Abstract
Overweight and obesity are common in severe and chronic psychiatric disorders. Up to 50% of patients suffering from schizophrenia or bipolar disorder are obese. The mortality rate is 4.5 times higher than in the general population, mainly due to metabolic and cardiovascular disorders. Numerous factors, interconnected by vicious circles of mutually reinforcing adverse physiological adaptations, contribute to this association. Close collaboration between mental health and somatic health specialists is essential for coordinated, individualized care. This will involve an integrative assessment to understand the factors behind the genesis of obesity, the consequences in terms of co-morbidity, and the possibilities of therapeutic options, including the ability to access treatment. Treatment paths should also include early detection of subjects at risk of weight gain, close monitoring of the metabolic effects of psychotropic drugs, hygienic-dietary measures and non-drug interventions. In addition, the role of bariatric surgery and obesity drugs requires more detailed investigations in these patients.