People with schizophrenia are at a greater risk of developing type 2 diabetes than the general population. Diabetes is seen in 1 in 5 people with schizophrenia. Metabolic syndrome occurs in 1 in 3 people with schizophrenia.

What is causing these physical illnesses in people with schizophrenia? Is this just due to our lifestyle factors? How significant a role does medication for schizophrenia play in developing these illnesses? And how can we manage to stay physically healthy with schizophrenia?

Hosts Rachel Star Withers and Gabe Howard share their struggles with weight issues and connections to mental disorders.

Guest Fran Hinson, a registered nurse, personal trainer, and behavior modification specialist, joins us. She works with special populations to help create small, sustainable habits inside and outside the gym.

Fran Hinson, Fitness Trainer and Registered Nurse

Fran Hinson is passionate about helping people step into their new lives. She has worked in the health and fitness industry for 15 years as a registered nurse, an ACE-certified personal trainer, and a group fitness instructor. She holds a certification as a Behavior Modification Specialist. Fran uses these tools to help her clients make small, sustainable habits inside and outside the gym. You will not become healthier overnight. It happens one small, sustainable step after another.

“My style is assessment, small changes, execution, and repetition. I will work with you to make small changes to your daily routine, supporting your progress and keeping you accountable along the way.” — Fran Hinson

Rachel Star Withers

Rachel Star Withers creates videos documenting her schizophrenia, ways to manage and let others like her know they are not alone and can still live an amazing life. She has written Lil Broken Star: Understanding Schizophrenia for Kids and a tool for schizophrenics, To See in the Dark: Hallucination and Delusion Journal. Fun Fact: She has wrestled alligators.

To learn more about Rachel, please visit her website, RachelStarLive.comm.

Gabe Howard

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without. To learn more about Gabe, please visit his website,

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Schizophrenia. Hosted by Rachel Star Withers, an advocate who lives openly with Schizophrenia. We’re talking to experts about all aspects of life with this condition. Welcome to the show!

Rachel Star Withers: Welcome to Inside Schizophrenia, a Healthline Media podcast. I’m your host, Rachel Star Withers, here with my great co-host, Gabe Howard. People with schizophrenia are at a greater risk of developing type 2 diabetes than the general population. In fact, diabetes is seen in 1 in 5 patients with schizophrenia. Metabolic syndrome occurs in 1 in 3 patients with schizophrenia. What is causing these physical illnesses in people with schizophrenia? Is this just due to our lifestyle factors? How big a role does medication for schizophrenia play in developing these illnesses? And how can we manage to stay physically healthy with schizophrenia? Joining us today is registered nurse, personal trainer and behavior modification specialist Fran Hinson, who works with special populations to help create small, sustainable habits both inside and outside of the gym. Gabe, when we’re talking about the physical side of schizophrenia, like is if do people with serious mental disorders like not have to deal with enough like right.

Gabe Howard: Right? Right, yeah.

Rachel Star Withers: We’re already dealing with the mental stuff. And then you find out that there’s all these physical illnesses that seem to be very connected to serious mental disorders, like schizophrenia.

Gabe Howard: It really turns out that humans can’t separate mental health and physical health out because it’s all into one person. I don’t know who came up with the idea that mental health and physical health were two separate things.

Rachel Star Withers: It does make you wonder though, like are there certain illnesses that are more connected than others? What in the world does diabetes have to do with schizophrenia? Diabetes tends to have issues with what you eat and insulin. Schizophrenia deals with your brain. And the people always talk about the chemicals in your brain. These are two separate things, but people with schizophrenia are at a higher than average risk of physical illnesses and have earlier death than the general population. Cardiovascular, respiratory and the metabolic disorders. And if you’re like me, you’re kind of like, wait, what exactly is a metabolic disorder? That’s where we’re talking about your body processing and distributing the macronutrients such as protein, fats, carbohydrates. Conditions like high blood pressure, heart disease, high cholesterol and diabetes all fall under a metabolic disorder. I try and be healthy. I try and have a relatively healthy diet. I try and exercise. Yet five years ago, I had to go to the doctor, they do my blood work.

Rachel Star Withers: And they sit me down. I had insanely high cholesterol enough that they were like, you need to get this under control. And the doctor, who did know I have schizophrenia. It was on my chart. He didn’t bring that up as an issue. He just gave me a talking to that I needed to stop eating fast food every day. And I needed to learn to eat healthy. I needed to cut out all the sodas I was drinking, and I was like, okay, I haven’t had fast food in like two years. I don’t drink soda. And he kind of rolled his eyes at me. He completely just went off on me and I’m like, okay, I’m screwing up. There must be cholesterol in something I’m eating and I don’t know about it. And I go home and I check all of my staple foods and there’s next to no cholesterol. What’s frustrating looking back now is that no one ever brought up that, hey, this could be tied to your schizophrenia and your treatment of schizophrenia. It was pretty much just, no, you need to change your diet and or we’re going to have to put you on some medication soon.

