Interventions for Weight Gain in Adults Treated With Novel Antipsychotics
Primary Care Companion J Clin Psychiatry 2000;2(1):20-23
© Copyright 2017 Physicians Postgraduate Press, Inc.
Background: Weight gain is a significant side
effect associated with typical and atypical antipsychotic agents.
It has the potential to add to the increased morbidity and
mortality associated with schizophrenia and schizoaffective
disorder. Because the newer antipsychotic medications have proved
to be superior to traditional agents in controlling the positive
and negative symptoms of schizophrenia, it is additionally
critical to address the relationship of these newer agents to
Method: Prior to the availability of novel
antipsychotic medication, we looked at a group of 17 residents,
of whom 71% had significant weight gain on treatment with
traditional antipsychotic medications between 1991 and 1994. This
prompted our interest in weight gain, especially after the
introduction of novel antipsychotic medications, and our decision
to look closely at their diets and help them make changes that
would minimize their weight gain. We monitored the effect of a
comprehensive primary intervention strategy on controlling
obesity in a retrospective study of 32 patients with DSM-IV
schizophrenia or schizoaffective disorders. All patients were
residents in an adult care facility for formerly homeless persons
with serious mental illness. Intervention consisted of complete
medical and psychiatric care; switch to a patient-optimal
atypical drug; low-calorie, monitored diet; nutritional
education; and supportive care.
Results: There was no significant change in mean
body weight at 12 and 18 months after initiation of intervention.
Weight gain was observed in only 30% of study patients after the
intervention as opposed to 71% at the start of the study. In
general, as the negative symptoms of schizophrenia improved,
patients were found to become more receptive to education and to
become proactive in their health care. The lack of weight gain
was consistently seen with all 3 agents tested--clozapine,
olanzapine, and risperidone.
Conclusion: A patient's diet appears to be a
better predictor of weight gain than the choice of novel
antipsychotic medication. Clinicians might prescribe nutritional
and lifestyle changes alongside medication with weight gain