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A Pound of Cure

Network, Spring/Summer 2006

You’re a strapping 16-year-old high school student. You’re active, you play soccer and other sports. By all accounts, you’re considered a “health nut.” You’re six feet tall and a trim 180 pounds. But by age 20 your weight has shot up to 250 pounds. And before you know it, it’s 315.

Chris Johnson knows what it’s like to gain weight. At the age of 18, Chris began to experience the early signs of psychosis. By the time he was 19, he had been diagnosed with schizophrenia and was prescribed the antipsychotic medication risperidone. Chris later switched from risperidone to clozapine, and after several years of treatment, he was well into recovery — his psychotic symptoms were much improved, his thinking was much clearer. But his weight was way, way up.

In Canada, adult obesity rates have more than doubled over the past 25 years. People with psychotic illnesses are at increased risk for weight gain and related conditions, such as diabetes and heart disease. Even so, medical attention is often focused on managing the psychiatric illness at the expense of other serious conditions.

“Weight gain is a very serious mental health issue which isn’t actually recognized by many physicians or many clients and their families,” according to Dr. Suzanne Archie, clinical director of the Cleghorn Early Intervention in Psychosis Program at St. Joseph’s Healthcare, Hamilton, and a founding member of the Ontario Working Group on Early Intervention. “It’s quite complex because the illness schizophrenia, in and of itself, increases the risk for weight gain, just as the illness depression also increases the risk for weight gain.”

The reasons for this are not fully understood. “It may be related to some of the chemical imbalances that occur with these disorders,” explains Dr. Archie. “There are changes in hormones. Some of these changes can alter the brain’s regulation of hunger and metabolism — so these chemical imbalances can change not just mood, but cravings for sweets.”

“Another part of it is that the symptoms that people experience impair their ability to engage in physical activity or to maintain healthy lifestyle habits. So if you lack motivation, energy, or drive, then that’s going to impact on weight gain.”

“And then there are social factors. If you have a change in functioning and you’re not able to work consistently, then you may have to go on disability, and then you may not have the budget to buy fresh foods.”

“But probably the biggest factor is the medication,” Dr. Archie concludes. “The medications themselves promote weight gain. They have an effect on appetite so people have a hard time knowing if they’re full. So they can eat a lot more than they used to. The weight gain — and perhaps the medications themselves — can then lead to changes in their triglycerides, cholesterol, and blood sugar, which can increase the risk for diabetes and heart disease.”

Reflecting on the role that food came to play in Chris Johnson’s life, especially in the earlier days of his illness, his mother Charlotte observes: “It’s almost the only kind of gratification [a person with a psychotic disorder] has at that point because they’ve lost everything else. Chris couldn’t read. He couldn’t concentrate. What else is there to do? He ate, and he started to smoke — about 40 cigarettes a day for a couple of years. And that was very unusual for him.”

The fallout from weight gain can be significant, not only in the way it exacerbates medical risk factors, but also in terms of the psychological and social experience of day-to-day life.

When people are overweight, they are stigmatized by society. “They are already dealing with the stigma of mental illness and now they also have to deal with the stigma of being overweight,” says Dr. Archie. “People do not understand, and blame them — and that’s really unfair. It makes it very discouraging. So medication side-effects continue to be a big issue in helping people get better. Weight gain in particular causes problems with quality of life, low self-esteem, self-image, and body image.”

Compliance too is at risk. People may stop taking their antipsychotic medications because they don’t want to gain weight, explains Dr. Archie. “If they’ve gained 15 or 20 pounds and they’re scared they might gain another 15 or 20 pounds, then that fear can lead to them stopping their medication.”

Despite that possibility, Chris didn’t stop taking his medication. He is, in fact, still taking clozapine. But the good news is that he’s managed to lose more than 50 pounds. He attributes his success to several lifestyle changes he’s made.

“There are a couple of factors,” he explains. “In the past I was eating lots of food, just pigging out on lots of stuff as a coping mechanism. We’d buy a pack of 24 popsicles and I’d eat them all. Or I might get two pounds of candy and I’d eat it. So I cut down on the foods I eat too much of. That’s one thing.”

“The second thing is I’m more active. I’m doing stained glass creations, and I walk a lot now. I’m active. So that probably helps with the weight loss.”

With his family’s support and encouragement, Chris joined a local fitness facility. “I started my exercising last summer,” Chris recalls. “I was watching a show about a bounty hunter and it showed him lifting weights and I thought, ‘I should do that.’ I used to do a lot of that in high school.”

Now 25, Chris has his weight down to 265. He’s changed both his eating and his exercise habits, and he has his sights set on 220 pounds. “One strategy is to eat breakfast. I used to have lunch and then have a huge supper and then pig out all night. I’m also on a Weight Watchers diet. I’ll have oatmeal for breakfast, and it helps cut the cravings for sweets.”

Dr. Archie’s clinical findings confirm Chris’s success as more than an anomaly. She has observed that people who continue to exercise regularly tend not to gain the weight. But the exercise must be consistent. Basically, it’s what everyone should be doing — a minimum of 30 minutes, five or six times a week, at a fairly vigorous pace. Walking is okay if you feel a little hot and sweaty; it’s got to burn the calories.

Even though it can be difficult to exercise during some stages of the illness, Chris believes that some degree of activity, no matter how little, is possible at virtually every point — and that every little bit helps.

“I call them baby steps,” he says. “For instance, someone with a first episode may not be able to take huge steps, but they might be able to do baby steps in that direction. So if I go to the gym three or four times a week, well maybe they could go twice a month. It’ll be different for each person.” Chris finds lifting weights is fun and immediately gratifying. Over time, he has added in some cardio training. He finds that exercise helps with depression and is generally therapeutic.

“I don’t think we even knew the potential for weight gain was so great,” says his mother Charlotte. “But you know what, even if we’d been told, the whole family was in crisis and working through the stages. We all had to come to terms with the fact that he has this illness and will have it for the rest of his life. I don’t know if anybody had the energy to focus on physical health until, as Chris says, he became more well mentally and his thinking processes cleared. Once his depression was dealt with, only then could he begin.”

“My mind got healthier, so I had more discipline, and more of a game plan,” says Chris. “So as soon as my mind started getting better, my body started to get better too. That’s what allowed me to start vigorously working out.”