Gabe Howard: It’s also very frustrating the assumption. Right? I know Rachel very well and she goes to the gym quite often. She’s a stunt woman. She’s very physical in many ways. I am the opposite. I am very sedentary. I don’t like to move. Rachel is constantly encouraging me to do more exercise to eat healthy. Rachel is that cheerleader in my life. So to have somebody just look at her and assume, oh well, this must be your fault. Stop going through the drive through. I imagine that that makes you lose faith in the process. You’re probably thinking, oh, well, they don’t know what they’re talking about because I’m not doing those things. And then, of course, secondary, when you point out that you’re not doing those things and they, you know, the medical staff, the doctors roll their eyes and just assume that you’re lying. It makes you think, well, now where do I go with this? I’m not getting the type of care that I need, which of course, can be triggering to somebody living with schizophrenia who is used to dealing with stigma or discrimination. It can be very, very damaging to somebody living with schizophrenia if they’re suffering from paranoia or grandiosity or other symptoms of schizophrenia while this is all happening. So we can see multiple pathways where this can fall apart very, very quickly, on top of the fact that you still have high blood pressure, you still have high cholesterol, you still have diabetes, you still have whatever physical issue has been brought up in the first place.

Rachel Star Withers: It actually took one of the registered nurses who worked at the doctor at a separate visit to bring up my mental health might be contributing into the high cholesterol.. That was five years ago when all this went down. Working through lots of management, I have been able to lower it and keep it down. But this is something that I’m going to be dealing with my whole life now.

Gabe Howard: If you are at higher risk for certain things because of a schizophrenia diagnosis, you want your physical doctors to be aware of that. You want your physical health needs to be met and them aware of your elevated risk. And that can be a challenge.

Rachel Star Withers: Based on blood samples, participants with schizophrenia were found to have a higher risk for type 2 diabetes, and that includes higher fasting glucose and insulin resistance compared to control groups.

Gabe Howard: I’m very fond of saying that just because you live with schizophrenia doesn’t mean that you also aren’t a human

Rachel Star Withers: Right.

Gabe Howard: Right. You have all of the same issues that all of the other humans do, including the culture in which we live. And the reality is, is that unhealthy food is easier to acquire, it takes less time to prepare, and it’s cheaper. And you can certainly see where if you’re somebody living with schizophrenia and maybe you’re not doing so well, maybe you’re only working part time, maybe you’re living on disability, maybe you’re unemployed at the moment. Then going out and buying an expensive quinoa salad with a light vinaigrette is going to be very cost prohibitive. They have to deal with this on top of managing and living with schizophrenia, it becomes this insurmountable problem.

Rachel Star Withers: Weight gain is tied to so many physical issues and so many people with schizophrenia. This has always come up is when I get to talk to somebody else who has schizophrenia, they bring up weight gain. They’ll say, Rachel, how do you manage it? You know, and I ask other people that when I see people with schizophrenia who are really thin and are talking about the different medications they take, I kind of want to be like, well, wait, hold on, let me write these down because I want to know what is what is this treatment you’re doing that. Yeah. You don’t seem to be gaining weight. When I first started getting my treatment for schizophrenia, I had gained 50 pounds and I was kind of freaking out about this. Keep in mind, I’m in college you know, in my early 20s, and my psychiatrist at the time was a very large man. And he laughed at me and made a joke about the fact that he weighed 500 pounds and 50 pounds was nothing and pretty much dismissed it. And I was kind of shocked, like, okay, because in any other world, gaining 50 pounds is kind of a worrisome thing. And I remember, like, my psychiatrist laughing about it. I don’t want to say it’s because I’m a woman, but I do think women tend to focus around weight gain. It has been a huge issue in my life. I wish it hadn’t. I wish I could tell you that I’ve taken all of my medication the exact way I should, and that weight gain hasn’t played an issue in my life.

Rachel Star Withers: But. But it has. I have stopped medications because I started gaining weight at a disturbing rate. I’ve chosen to reduce my medication without asking my doctor. And none of this is good. But what I think a lot of times doctors dismiss that this is really a big deal. Gaining weight, does, does change people and it for me, it really played on my depression and it’s been just it’s been a constant thing in my life. They found that people with schizophrenia. Weight gain has been one of the biggest issues when it comes to noncompliance on taking medications, which kind of shocked me because I’ve always felt like it was just me thinking, I brought this up to so many doctors, and they all kind of just shrug it off like, well, that’s life. Get used to it. And then to find out, oh, wait, no, this is a major issue with staying on your meds. I want to be medicated. I want to manage my schizophrenia. I understand this could be a side effect. How do we go from here? What are my options? Because I feel like so many doctors just kind of like, okay, well, you just got to grin and bear it. Help me grin and bear it.

Gabe Howard: Unfortunately, so often the issue becomes one of triage. You have more important things to worry about than weight gain, but even if that is true from a medical standpoint, it’s not true for the person living with schizophrenia. It’s not true for the patient. You’ve got to design systems for the people who will be using them. And if your doctor or the medical industry doesn’t see weight gain as an issue among, you know, schizophrenia patients, that’s all fine and well. But people living with schizophrenia, they see a big issue with it.

Rachel Star Withers: Most of us are aware that weight issues and taking care of yourself, trying to be physically healthy, I mean, we learn about that since we were little kids. We’ve learned good and bad habits. Gabe, you have had a different experience with weight than I have, and I was hoping you could share that with some of our listeners. You are? How tall are you? You’re like six.

Gabe Howard: I am six foot three.

Rachel Star Withers: Six foot three. So you’re a tall guy to begin with. Your weight has fluctuated a lot in just the few years that I’ve known you. Can you tell us a little bit about your weight struggles?

Gabe Howard: I’m absolutely willing to share. Rachel. So first, I weighed over 550 pounds and I say over 550 pounds because I don’t know the true weight because the scale maxed out at 550. So it did that flashing thing on the 550 number, which means I weighed over 550 pounds. Now,

Rachel Star Withers: Wow.

