting, and nutritional monitoring. Age of admission, diagnosis, length of stay, and number of medications did not affect weight gain risk.

The mean length of stay (141 days) may be too short for lipid and glucose effects of weight gain to be apparent.

Providers should note any weight gain that pushes patients toward overweight as an opportunity to intervene. An intervention can help avoid metabolic syndrome in patients with mental disorders. Weight gain during youth is predictive of later obesity and the associated co-morbidities.