Exploring Factors Implicated in Secure Psychiatric Inpatient Weight Gain and Obesity

People who have serious mental illness experience greater levels of early mortality compared to their mentally healthy counterparts (Chesney, Goodwin & Fazel, 2014). This early death is largely attributed to physical illnesses that are associated with obesity. Individuals who have serious mental illness and who are treated in secure psychiatric hospitals experience significant increases in their weight upon admission. Several factors predispose people with serious mental illness to weight gain and obesity. This thesis explored the factors that mediate weight gain and obesity maintenance in secure psychiatric inpatients. Study 1 used routine patient data to explore changes in body weight following admission into secure services. This established that patient’s body weight on admission was a significant predictor of weight gain over the first twelve weeks of secure inpatient treatment. Study 2 explored the influence of cognitive factors known to influence eating behaviour, the data demonstrated that although the patient group displayed attentional bias to food cues this was not predictive of weight gain. Levels of emotional and disinhibited eating were associated with weight gain over 3 months. Study 3 explored psychological predictors of weight gain; it was found that anxious-preoccupied attachment style was associated with weight gain over 6 months. Study 4 explored staff member’s views on how the secure psychiatric environment impacts on patient weight gain and obesity. A thematic analysis highlighted 5 themes: secure service culture, food culture, poor diet versus lack of physical activity, poor mental health, and weight management initiatives. The results of this thesis are discussed in terms of theoretical perspectives of psychological factors and the wider implications for understanding secure psychiatric inpatient obesity