Gabe Howard: I weighed this before I was diagnosed with bipolar disorder. So I have the advantage of hindsight, and I now know that all of my eating was really a maladaptive coping skill. We talk about the concept of self-medication. It’s almost always discussed in substance abuse. You know, there were self-medicating with drugs, self-medicating with alcohol. And I self-medicated primarily with food. I did abuse drugs and alcohol, but food was my comfort. Whenever I would feel depressed, suicidal, sad, manic, grandiose, hypersexual, any of the symptoms of bipolar disorder, I could sort of squelch them with, with food.

Rachel Star Withers: It’s hard for me to even imagine having that type of weight and trying to function in the world. How did weighing that much affect just your mental health in general? Not just your bipolar, but just living day to day mental health?

Gabe Howard: Listen, people pointed at me when I walked in public, so that’s obviously going to be a sting to, to your just your overall emotional well-being. I couldn’t walk from the car into a restaurant without having to take a break. I always had to go into restaurants and say, I would like a table, no booth, because if they sat me in a booth, I wouldn’t fit. I was too large for the booths. There were certain places I couldn’t go, like concerts or sporting events, because I was just too large for the seats. And those seats are fixed. I could only see movies if I went to like, morning matinees, because then I could be sure to get two seats you know, and I wouldn’t be squished into one. And, and I would only go with certain friends because, well, they were small and I could have half of their seat. And I started making decisions based on my size. And I was in constant pain. I was constantly breathing hard. Everything was just difficult, from standing up, to walking across my house, to walking up a flight of stairs. I couldn’t I couldn’t do much physically.

Rachel Star Withers: Were the doctors worried about your weight? Did they treat it as a serious thing, or were they more hey, we need to keep your bipolar under control? Did they worry at all about the physical side?

Gabe Howard: By the time I got diagnosed with bipolar disorder, I was on my way to getting gastric bypass. So I’m so fortunate to be able to have afforded gastric bypass. It was a powerful tool that that really helped me in a tremendous way. But the gastric bypass doctors and my general practitioner, they were ultra-focused on losing the weight by any means necessary. During that process, I was diagnosed with bipolar disorder. And that’s where the hindsight sort of comes in. And the other side, the psychiatrist, the therapist, they were ultra-focused on my mental health and managing bipolar disorder. And I don’t feel that those two sides did a good job of cooperation at all. They treated them separately. While it did ultimately turn out okay, one it might not have. There’s an element of luck here. But two, I really don’t understand why those two sides never talk to each other. I mean, I was a 550-pound man living with bipolar disorder. There’s got to be some crossover there. But they were largely handled separately, and problems would come up on either end that each side had to deal with. And instead of working it out together and coming up with a cohesive plan, they just kept coming up with multiple plans that I somehow had to fit together on my own.

Rachel Star Withers: It’s frustrating, but it’s also like most of us who have a serious mental disorder are used to that. The doctors are like, we will focus on one thing and the other doctor can focus, focus on the others. And that that’s such a frustrating thing because. It’s so interconnected. Many times, the person with the disorder is blamed like, well, you’re not exercising enough. Well, you need to change your diet. So what is the cause of all this? Well, there isn’t one cause. Yes, having a serious mental disorder does play into that. Kind of like Gabe was discussing your negative coping skills, the eating. Also negative symptoms of schizophrenia. My depression of just not wanting to move or get out of bed or be active in any way has caused weight gain, my lack of motivation, my apathy, just not caring sometimes to move, not caring whether I lived or died. I sure, I sure didn’t care about if I gained weight because at that time I was very, very, you know, suicidal ideation. That does play a part. But of course it’s not everything. And when we are treating and managing schizophrenia, we need to look at overall what are all of the issues that are happening? That way we can stay both mentally and physically healthy.

Rachel Star Withers: Please understand that as we talk about this next part, we are not saying to stop taking any medications. If anything, I am all for medications, antipsychotics, antidepressants and having them work to their full extent. But yes, it has been shown that antipsychotics can cause weight gain. They can also induce feelings of fatigue and inhibit physical activity. Keep in mind that antipsychotics were originally named major tranquilizers. That’s kind of what they do, they can slow you down, which is not great if you are trying to maintain a certain weight. They do make it harder to want to exercise, harder to get up and move, harder to make decisions with your healthy eating. Evidence shows that antipsychotic drugs increase the risk of type 2 diabetes, both directly affecting insulin sensitivity and indirectly then causing the weight gain. And if you’re like. But, Rachel, why? Because that’s my thing is like, why? Why are these things connected? Why can’t I just have the good? It’s because the way that anti-psychotics works is that it plays on your brain’s hormone levels, which can help you deal with your schizophrenia, but also affects other parts of your body.

Gabe Howard: All of that sounds so incredibly negative because it largely is. It’s problematic. I don’t think there was a lot of good news there. Does knowing this help us? Is there some positive steps that the people listening can take so that they can have a better outcome than, than what we’ve been describing up until now?

