In hindsight, considering how much stigma and psyche impact people dealing with obesity and type 2 diabetes, this positive side effect was to be expected. But now science puts on paper the value of this approach also for mental health.
The reasons? On the one hand, these treatments help to counteract weight gain linked to some psychotropic drugs, which can compromise adherence to the treatments dictated by the specialist. But that’s not all: they could even help reduce the risk of depression and bipolar disorder.
This is what the experts from the Italian Society of Neuropsychopharmacology (Sinpf) say, which recently closed in Milan, and which dedicated an entire session to the interaction between these therapies and mental health.
How much obesity weighs
According to the latest WHO estimates for 2022, there are 890 million adults with obesity (16%) and 2.5 billion are overweight (43%) in 2022. According to ISTAT data from 2023, there are almost 23 million adults in Italy who are overweight, i.e. with a body mass index (BMI) equal to or greater than 25, representing almost half of the adult population (46.3%). Of these, approximately 5.8 million (equal to 11.8%) are obese, with a BMI equal to or greater than 30.
Again: in Italy over one in 4 children between the ages of 3 and 17 (equal to 26.7%) is overweight.
All of this, as the recently presented report on Obesity by Auxologico IRCCS points out, with a marked territorial gradient between children and young people, there is a marked territorial gradient, which has consolidated over time. The prevalence of overweight and obesity increases significantly from the North to the South of the country, outlining a geography in which seven of the ten regions with values higher than the national average are located in the South. The highest levels, with over a third of minors overweight, are recorded in Campania (36.5%), Calabria (35.8%), Basilicata (35.0%) and Sicily (33.8%). On the contrary, the lowest percentages are observed in the autonomous provinces of Trento and Bolzano (15.1% and 17.4%), in Friuli-Venezia Giulia (18.4%) and in Lombardy (19.5%).
The impact of stigma
The problem, more generally, is that in recent decades, obesity has shown constantly increasing growth rates at a global level, to the point of now being considered a real epidemic, with all the implications this entails for public health. All this entails an important commitment in terms of health and public spending, as metabolic syndrome not addressed and treated in the correct time and manner at specialized health centers inevitably leads to complications which, as documented and illustrated in the volume, affect practically all the vital organs of the patient suffering from obesity.
It is also of fundamental importance to treat patients already affected by the pathology, but also to implement the prevention and early diagnosis of the prodromes that can lead to severe obesity with all the corollaries of related alterations and diseases.
In short: obesity is a chronic and relapsing disease, not simply linked to incorrect eating and sedentary habits. And it is essential to reduce the stigma that still surrounds this condition, given that we are not faced with a simple lack of willpower. The pathological picture requires early diagnosis, management and continuity of care. Only by overcoming prejudices and discrimination will it be possible to guarantee effective and dignified treatment paths for all people with obesity.
Drugs active on weight gain from psychiatric drugs
At the Milan conference there was talk of a study that appeared in JAMA Psychiatry, conducted by experts from the Charité University Hospital in Berlin. Research shows that semaglutide can help overcome one of the biggest obstacles in treating psychosis: drug-induced weight gain.
“This is a problem that often leads patients to discontinue treatment or develop serious metabolic complications. The study results show that the use of semaglutide in patients on antipsychotic therapy led to an average reduction in body weight of 8% in just 24 weeks, while the use of liraglutide led to a reduction of approximately 5%”
explains Matteo Balestrieri, former professor of psychiatry at the University of Udine and co-president of Sinpf.
“For the first time we have an effective tool not only to treat the mind, but to protect the body of psychiatric patients, drastically reducing the risk of diabetes and cardiovascular diseases related to therapy. GLP-1s act on the satiety centers in the brain, counteracting hyperphagia (excessive hunger) often caused by psychotropic drugs”
adds Claudio Mencacci, psychiatrist, director emeritus of the Neuroscience department of the Fatebenefratelli Sacco hospital in Milan and co-president of Sinpf.
Another research, published in BMC Psychiatry and conducted by experts from Seoul National University Biomedical Informatics, investigated the genetic link between the GLP-1 receptor and psychiatric disorders.
“The results speak clearly: greater genetic activity of the GLP-1 receptor is associated with a reduction in the risk of major depression and bipolar disorder. It is the first genetic evidence to suggest that the GLP-1 system does not only regulate insulin, but directly influences affective regulation circuits, thus confirming the potential role of GLP-1 agonists in the treatment of depression and excessive food and alcohol use disorders”
says Balestrieri.
Towards precision psychiatry
Body and mind are therefore profoundly interconnected through metabolism. And these data suggest that the brain and metabolism speak the same language.
“This evidence opens the way to precision psychiatry, where metabolic drugs could become fundamental adjuvants in the treatment of mood disorders”
Mencacci specifies.
“It means treating the patient in a holistic way, stabilizing both the metabolism and the psyche. Furthermore, evidence suggests that genetics can help identify who could benefit most from these treatments. Positive effects are also present with respect to adherence to treatments: by reducing aesthetic and metabolic side effects (weight gain), patients are more likely to follow psychiatric therapies.”
