Clinical Summary: Mind and Metabolism in Crisis: US Mortality Involving Obesity and Psychiatric Disorders—Trends, Disparities, and ARIMA Projections
Patients with psychiatric illness and obesity face overlapping metabolic, behavioral, and treatment-related risks, yet national mortality patterns for this combination have been poorly defined. This analysis shows a steep long-term rise in US deaths involving both conditions, with clear disparities by sex, age, ethnicity, and geography that matter for whom psychiatrists screen, monitor, and prioritize for integrated care.
Key Findings
- Between 1999 and 2023, the age-adjusted mortality rate rose from 6.0 per million in 1999 to a peak of 82.2 per million in 2021, before declining to 66.6 per million in 2023; joinpoint regression showed the sharpest recent increase from 2018 to 2021 (APC 20.64%, P<.05) and a subsequent decline from 2021 to 2023 (APC −9.35%, P<.05).
- Substance use disorders carried the greatest mortality burden, with a weighted mean AAMR of 29.77 (95% CI: 29.61 to 29.91), compared with 2.60 (95% CI: 2.56 to 2.64) for mood [affective] disorders, 2.21 (95% CI: 2.17 to 2.24) for organic mental disorders, 1.00 (95% CI: 0.96 to 1.03) for schizophrenia, schizotypal, and delusional disorders, and 0.67 (95% CI: 0.63 to 0.69) for anxiety disorders (F41).
- Adjusted mortality was higher in males than females (IRR =1.41, 95% CI: 1.30–1.52, P<.001), and the highest relative rate by age was in individuals aged 65–74 years versus those aged 25–34 years (IRR =8.34, 95% CI: 7.67–9.06, P<.001).
- Non-Hispanic decedents had more than twice the adjusted mortality rate of Hispanic decedents (IRR=2.66, 95% CI: 2.46–2.87, P<.001), and the Midwest had the highest regional risk versus the Northeast (IRR=1.21, 95% CI: 1.10–1.33, P<.001).
- ARIMA (0,1,0) with drift projected that AAMR will rise from 55.1 in 2025 (95% confidence interval [CI]: 51.4–59.0) to 74.2 in 2030 (95% CI: 66.1–82.8).
Mortality involving co-occurring obesity and psychiatric disorders has risen markedly in US adults and remains concentrated in patients with substance use disorders, older age, male sex, non-Hispanic ethnicity, and Midwestern residence. Psychiatric care should treat metabolic risk assessment and obesity management as core components of care, not peripheral issues.
Practice Implications
- Prioritize routine metabolic screening and weight management in psychiatric practice, especially for patients with substance use disorders, which had the highest weighted mean AAMR at 29.77 (95% CI: 29.61 to 29.91).
- Do not limit cardiometabolic surveillance to psychotic disorders; mood [affective] disorders had a weighted mean AAMR of 2.60 (95% CI: 2.56 to 2.64), including 1.95 (95% CI: 1.91 to 1.99) for major depressive disorder (F32–F33).
- Use a lower threshold for intensive follow-up in higher-risk groups identified here, including males (IRR =1.41, 95% CI: 1.30–1.52, P<.001), adults aged 65–74 years (IRR =8.34, 95% CI: 7.67–9.06, P<.001), and non-Hispanic patients (IRR=2.66, 95% CI: 2.46–2.87, P<.001).
- Build or refer to integrated care pathways that combine psychiatric stabilization, metabolic screening, and weight management, particularly in underserved rural and Midwestern settings where mortality burden was higher.