Rachel Star Withers: Yes. And here is kind of my big issue, annoyance with the psychiatry community. As we’ve talked about in previous episodes, I also have tardive dyskinesia, uncontrolled muscle movements that happen from time to time. And no one had ever warned me when they started happening. They acted like if it was, it was no big deal. And here we have another major side effect of antipsychotics that no one ever warned me about. When I started to gain weight, they laughed it off. And even when I had a major issue with the high cholesterol, it was never looked at as being part of my schizophrenia. Doctors need to be more up front about these things. Say, look, we’re going to start you on antipsychotics. And as part of this, we need to check your blood every six months. We need to screen you for diabetes. Let people know that, hey, this isn’t just about taking a pill. This is a whole-body thing. I’ve always had issues with acne, and I’m not sure if you know this, but there was a very strong medication that was out for acne. And when you took the medication, even though it was for your skin, you had to, if you were female, also be on birth control and continually doing these birth control tests and whatnot, because the way it affected your hormones, which is crazy because you’re like, okay, what does the skin have to do with becoming pregnant? But that was a big deal.

Rachel Star Withers: If you do this medication, this is what you also have to do. I feel that more antipsychotics should be dealt with that way. Like, okay, this is for your brain. It’s great. However, it does affect other parts of your health. So we need to keep an eye on this, this and this. I have never had that conversation with any doctor at all. Anytime I’ve brought up side effects, it has always been 100% me bringing up the issue, and that’s ridiculous. I, I don’t see how there shouldn’t be like a warning, like, okay, we know that this has been a serious side effect. People have with schizophrenia are more likely to have the metabolic issues. So that’s something we need to start looking at for you, Rachel, every so often you need to be screened for cholesterol. You need to be screened for such and such. It’s just part of your general physical. That’s my big question to psychiatrists. Why aren’t we bringing this up more?

Gabe Howard: It’s a really important question, and it’s one that I personally would have liked to know the answer to during my struggles. I do think that I would have had a better outcome if the doctors would have been talking to each other, if I would have had more understanding of the process. I think that my outcome could have been better. That said, I had a very good outcome. So it’s always very difficult to discuss this because people are like, well, but Gabe, you did fine. And I did. And I want to make sure that the listeners know I did fine. But I think when it comes to medical care, we should be striving to do better than fine. And as Rachel has alluded to, there’s many people who didn’t do fine. There’s many people who weren’t as fortunate as myself or as Rachel.

Rachel Star Withers: Many times, the reason it’s not brought up is that they’re afraid, that, well, the side effects will scare the person away. And clearly treating the schizophrenia, treating hallucinations, treating delusions is more important than this person worrying about the side effects. As someone with schizophrenia, I feel, no. Let me know everything going in so I’m not surprised later on. Back to that acne drug that had the horrible consequences with it. It was like a black box drug. It was a big deal. Oh, I went on it. It was very popular, like everyone I knew was on it. Every one of us, these teenage, early 20s women, all went on this horrible drug because we knew what the good of it was, and we all went into it open eyed. I wish antipsychotics were presented more like that. You would have a lot better medication adherence if you knew going in. Hey, here’s what you need to look for. Here’s what you need to be ready for. Okay, I’m taking this antipsychotic. I might need to start eating healthier and watching my glucose, watching my cholesterol levels.

Gabe Howard: And that’s why I think this is a worthy conversation to have. So for the people listening, bring this up to your doctors. It does stink that it’s got to come from the patient or from the patient’s loved ones, and not directly from the doctors. But hopefully if enough of us ask, they’ll just start telling us on their own. And then we can we can certainly we’ll start a movement for, for lack of a better word.

Rachel Star Withers: Gabe, I would say at least twice a week I get an email from someone about a brand-new diet that that’s going to help me. I don’t know, do you get these diets that are supposed to, like, fix all your mental problems?

Gabe Howard: Oh, everything. I get so many things that if I just eat this, do this, buy this, share this, have this, whatever, I can stop taking pharmaceutical medications, I can stop going to my doctor. And I will live a much better life, no doubt sexier and smarter. And it’s magical. And it’s all for the low, low price of some ridiculous amount of money.

Rachel Star Withers: Is there any truth to it?

Gabe Howard: No.

Rachel Star Withers: [Laughter]

Gabe Howard: I mean, listen, is there any truth to it? There is truth to diet and exercise is healthy. Remember, we are humans

Rachel Star Withers: Yes.

Gabe Howard: So is there any truth to it? I suppose potentially, maybe. But the truth is in what we know. If we eat better, if we exercise more, we will have better outcomes. That’s not true because you live with schizophrenia. That’s not true because you have a severe and persistent mental illness. That’s true because you’re a human.

Rachel Star Withers: I agree. Now let’s talk a little bit about diets here. Please understand we are not endorsing any diets. In fact, one of the things is that when you read different medical studies that have come out about these diets and that’s great, is that it’s very controlled. It’s not just like Rachel printed off a page of the internet on what I should and shouldn’t eat based on a crazy new wacky idea diet. Because we’ve already discussed I have some strange nutritional needs. For instance, I need to watch my high cholesterol. That being said, something that has grown more and more in the past few years is the keto diet or the ketogenic diet, and it also is known as metabolic therapy. It has been used in the treatment of obesity, type 2 diabetes. But what’s interesting is that it’s used for the treatment of epilepsy. And they’ve started saying, how could the ketogenic diet, which revolves around a high fat, low carb, affects schizophrenia symptoms? Yes. It has been shown to potentially help with schizophrenia psychotic symptoms and depressive symptoms. Now, I say, take this with a grain of salt. Because the ketogenic diet also raises your cholesterol. Do I think it’s an option maybe that people should look into? Yeah, I think that is something, hey, I want to bring this up to my doctor, I’m looking at trying diet approaches for dealing with my schizophrenia, with managing my weight, managing diabetes. What do you suggest? And talking to them, not just taking it upon yourself to start some type of diet that influencer or celebrity promotes. But I do want to stress that, yes, more and more, they are finding studies where the ketogenic diet has helped people with psychotic disorders.

