Introduction

Weight gain is a common side effect in patients with schizophrenia, often associated with the use of antipsychotic medications. This weight increase can contribute to higher rates of mortality and morbidity.1 The prevalence of obesity in individuals with schizophrenia is reported to be 1.5 to 4 times higher than that of the general population, with an even greater risk for long-term inpatients.1

Effects of Weight Gain

Weight gain and obesity in patients with schizophrenia can lead to several serious health issues, including1,2:  

  • Increased risk of type 2 diabetes mellitus, cardiovascular disorders, musculoskeletal problems, and some cancers
  • Nonadherence to pharmacological interventions
  • Decreased quality of life
  • Increased psychiatric readmissions

Apart from the significant impact on physical health, obesity in patients with schizophrenia also affects mental health, carrying negative psychological consequences.1,3

Managing Weight Gain: Pharmacotherapy

Research on pharmacologic treatment of psychotropic drug-related weight gain in people with schizophrenia has shown that:  

  • Metformin, when started concurrently with an antipsychotic, may be effective and well-tolerated in preventing the weight gain caused by antipsychotics. Thus, it is recommended as a level 1 treatment.1,4  
  • Glucagon-like peptide-1 (GLP-1) receptor agonists, including liraglutide, exenatide, and semaglutide, have been associated with clinically significant weight loss in patients with schizophrenia receiving antipsychotic treatment.4  
  • Topiramate has also been shown to be effective in preventing weight gain caused by antipsychotics and is associated with cognitive side effects.4 
  • H2 antagonists and monoamine modulators may be effective in preventing antipsychotic-associated weight gain, although there is limited evidence.1

Conclusion

On average, individuals with schizophrenia are approximately twice as likely as the general population to be overweight.1 Adjunctive pharmacological interventions may be necessary to manage antipsychotic-induced weight gain. However, pharmacological treatments should supplement lifestyle interventions rather than replace them. It is important to assess the metabolic risks associated with the antipsychotic medication when aiming to prevent weight gain, although ensuring effective treatment of schizophrenia should remain the priority.1  

References:  

  1. Agarwal SM, Stogios N, Ahsan ZA, et al. Pharmacological interventions for prevention of weight gain in people with schizophrenia. Cochrane Database Syst Rev. 2022;10(10):CD013337. doi:10.1002/14651858.CD013337.pub
  2. Doane MJ, Bessonova L, Friedler HS, et al. Weight gain and comorbidities associated with oral second-generation antipsychotics: analysis of real-world data for patients with schizophrenia or bipolar I disorder. BMC Psychiatry. 2022;22(1):114. doi:10.1186/s12888-022-03758-w  
  3. Bora E, Akdede BB, Alptekin K. The relationship between cognitive impairment in schizophrenia and metabolic syndrome: a systematic review and meta-analysis. Psychol Med. 2017;47(6):1030-1040. doi:10.1017/S0033291716003366
  4. McIntyre RS, Kwan ATH, Rosenblat JD, Teopiz KM, Mansur RB. Psychotropic drug-related weight gain and its treatment. Am J Psychiatry. 2024;181(1):26-38. doi:10.1176/appi.ajp.20230922