Managing Atypical Antipsychotic-Associated Weight Gain: 12-Month Data on a Multimodal Weight Control Program

Matthew Menza, M.D.; Betty Vreeland, A.P.R.N.; Shula Minsky, Ed.D.;Michael Gara, Ph.D.; Diane Rigassio Radler, M.S., R.D.; and Marie Sakowitz, R.D.

Background: The purpose of this study was to test prospectively the feasibility and efficacy of a multimodal weight control program for overweight and obese severely mentally ill adults who had gained weight while taking atypical antipsychotic medications.

Method: Thirty-one subjects with schizophrenia or schizoaffective disorder (DSM-IV), on treatment with atypical antipsychotics, participated in a 52-week, multimodal weight control program that incorporated nutrition, exercise, and behavioral interventions. The primary outcomes were measures of body mass index (BMI) and weight. A variety of secondary outcomes, including hemoglobin A_1c level, systolic and diastolic blood pressure, and cholesterol level, were compared from baseline to endpoint. Weight and BMI changes in the intervention group were also compared with changes in 20 nonintervention patients ("usual care" group) who were contemporaneously treated in the same clinics.

Results: Twenty of the 31 subjects in the intervention group completed the program. Statistically significant pre-post improvements in weight (p < .02), BMI (p < .02), hemoglobin A_1c levels (p < .001), diastolic (p < .001) and systolic (p < .05) blood pressure, exercise level (p < .003), nutrition knowledge (p < .0001), and stage of change (exercise [p < .0001] and weight [p < .008]) were seen in the intervention group. Patients attended a mean of 69% of the sessions during the year of the program. Weight and BMI also decreased significantly (p = .01) in the intervention group compared with the "usual care" group, who gained weight during the observation period.

Conclusions: Individuals with schizophrenia and schizoaffective disorder were willing to attend, and benefited from, a weight control program that focused on nutrition, exercise, and motivation. The program resulted in clinically significant reductions in weight, BMI, and other risk factors for long-term poor health, including hemoglobin A_1c. In contrast, patients who did not receive the weight control intervention continued to gain weight.

(J Clin Psychiatry 2004;65:471-477)

Received Oct. 10, 2003; accepted Feb. 19, 2004. From the Department of Psychiatry, Robert Wood Johnson Medical School (Drs. Menza, Minsky, and Gara and Ms. Vreeland); University Behavioral HealthCare (Drs. Menza, Minsky, and Gara and Ms. Vreeland); the School of Health Related Professions (Mss. Radler and Sakowitz); and the School of Nursing (Ms. Vreeland), University of Medicine and Dentistry of New Jersey, New Brunswick, N.J.

Supported by an investigator-initiated grant from Eli Lilly and Co., Indianapolis, Ind.

Dr. Menza has been a consultant for Pfizer, Lilly, Cephalon, GlaxoSmithKline, Bristol-Myers Squibb, Forest, and Bayer; has received grant/research support from Pfizer, Lilly, Merck, Cephalon, GlaxoSmithKline, Bristol-Myers Squibb, Forest, and Bayer; and has received honoraria and participated in speakers/advisory boards for Pfizer, Lilly, Bristol-Myers Squibb, Cephalon, and AstraZeneca. Ms. Vreeland has been a consultant to, received grant/research support and honoraria from, participated in speakers/advisory boards for, and received salary support from Lilly and is a major stock shareholder in Pfizer and Johnson & Johnson.

Corresponding author and reprints: Matthew Menza, M.D., Robert Wood Johnson Medical School, D207A, 671 Hoes Lane, Piscataway, NJ 08854 (e-mail: menza@umdnj.edu).