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Mental health: why dietitians matter

By Paula Goodyer

There’s a fact about mental health that dietitian Scott Teasdale wants to change: the one that says people with severe mental illness such as schizophrenia, bi-polar and other psychotic conditions die 20 years earlier than the rest of the population.

“A key reason is weight gain associated with anti-psychotic medication which in turn increases the risk of heart disease and diabetes. Weight gain can start within 12 weeks of starting medication and build to an average of 12 kilos after two years of treatment and 19 kilos after four years,” says Teasdale, a mental health dietitian with Keeping the Body in Mind, a community based multidisciplinary program in Sydney’s Bondi, targeting young people experiencing psychosis for the first time. 

Although medication improves symptoms of psychosis, side effects can include increased hunger, food cravings, altered taste and sedation. Combined with other problems like low income, low motivation and low confidence, it’s a perfect storm for gaining weight.

Yet weight gain isn’t inevitable, stresses Teasdale whose 2016 study  with clients at KBIM found that a 12 week intervention by dietitians and Accredited Exercise Physiologists in the early weeks of starting medication resulted in only a little weight gain - 1.8 kilos - and no significant changes in waist measurement compared to a control group of young people receiving standard care who gained an average of 7.8 kilos and 7 .5 cm around the waist.  Clients taking part in the intervention had consultations with a dietitian, weekly shopping tours and group cooking classes.

A 2017 systematic review and meta-analysis of nutrition interventions in severe mental illness by Teasdale and colleagues published in The British Journal of Psychiatry backed this up. It found these interventions led to significant weight loss, decreased BMI and lower blood glucose levels. The biggest effect was in interventions led by dietitians and interventions delivered at the start of medication.

Although the physical health of people with mental illness has been neglected in the past, he believes this is changing.

“Research in this area is expanding. More services are replicating what we’re doing - and it’s an area rapidly opening up to dietitians,“ says Teasdale, a PhD candidate with the School of Psychiatry at the University of NSW.

As for building rapport with clients and motivating them, Teasdale says it’s important to understand the challenges clients may experience including the symptoms of their illness.  

“If someone is anxious or hearing voices, bombarding them with questions or information won’t work,” he says.

His advice:

  • Keep questions short.
  • Don’t expect perfection. As an example, Teasdale cites a client who’s had schizophrenia for many years, is very overweight and has had difficulty improving his diet - but who’s now managed to cut out soft drink and include vegetables with dinner. “For someone who’s had a serious mental illness for a long time, this is real progress.”  
  • Don’t underrate small weight losses - they’re a measure of success in a client group which gains weight easily.
  • If you want clients to remember strategies you suggest, write them down. They may see multiple health professionals and have a lot to remember.  
  • Be practical - show them how to cook something cheap and healthy and show them how it works for their wallet.
  • Make use of group sessions - they help people make friends and motivate each other.
  • Don’t give up - it can take multiple sessions to build rapport.

What’s next for Scott Teasdale?

“I’m extending my research to look at the link between binge eating and food addiction and severe mental illness as a driver of weight gain,” he says. “Rates of disordered eating are higher in people with mental illness, especially severe mental illness - this could be a mixture of side effects from the drugs but also the effects of illness on the brain including the impact on impulse control.”