Rachel Star Withers: And this actually dates back to 1965. So it is not a new fad. But, make sure you’re doing it with your doctor. Another one that has come up in schizophrenia, is gluten free diets. And back at World War II was when they first realized that when consuming wheat increased, so did schizophrenia admissions, and this was seen across multiple countries. Why that is? It’s still a toss-up. On average, celiac disease is three times as prevalent in schizophrenia than it is in the general population. That is an odd thing. Not saying that gluten is what causes schizophrenia, but they have found some kind of strange things and people with schizophrenia that they can’t quite explain. Why would wheat cause people to need to be administered to the hospital more with schizophrenia? I have no idea. And neither does the scientists. But this is something in studies that they have known. I worry when people send me emails and they’re like, oh my gosh, Rachel, I know how to fix your schizophrenia because I saw this one thing and it’s like, okay, I’m not saying it can’t help, but we do need to be careful, especially when you’re going gluten free. You might be missing out on other key nutrients and fiber and could lead to higher issues of other health concerns. Take it with a grain of salt. Talk to your doctor first. Hey, what is the best way to manage the issues that I’m having? How can I be the healthiest possible?

Sponsor Break

Rachel Star Withers: And we’re back discussing how to stay physically healthy with schizophrenia.

Gabe Howard: It’s fascinating to study this, and I always think of like eggs. In my lifetime’s eggs have been healthy. And then a study

Rachel Star Withers: Yeah.

Gabe Howard: Comes out that eggs are unhealthy, and then a study comes out that eggs are healthy again. So it’s important to understand that research into nutrition is ongoing, research into schizophrenia is ongoing, research into nutrition and schizophrenia is ongoing. So the most important thing that I want to point to everybody is I think this is great foundational knowledge. But what Rachel said specifically was follow up with your doctor, talk to your doctor. Do this in conjunction with your doctor. I cannot stress that enough. Another thing that people don’t realize that you should talk to your doctor about is exercising.

Rachel Star Withers: I’m, I am I’m big on exercise. And if that just made you roll your eyes, I rolled my eyes too. Don’t worry. Because that’s like always the number one thing that people say with health issues like, oh, you need to exercise more, you need to go on more walks, you need to do this. You need to do that. I personally like to think of just activity. I need to be moving. I need to get up and move around. That makes me feel better about myself. Period. As far as how much should we exercise? They say 150 minutes of moderate exercise weekly is good, however you want to break that down. And yes, when it comes to schizophrenia, it has been shown that exercising does help us manage our symptoms both positive symptoms, hallucinations, delusions and negative symptoms. Lots of theories onto why if it has to do with just our body getting out there moving, if there’s actually any connection with the brain all across, there’s theories. But yes, it’s been shown repeatedly that exercise helps. Deal with your mental disorders. Now, what’s really interesting, Gabe, is that if you kind of remember back to me pushing this whole deal, that if I’m on a antipsychotic, let me know ahead of time what to look out for. They found that when you do antipsychotic treatment in conjunction with an exercise plan specially set up for the medication that you’re on, meaning if they know that this medication tends to cause more depressive symptoms in people, they tend to be more lethargic. So let’s get them also doing a six-month exercise plan that is going to get them moving twice a week in a group, the people are more likely to adhere to the medication.

Gabe Howard: Really?

Rachel Star Withers: I love that and it seems like common sense. So here’s one way right off the bat, like, okay, we have a problem with people with schizophrenia gaining weight, not being healthy and not taking their medication. Yet when we deal with these two things head on, people are more likely to fix both those problems.

Gabe Howard: Incredible.

Rachel Star Withers: I wish this was more common. Like, okay, well, we’re going to put you on this medication. Let’s look at the side effects. Okay. You might have problems with insulin resistance. That’s great. We have a program that is going to teach you how to change your diet and is going to get you, like moving here at the health center.

Gabe Howard: That would be a great thing to add to mental health. We’re always talking about schizophrenia treatment in terms of what medications do my loved one needs? What medication can I take? How do I become stable on medication? And we easily forget that there’s an entire person there that has other needs. They need food. They need water. They need shelter, they need exercise, they need good nutrition and food

Rachel Star Withers: The best ones that tend to work are structured and observed. I wish I could be like, hey, I can trust myself to go for a 20-minute run every day. That’s not going to happen, Gabe. I will go ahead and tell you that is not going to happen. Now, if I have a friend who says, Rachel, we’re going to every day walk, I’m going to come by your house after work, I’ll pick you up at five, and we’re going to walk down to such and such road and back. Okay. Now there’s accountability. There’s an actual plan there. We’re going to walk to this point and back. Now we might not make it, but that’s going to be our goal. Having someone else to hold you accountable is also good. Another thing is if you’re able to join a program that’s like a three, three months long or like a one-month situation where, okay, I’m going to set a goal for this amount of time as opposed to, okay, I got to just exercise the rest of my life fun. But being like, okay, I’m going to do this program. That’s a six-week boot camp. Being able to sign up for things like that helps with holding yourself accountable.

Gabe Howard: Speaking of being held accountable, we have a great guest for the show, Fran Hinson. And, she works with special populations to help create small, sustainable habits that you can do both inside and outside of the gym. So let’s go ahead and roll that interview now.

