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Introduction
People with severe mental illness have an approximately threefold risk of dying from coronary heart disease and stroke compared to the general population ([14] Osborn et al. , 2007). Many patients with severe mental illness are overweight or obese. Obesity is associated with increased morbidity and mortality from cardiovascular, respiratory, gastrointestinal and metabolic disorders and certain cancers ([19] Solomon and Manson, 1997). Those who are morbidly obese are at greater risk. People with severe mental illness frequently eat a poor diet high in fat, sugar and calories. For example, [9] McCreadie et al. (1998) compared the dietary intake of chronic schizophrenic patients living in supported accommodation with normal matched controls. Patients consumed less fruit and vegetables and less fibre than controls and their saturated fat intake was higher than the suggested UK requirement.
Despite the advent of community care, a significant number of psychiatric patients continue to require long-term institutional care. Some of these require treatment under the Mental Health Act (1983), amended in 2007, in locked units. In secure settings, patients may have limited access to fresh air and exercise because of unstable mental state, unfavourable risk assessment or insufficient staff to escort them off the unit. In addition, those who have access to exercise do not always make use of facilities because of poor motivation. Patients may consume large amounts of confectionary, crisps, high calorie-carbonated drinks and take-aways in addition to the meals provided. Antipsychotic drugs, particularly, the second generation drugs clozapine and olanzapine, have a propensity to cause significant weight gain ([2] Gebhardt et al. , 2009). Weight gain induced by second generation antipsychotic drugs is thought to be mediated by histamine H1 receptor-linked activation of hypothalamic AMP-kinase ([6] Kim et al. , 2007). In patients treated with clozapine, most weight gain occurs within the first 6-12 months of treatment but does continue into the third year of treatment ([21] Umbricht et al. , 1994). Weight-gain and associated metabolic outcomes are dose dependent for clozapine and olanzapine ([18] Simon et al. , 2009). Other psychotropics, such as valproate, lithium and certain antidepressants can also contribute to weight gain.
Metabolic syndrome is a term used to describe a combination of medical disorders that increase the risk of developing cardiac and...