People with mental disorders often have increased rates of physical disorders, including obesity. This may be due to genetic factors, lifestyle choices, and metabolic effects of psychotropic medications. Obesity is defined as abnormal or excessive fat accumulation that presents a risk to health. A crude population measure of obesity is the body mass index (BMI), which is a person’s weight divided by the square of his or her height. A person with a BMI of 30 or more is generally considered obese. Being obese is a major risk factor for diabetes, cardiovascular diseases, and cancer.

What is the evidence for obesity in people with PTSD?

Moderate to low quality evidence found around half of middle-aged people with PTSD are obese. Higher quality evidence finds this represents a medium-sized increase in risk of obesity when compared to people without PTSD. Moderate to high quality evidence also found large effects of increased rates of obesity in people with PTSD aged between 20 and 30 years and aged over 60 years when compared to age-matched controls.

August 2021

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People with mental disorders often have increased rates of physical disorders, including metabolic syndrome. This syndrome is a risk factor for diabetes and cardiovascular diseases and is defined as a clustering of at least three abnormalities. These include obesity, high blood pressure, high blood triglycerides, low levels of high-density lipoprotein (HDL) cholesterol, and insulin resistance. Any increased risk of metabolic syndrome may be the result of unhealthy lifestyle factors, genetics, and factors associated with medications.

What is the evidence for metabolic syndrome?

High quality evidence finds a small to medium-sized increased risk of metabolic syndrome and its components in people with PTSD compared to general population rates. This effect was found regardless of age, gender, geographic region, setting or population (war veterans or other).

August 2021

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People with mental disorders often show increased rates of co-occurring physical conditions such as heart disease. An increased risk of heart disease in people with PTSD may be a consequence of the disorder itself, as it is associated with dysfunction of the immunological system and excess inflammation. This in turn is associated with significant cardiovascular health problems. Unhealthy lifestyle factors such as smoking and poor diet may also contribute to any increased risk of heart disease.

What is the evidence for heart disease?

High quality evidence finds a small increased risk of coronary heart disease in people with PTSD than in people without the disorder.

Moderate quality evidence finds large effects of lower high-frequency and RMSSD (root mean square of the successive differences) heart rate variability in people with PTSD. These effects were largest in clinical populations. There was also a small increased risk of lower resting respiratory sinus arrhythmia. There was no change in low-frequency heart rate variability. The results remained regardless of medication status, year of publication, study quality score, study methodology, or participant age or sex.

Moderate to high quality evidence finds a small association between increased PTSD symptoms and increased cardio-respiratory symptoms in general.

August 2021

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Diabetes is a state of impaired insulin function, either as a result of reduced insulin production (type 1 diabetes) or reduced insulin responsiveness (type 2 diabetes). Insulin regulates blood glucose levels, and reduced insulin function effectively increases blood glucose levels (hyperglycaemia). This is a dangerous state in the long term, and can ultimately damage the retina, kidneys, nerves, and blood vessels. It is also an established risk factor for cardiovascular diseases including coronary heart disease, major stroke subtypes, and deaths attributable to other vascular causes. Therefore, diabetes is an important comorbidity in people with mental health problems and its prevention and treatment require attention in these populations.

What is the evidence for diabetes in people with PTSD?

Moderate quality evidence finds around 10% of people with PTSD have type 2 diabetes, which represents a small increased risk when compared to people without PTSD. People with PTSD most at risk were older people, war veterans, and non-Hispanic white people.

No reviews were identified that assessed type 1 diabetes in people with PTSD.

August 2021

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Obesity is defined as abnormal or excessive fat accumulation that presents a risk to health. A crude population measure of obesity is the body mass index (BMI), which is a person’s weight divided by the square of his or her height. A person with a BMI of 30 or more on metric measures is generally considered obese. Being obese is a major risk factor for diabetes, cardiovascular diseases and cancer.

People with a severe mental illness are at increased risk of obesity, which may be due to genetic and/or socio-economic factors, lifestyle choices, and metabolic effects of many psychotropic medications.

What is the evidence for obesity in people with bipolar disorder?

Moderate quality evidence finds a small, increase in the rate of obesity in people with bipolar disorder compared to people without the disorder. The rate of obesity in children and adolescents with bipolar disorder is around 15%. Moderate to low quality evidence finds obesity is associated with worse symptoms and functioning. Weight loss following bariatric surgery is similar in people with bipolar disorder as in controls.

October 2021

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Metabolic syndrome is defined by a clustering of at least three interrelated abnormalities including abdominal obesity, hyperglycemia, hypertension, high triglycerides, or low high-density lipoprotein (HDL) cholesterol levels. Metabolic syndrome increases the risk of diabetes and heart disease.

What is the evidence for comorbid metabolic syndrome?

Moderate to high quality evidence finds the prevalence of metabolic syndrome in people with bipolar disorder is around 37%. Rates were highest in New Zealand, Australia and North America, in people treated with antipsychotics, and in older people. Compared to people without the disorder matched to people with the disorder for age and sex, there was a small increased risk of metabolic syndrome in people with the disorder. Moderate to high quality evidence also shows a small increased risk of hypertension. Moderate quality evidence suggests no significant differences in the rates of metabolic syndrome between people with bipolar disorder and people with schizophrenia or major depression.

October 2020

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People with bipolar disorder may show increased rates of unrelated co-occurring illnesses, one example is diabetes. Diabetes is a state of impaired insulin function, either as a result of reduced insulin production (type I diabetes) or reduced insulin responsiveness (type II diabetes). Insulin regulates blood glucose levels, and reduced insulin function effectively increases blood glucose levels (hyperglycaemia). This is a dangerous state in the long term, and can ultimately damage the retina, kidneys, nerves and blood vessels. Consequently, effective management of diabetes is crucial. It is unclear if any increased risk in people with bipolar disorder is purely a consequence of biological risk, the metabolic impact of antipsychotic administration, or unhealthy lifestyle choices, but it is likely a combination of many factors.

What is the evidence for comorbid diabetes?

Moderate quality evidence suggests the overall prevalence of type 2 diabetes in people with bipolar disorder is ~9.4%, with a small to medium-sized increased risk of diabetes when compared to age and gender-matched controls.

October 2021

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People with bipolar disorder show increased rates of co-occurring conditions. Heart disease is a common co-occurring disorder. It is unclear if the increased risk of heart disease is a consequence of the metabolic impact of medications or unhealthy lifestyle choices, or most likely, a combination of both.

What is the evidence for heart disease in people with bipolar disorder?

Moderate quality evidence suggests small increased risks of cardiovascular disease, congestive heart failure, and death due to cardiovascular disease in people with the disorder compared to people without the disorder. These findings were adjusted for other variables that may have explained the increased risks. Moderate to low quality evidence also suggests a large effect of reduced heart rate variability in people with bipolar disorder. High quality evidence finds no increases in rates of myocardial infarction.

October 2021

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