Rachel Star Withers: I am so excited today to be speaking with Fran Hinson, who is a registered nurse, personal trainer and behavior modification specialist. Thank you so much for joining us, Fran.

Fran Hinson: Oh, thank you so much for having me.

Rachel Star Withers: Okay, so I just listed off a lot of things. So right away all of this kind of makes you a health coach. Explain to us what is that?

Fran Hinson: A health coach is something that people are saying a lot these days. There’s a lot of health coaches popping up online, health coaches popping up in doctor’s offices. What a health coach does is a lot different than what people think we do. We are not psychologist or psychiatrist. We are not health care professionals, although I am also a registered nurse. A health coach is someone who takes your daily lifestyle and helps you break down the habits that you want to have into small, bite sized pieces and then over time, helps you build on your momentum of success to get where you want to go. What I like to kind of think of it as is a health coach is someone who basically takes your idea, not our idea, takes your idea and helps you succeed in your idea.

Rachel Star Withers: Now dealing with fitness and with your nursing background, how does that help you work with special populations?

Fran Hinson: What it gives me is the understanding of there is no there’s not even one size that fits all. There’s not even a one size shirt out there. It is so diverse. When we’re looking at special populations, you really have to look at each individual person. Every single person is coming from a different place. Fitness is going to look different on each individual.

Rachel Star Withers: Obviously today we’re talking about those who have mental health disorders. But then even being like, hey, amongst us, it’s still going to be very individualized because my background is going to require different health than another person with schizophrenia.

Fran Hinson: That’s exactly right. Yours is going to look different from another person’s. Well, then also each person’s resources are going to look different, right?

Rachel Star Withers: Yes.

Fran Hinson: This person may have access to outdoor walking spaces that are safe versus this person. So even still it does have to be individualized. [Laughter]

Rachel Star Withers: [Laughter] I’ve worked up is some basic profiles that might fit someone who has schizophrenia. And you give us some of your suggestions for how this person can start to work out a fitness routine, a health routine.

Fran Hinson: Okay. Let’s go.

Rachel Star Withers: We have a person. They have been recently diagnosed with schizophrenia and they’re worried about being able to manage weight gain due to medication. They’ve already gained 10 pounds and they’re worried it’s going to continue on. The person wants to make sure that they’re still eating healthy and they keep their cholesterol in check. However, it’s getting harder and harder due to their negative symptoms of schizophrenia like depression.

Fran Hinson: I like how you said this was a recent diagnosis.

Rachel Star Withers: Mm-hmm.

Fran Hinson: Their health care physician, has recently gotten a diagnosis, so therefore they have their first point of contact.

Rachel Star Withers: Okay.

Fran Hinson: So what I like to think of is you have people on your health care team and you are the president. So, this person now has the first member of their health care team. It’s their first doctor. First of all, that medication that is now in their toolbox is obviously needed. If it is a situation where you’re having a negative side effect, it’s first important to talk with your doctor about it. It could be that the negative side effect of weight gain is necessary. Sometimes in the medical field, I have seen people taking a medication, not like one negative side effect, so they completely get rid of it and don’t tell their doctor. So the first thing I will say is that this person picked out, hey, I’ve had weight gain. It’s important for them to understand that that doesn’t mean they get to stop taking their medication without having good, productive conversation in a conclusion from their health care professional. That’s number one. Number two.

Rachel Star Withers: Mm-hmm.

Fran Hinson: If you have a health care professional, you should be able to ask them, okay, wait, I have this new diagnosis. Tell me what my resources are within the health care community, and that doctor should be able to give you some resources. Are there any community groups, any health groups for people with my diagnosis? Healthy resources within your community for walking groups, for activity groups, things like that? And then they have to go, okay. Now I have these other resources. I have these other people on my team. Now what can I do? I want to eat healthy. I want to have all of these other. Healthy lifestyle items in play in my life.

Fran Hinson: Then they have to do their own community research. Okay, who do I have on my side? I have my mom. I have my sister. Then they need to enact those people as well. What my main thing is, is to keep it simple. You have to sit down and look at all your resources and say, all right, these are the people who care about me, and these are my safe people. They’re on my team. And enlist them. Mom, I want to go on a walk every day at 4:00. Can you help me with that and be my accountability partner? One thing that I will say we tend to think about when it’s weight loss is, oh, well, we have to start a big program at a gym and get like a really sexy diet plan. Well, no not really. It needs to be simple. That 4:00 walk that you decide to take with your mom every day can parlay into something much bigger, which could be a run, which could be a 5K in the future. But it all has to start somewhere, and it has to start with keeping it simple. They might also feel like food choices are a big deal. If they are able, they can start adding in 1 or 2 extra pieces of fruit and vegetable a day to keep it simple from starting these big, restrictive diet plans.

Rachel Star Withers: I want to throw out some kind of specific issues with schizophrenia and tell us what are some of the suggestions that you might have for someone. Many people with schizophrenia have paranoid issues where we feel that the people around us are watching us or judging us or thinking things about us. This obviously can be an issue when it comes to a gym setting. What advice might you have for someone who is dealing with the paranoid issues of schizophrenia?

Fran Hinson: One of the major things is, does it have to be a gym that you’re getting fit in? There are public parks. There are private neighborhoods to walk in. Is there somewhere else that you could go? I don’t I don’t always think that gyms are the best place for anybody. It sometimes can be crowded.

Rachel Star Withers: Yes.

