Metabolic Health Impacts in Severe Mental Illnesses

Severe mental illnesses such as schizophrenia, bipolar disorder and schizoaffective disorder are associated with a markedly elevated burden of metabolic comorbidities. Patients experience higher rates of obesity, insulin resistance, dyslipidaemia and type 2 diabetes than the general population, contributing to an estimated loss of 10–20 years in life expectancy. This excess arises from a complex interplay of factors, including intrinsic disease mechanisms, antipsychotic pharmacotherapy, lifestyle determinants and socio-economic disadvantage. Many antipsychotic agents induce weight gain and alter glucose and lipid metabolism to varying degrees, while sedentary habits, poor diet quality, smoking and substance misuse further amplify cardiovascular risk. Emerging evidence suggests shared genetic and inflammatory pathways between psychosis and metabolic dysfunction, pointing to a bidirectional relationship. The global significance of these findings is underscored by the high prevalence of severe mental illness worldwide and by the fact that metabolic complications often remain under-recognised or undertreated in psychiatric settings. Integrating routine metabolic monitoring with tailored lifestyle interventions and individualised medication choices is essential to mitigate long-term health consequences and to improve overall outcomes.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Metabolic Health Impacts in Severe Mental Illnesses publication trend

The graph below shows the total number of articles in metabolic health impacts in severe mental illnesses across all publications each year (not limited to Nature Index journals).

Technical terms

Body mass index (BMI): A measure of body fat based on weight in kilograms divided by the square of height in metres.

Dyslipidaemia: An abnormal lipid profile, typically elevated total cholesterol, low-density lipoprotein cholesterol or triglycerides, or reduced high-density lipoprotein cholesterol.

Insulin resistance: A reduced responsiveness of cells to insulin action, often preceding type 2 diabetes.

Metabolic dysregulation: Disturbances in normal metabolic processes, including glucose and lipid homeostasis.

Metabolic syndrome: A cluster of conditions—central obesity, hypertension, dyslipidaemia and hyperglycaemia—that together increase cardiovascular risk.

References

1. Excess Mortality, Causes of Death and Life Expectancy in 270,770 Patients with Recent Onset of Mental Disorders in Denmark, Finland and Sweden. PLOS ONE (2013).
2. Life Expectancy at Birth for People with Serious Mental Illness and Other Major Disorders from a Secondary Mental Health Care Case Register in London. PLOS ONE (2011).
3. Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis. The Lancet Psychiatry (2019).
4. Motivating factors and barriers towards exercise in severe mental illness: a systematic review and meta-analysis. Psychological Medicine (2016).
5. Almost All Antipsychotics Result in Weight Gain: A Meta-Analysis. PLOS ONE (2014).