The British Journal of Forensic Practice

Purpose – Patients in secure units are at high risk of obesity because of antipsychotic medication, restrictions on freedom, and poor motivation to eat healthily and exercise. The aim of this paper is to investigate how consultant forensic psychiatrists address weight management, particularly with respect to inpatients.

Design/methodology/approach – Based on a review of the literature, a structured questionnaire was developed and piloted locally. After revising the questionnaire, it was sent to all 442 consultant psychiatrists listed by the Royal College of Psychiatrists as having a special interest in forensic psychiatry.

Findings – A total of 183 usable questionnaires were returned (response rate 45.9 per cent). Most respondents monitored patients' weight and had some access to a dietitian. Respondents rated a median of 40 per cent of their inpatients as obese. A total of 68.9 per cent said their patients did not have unrestricted access to food. Use of weight loss drugs such as orlistat was infrequent. A few patients had been referred for bariatric surgery but most had been judged unsuitable.

Research limitations/implications – The responses reported in this paper are based on participants' self-report and have not been confirmed by independent observation. Further research is needed to determine which weight loss measures are effective for psychiatric patients in real-life situations.

Practical implications – Obesity appears to be common among forensic inpatients despite weight monitoring, dietetic interventions and exercise programmes. Comprehensive and continuing efforts are needed to help patients lose weight and lead healthier lifestyles.

Originality/value – This survey reports on clinicians' views and clinical practice.