Fran Hinson: It sometimes can have really loud music, and sometimes it can be like very overwhelming. But you don’t have to go to that place. One thing I like to ask people who are like, oh, I have to go to the gym today. One thing I like to ask them is, well, do you like the gym? And most of the time they’re like, well, no. I’m like, well, why are you going? Don’t

Rachel Star Withers: Mm-hmm.

Fran Hinson: Do it. If it is somewhere you’re uncomfortable. Okay, well, let’s brainstorm someplace that you are comfortable. So, Rachel, where do you find your comfortable outlet to exercise?

Rachel Star Withers: I do like going to the park a lot because I have to walk my dog either way.

Fran Hinson: All right.

Rachel Star Withers: Yeah. So I will say I like I like going to the park and I don’t, I like more like rough trails. I get bored if I’m walking on a sidewalk.

Fran Hinson: I like that, I like that. So I like rough the rough trails to nature. So. And I also like you mentioned your dog

Rachel Star Withers: Mm-hmm.

Fran Hinson: Walking in a public place may not be the best thing for you. It could be walking on a nature trail. Finding the right space and finding a safe person. So my safe people happen to be three particular friends, and I really enjoy being around these three particular friends because I know what’s going on. They know my life. We don’t have to put on airs and we don’t have to put up, you know, lipstick or anything. We are just normal people. So I know my safe people and I know the places I like to be. M my advice to them would be, if you don’t like to be in a gym, don’t go to a gym. Sometimes

Rachel Star Withers: Mm-hmm.

Fran Hinson: Your garage with some hand weights that you bought from Target can be perfect.

Rachel Star Withers: When it comes to schizophrenia, there’s what are called negative symptoms. So and that’s a lacking. So depression apathy these obviously make it really hard for people with schizophrenia to leave the house to have any motivation to like get out and do things to move around. That’s something I’ve struggled with my whole life where I want to be active, and yet, at the same time, getting out of bed is the hardest thing to do. It’s like, I would love to go to the gym. I would love like I want to in my mind. But then there’s also another side of me that just getting out of bed to go brush my teeth is an exhausting, overwhelming thought. Talk to me. What? What would you say to people who are in that situation?

Fran Hinson: One thing that I would say is. What is your smallest thing that you can do to help your day? Let me give you a for instance here. And this comes from

Rachel Star Withers: Okay.

Fran Hinson: A personal story that I don’t mind sharing. I particularly can go to a very depressive place, and over the course of my years I have. Oh wait, here comes the wave. I can see it. And for me, my one little thing is I have to open the blinds and not get back in the bed. I have before had those days where I. Didn’t open the blinds and I did stay in the bed and it tends to escalate and things happen. So for me, my one teeny tiny habit is I’ve got to open the blinds and sometimes I get back in the bed, but like I make up the bed. So I’m like on top of the covers. So it doesn’t really count. But I have to open those blinds. That’s my one teeny tiny thing. So if it is a situation where you’re having those negative symptoms, is there one teeny tiny thing? And even if you have to write it on a piece of paper and put it up on the wall that says, open the blinds, or you have to have your, remember we talked about the team of safe people.

Rachel Star Withers: Yes.

Fran Hinson: Do you have someone from your team of safe people that can come in and open the blinds for you that day? Do you have someone who’s calling, who’s checking on you? I would say if you have those negative symptoms and you have the lower motivation, number one. Enlist your safe people. And number two, figure out what your teeny tiny habit is.

Rachel Star Withers: What type of activity should a person strive to do? Daily. Weekly? Monthly. Like give me a breakdown. Like, okay, here’s the basics, Rachel. You should at least try to. What do you think?

Fran Hinson: Oh, I’m glad you asked this question. Okay, here, let me give you what a perfect world looks

Rachel Star Withers: Okay.

Fran Hinson: Like. Okay. As a nurse, guess how many times I’ve recited this?

Rachel Star Withers: Okay.

Fran Hinson: The American Heart Association suggests that you should have 150 minutes of moderate intensity aerobic exercise p er week, or 75 minutes of vigorous intensity aerobic exercise per week. Listen, I know it verbatim. Here’s what it looks like in the real world.

Rachel Star Withers: Yes.

Fran Hinson: You should have about two days at least where you do resistance training in your entire body. Now this is for a perfect world, a perfect scenario. Is it always going to be that? No. You know why? Because life, life be life-ing sometimes it doesn’t always work out perfectly. But

Rachel Star Withers: Mm-hmm.

Fran Hinson: Hitting resistance training in your whole body. Resistance training is weight. Twice a week. Strength training is really good. We all know, of course, building muscle to help us age well. Building muscle also helps us stay healthy and safe because we’re not falling down, etc. it keeps our hips and our backs all good. The other part of that is what some people consider cardio

Rachel Star Withers: Mm-hmm.

Fran Hinson: And cardio can mean a lot of different things. I say cardio and I immediately think elliptical, treadmill, running fast.

Rachel Star Withers: Yeah.

Fran Hinson: No, sometimes it’s like mall walking. It’s perfect cardio. A nice walk is fantastic. That’s your moderate intensity. This is where you can still talk and carry on a conversation. Then you also have things like flexibility and balance. Flexibility is like stretching yoga. When’s the last time you tried to stand on one foot? Well, like somewhere along the line, we lose that in life.

Rachel Star Withers: Mm-hmm.

