Growing evidence links metabolic syndrome and psychiatric conditions. Dual-purpose treatments can enable insurers to provide more targeted and effective solutions, potentially reducing long-term costs associated with chronic comorbidities.
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Mental disorders are metabolic disorders of the brain.鈥
Dr. Chris Palmer, author of the book Brain Energy
Growing evidence suggests metabolic syndrome and psychiatric illnesses are closely linked. In fact, a new subspeciality in psychiatry called metabolic psychiatry explores the overlap of mental health issues with metabolic dysfunction. This article aims to give an overview of this critical relationship and provide insights for insurers moving forward.
Metabolic syndrome (MetS) is a clustering of risk factors, including central obesity, insulin resistance, dyslipidemia, and hypertension, that together increases the risk of Type 2 diabetes mellitus (DM), coronary artery disease, and stroke.1
MetS and its related cardiometabolic components are highly prevalent worldwide. A recent metanalysis revealed that the MetS global prevalence varied from 12.5% to 31.4%, with higher prevalence in Eastern Mediterranean region and Americas.2
A range of studies indicate that metabolic dysfunction affects mental health. A large Swedish, population-based, longitudinal cohort study found that elevated levels of glucose and triglycerides and reduced levels of high-density cholesterol are associated with a higher risk of subsequent diagnosis of depression, anxiety, and stress-related disorders.3 The exact cause for this intricate association is not clear but appears to be multifactorial.4
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Adult obesity has more than doubled globally since 1990, according to the World Health Organization, and adolescent obesity has quadrupled.6 There appears to be a bidirectional relationship between mental health and obesity.
People with obesity had a 55% increased risk of developing depression over time, and depressed people had a 58% increased risk of obesity.7 Obesity also significantly increased the odds for a wide spectrum of psychiatric disorders across all age groups, including depression, psychosis-spectrum, anxiety, eating disorders, and personality disorders.
On the positive side, a UK Biobank study showed that improvement of social isolation and loneliness equated to a 36% decrease in all-cause mortality in people with obesity.8
As with obesity, diabetes also appears to have a mutually influential relationship with mental health. A recent study examined insurance claims data from 2001 to 2018 from more than 500,000 people with Type 1 or Type 2 DM and 350,000 people without DM.
People with chronic diabetic complications had up to a three-times greater risk of having a mental health condition such as anxiety or depression. Those with diabetes and a mental health disorder were up to 2.5 times more likely to experience sustained diabetic complications.9
People with SMI and diabetes experience high long-term mortality rates, with the overall mortality rate ratio of 4.14.10 Eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating are more common in individuals with diabetes compared to the general population, especially in females with Type 1 DM.
In addition, some people with Type 1 DM present with diabulimia, a unique form of disordered eating where insulin doses are intentionally restricted or skipped entirely due to fears of weight gain.11
Prevention and treatment of either MetS or mental illness may help reduce the risk of developing the other. The need is growing to consider diagnosis and treatment of MetS in patients with psychiatric conditions. Lifestyle interventions such as diet and nutrition, counselling, increased physical activity, and improved sleep can help correct the metabolic dysfunction and thereby improve mental wellbeing.
The potential role of ketogenic diet (KD), also known as the metabolic diet, is generating increased interest. KD is characterized by elevated fat and low carbohydrate content that effectively mimics the physiological state of fasting. It is currently being used as a treatment modality for obesity, Type 2 diabetes, and epilepsy.
With growing evidence that psychiatric illnesses are neurometabolic illnesses, KD has shown promise in treatment of SMI. A recent clinical trial investigated the effects of KD on individuals with schizophrenia or bipolar disorder with existing metabolic abnormalities. Results showed that KD therapy resulted in metabolic syndrome reversal in this cohort with SMI.12
A class of pharmaceuticals currently in the spotlight is the glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 RAs). GLP-1 RAs such as semaglutide (Ozempic) mimic the hormone GLP-1 in the body, which helps control insulin and blood glucose levels and promotes feelings of satiety. These drugs are being used to treat patients with type 2 DM and obesity. Evidence supports the positive neuropsychiatric effects of GLP-1 RAs. A recent metanalysis showed that GLP-1 RAs alleviate depressive symptoms in adult Type 2 diabetes patients.13
Initial concerns about adverse mental health effects from GLP-1 Ras have emerged, especially regarding suicidal thoughts and self-harm. A recent study published in the Journal of the American Medical Association showed no association between use of GLP-1 RAs and an increased risk of suicide death, self-harm, or incident depression and anxiety-related disorders.14 However, more research is needed.
Combination management for metabolic dysfunction, including lifestyle changes and new treatment options such as ketogenic diet and GLP-1 RAs, may transform mental health treatment in the future.
For insurers, understanding the intricate relationship between metabolic syndrome and psychiatric illnesses is crucial for developing comprehensive insurance products that cater to the evolving needs of consumers.
With the rising prevalence of these conditions globally, insurers can support specialized health plans and wellbeing programs that not only cover medical treatment for metabolic syndrome and psychiatric conditions but also incorporate preventive care measures and treatments such as the ketogenic diet and GLP-1 receptor agonists.
Insights into the potential for dual-purpose treatments that address both metabolic and mental health issues can enable insurers to provide more targeted and effective solutions, potentially reducing long-term costs associated with chronic comorbidities. Moreover, integrating mental health support and lifestyle intervention programs into insurance plans can enhance patient adherence to treatment protocols, improve overall health outcomes, and reduce the incidence of complications that can lead to high claims.
Such proactive, holistic approaches could distinguish forward-thinking insurers in a competitive market, promoting patient wellbeing while managing financial risk.
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