Perceptions on health and lifestyle behavior of obese patients with a severe mental illness in forensic psychiatric care: the influence on motivation to improve health behaviors and lose weight

Abstract

Background. Within in forensic care there is little attention for somatic wellbeing of patient with a severe mental illness (SMI). Patients with a SMI face the probability of a shorter life expectancy, caused by an increased risk on physical illnesses. Obesity is one of the greatest challenges. It is necessary to obtain a understanding about the perceptions of SMI patients on health, weight and lifestyle behavior. Aim. Investigating the perceptions of obese patients with a SMI in forensic psychiatric care on their physical health, weight and lifestyle behavior, to explain how these perceptions influence the motivation for changing lifestyle behavior regarding obesity. Method. Generic qualitative approach was used, following the principles of the Grounded Theory (GT). Twelve participants from forensic psychiatric hospitals were purposefully sampled. Semi structured face-to-face interviews were conducted and analysed following GT-methodology. Results. Participants were aware of their obesity and express the desire to lose weight. They have adequate knowledge on healthy lifestyles, but do not apply this knowledge to change their lifestyle. This is mainly the result of lacking motivation caused by personal, interpersonal and contextual, some related to the forensic setting. The negative aspects of their living situation overshadowed the positive intentions, causing no behavior change. Conclusion. The negative aspects of a mandatory situation overshadow the positive intentions to change lifestyle behavior and lose weight. Subsequently, patient lack motivation to actively make healthier lifestyle choices. This phenomenon seems to be a common behaviour for mentally healthy as well but attention should be given to the specific setting these patients reside in. Recommendations. Patients benefit from participating in creating a healthy eating environment. Psychoeducation on the side-effects of medication may help to understand medication on its own does not cause obesity. Future research should focus on the needs of patients with a SMI in forensic care concerning lifestyle interventions.