Fran Hinson: What daily exercise looks like. It looks like at least two days of that whole body resistance about. Three 30-minute walks. And. Stretching for about 15 minutes twice a week or so. And that’s in a perfect world.

Rachel Star Withers: Mm-hmm.

Fran Hinson: Now let’s talk about the real world.

Rachel Star Withers: Okay.

Fran Hinson: It looks like what it looks like. And here’s why I say that. Because if you happen to be having a situation where those negative symptoms that we

Rachel Star Withers: Mm-hmm.

Fran Hinson: Talked about are showing themselves and you’re really all you could do that day was open those blinds. If I were to tell you to go out there and lift weights, is that realistic? Absolutely not. But what if I could talk you into a five-minute walk outside, then that day that is your best and that is okay. And we’ll get, we’ll get to tomorrow on tomorrow.

Rachel Star Withers: Fran, you’ve given us all this great information. Sum it up for us. Give us some tidbits to take home that we can act on.

Fran Hinson: Number one, figure out who your health care team is. Number two, start slow. Don’t judge yourself by what you see out there. Start slow. Meet yourself where you are. Aim for a little bit of body resistance exercise. Twice a week. Don’t underestimate the sunshine and getting a little bit of outdoor movement. Finally do a little digging and figure out what is your small habit that you need to do that sets your day at for success, whether that be opening the blinds, brushing your teeth, or making your bed. What is your first good habit of the day?

Rachel Star Withers: Sounds great. Let me ask you, Fran, because you’ve been working in a fitness background, a health background for many years, and I’m sure you’ve come across different people with all different backgrounds and different issues when it comes to their health. In our discussion today, while I was specifically talking about a person with schizophrenia, let’s say I took that part out. Did anything stand out as, oh wow, this is really weird or I’ve never heard that before.

Fran Hinson: Yeah. And I’m really trying to analyze that question in my head. And the answer is no, it it’s not. Everybody enters the gym thinking that people are looking and judging and this

Rachel Star Withers: Mm-hmm.

Fran Hinson: And that. None of it, none of it is unique. I

Rachel Star Withers: Mm-hmm.

Fran Hinson: Feel like a lot of people think that. And

Rachel Star Withers: Mm-hmm.

Fran Hinson: I can specifically say my favorite demographic is working with people who kind of not gone to the gym in a while, not taking care of themselves in a while, not taking a good hard look at their positive, healthy habits in a while. And so none of the things that you mentioned felt unique, or they absolutely didn’t feel weird,

Rachel Star Withers: Mm-hmm.

Fran Hinson: And they all felt very like, yeah, no, that’s not a specific to this conversation thing. One thing we stop considering is that, oh, wait, that person who looks like they have it together may actually be feeling just like me on the inside.

Rachel Star Withers: Fran, how can our listeners learn more about you?

Fran Hinson: You can find me on my Instagram @franmhin. That’s Fran M H I N.

Rachel Star Withers: Awesome. Thank you so much for joining us today, Fran, and sharing some ideas for us to hopefully work towards being healthy.

Fran Hinson: Yeah. Thank you for having me. I always love a health conversation.

Gabe Howard: Well, Rachel, as always, you did an incredible job. And I want to ask what was your biggest takeaway? She really taught us a lot in a fairly small amount of time.

Rachel Star Withers: I love how she talked about changing your perspective that you’re putting together a health care team, but you’re the president. I never feel like I’m the one in charge. Those of us with schizophrenia, we’re the bottom toe. We’re just kind of getting pulled along in the ride. But no, no, no, we’re the main one. We’re the star of the show like we’re the president. And we need to get our team together. Like, okay, guys, what do we need to do to deal with this problem? Whether it’s weight gain, whether it’s insulin resistance, whether it’s cholesterol, like, guys, we got to work together here. I love that. That proactive nature, that’s all about what we stress with managing our schizophrenia. How can we be proactive with the physical side too? Another thing she brought up are what are your resources? So many times that people will be like, man, I can’t, I can’t do exercise. I can’t do this because I can’t afford a gym, I can’t afford a fancy trainer, I can’t afford, you know, this, this, this program. What is it that you already have access to? Whether we’re talking about internet videos, whether we’re talking about friends, neighbors that you can be like, hey, you want to go for a walk with me? What is it that you already have near you that you can just start with? Because those are those tiny little habits being able to be like, yeah, hey, every day it’s free that I can walk down to such and such street and back. Every day I can take the dog walking with me finding those little things. Managing your physical health doesn’t have to be this major draining situation. It’s small, little changes. Just like managing our schizophrenia. It’s a constant battle. But. Step by step.

Gabe Howard: I know it sounds cliche, but slow and steady wins the race.

Rachel Star Withers: It’s easy to think of schizophrenia as just a mental issue. Whether you’re the person with schizophrenia, a caretaker, a loved one, or even the medical community. But dealing with schizophrenia is a whole-body issue. Managing your schizophrenia is about making healthy decisions all around, making sure that you’re still getting the nutrients you need, and keeping your heart, bones, and muscles healthy. So let’s be proactive together. Thank you so much for listening to this episode of Inside Schizophrenia. Please like, share, subscribe and rate our podcast and we’ll see you next time here on Inside Schizophrenia, a Healthline Media podcast.

Announcer: You’ve been listening to Inside Schizophrenia, a podcast from Psych Central and Healthline Media. Previous episodes can be found at or on your favorite podcast player. Your host, Rachel Star Withers, can be found online at Co-host Gabe Howard can be found online at Thank you and we’ll see you next time.