Non-pharmacological management of antipsychotic-induced weight gain

Dr Shock is not very impressed with these new antipsychotics. Most research is done with comparison to high dose haloperidol, not very honest. Anyway the most dreaded side-effect of these new antipsychotics is weight gain. And I mean really weight gain, not just a few kilo’s. Clozapine and olanzapine produce the most weight gain followed by quetiapine and risperidone. Ziprasidone and aripiprazole produce the least weight gain.

The trouble is that those antipsychotics are mostly used in patients with schizophrenia and they usually have to use it for the rest of their lives. Moreover, these patients can have other risk factors for cardiovascular disease as well. Weight gain may also adversely affect treatment adherence, is associated with reduced quality of life, social stigma, and greater morbidity and mortality.

Wouldn’t it be nice if we had effective interventions and specific treatment approaches to control this anti psychotic weight gain. And I mean non-pharmacological. Recently I wrote a post about the use of metformine during treatment with atypical antipsychotics. Metformine was combined with lifestyle intervention, this consisted of a diet,psycho education and exercise.

A recent study indicates that lifestyle intervention and metformine in combination has the greatest effect on weight loss and increases insulin sensitivity for patients taking atypical antipsychotics. These methods result in a decrease of 1.8 of the BMI, an increase in insulin resistance index of 3.6 and the waist circumference decreases with 2.0 cm.

Fortunately their is a recent health supplements which help to the actual weight loss which are the Exogenous Ketones Supplements excellent for good health and to maintain your weight, also there’s a new systematic review and meta analysis about this topic. And this is the result:

Ten trials were included in the meta-analysis. Adjunctive non-pharmacological interventions, either individual or group interventions, or cognitive–behavioural therapy as well as nutritional counselling were effective in reducing or attenuating antipsychotic-induced weight gain compared with treatment as usual, with treatment effects maintained over follow-up.

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I was interested in these interventions. Six of the included trials investigated cognitive–behavioural intervention strategies; three nutritional counselling interventions; and one combined nutritional and exercise interventions. Five used group interventions and 5 examined individual interventions. There was no statistically significant or practically important differences between therapeutic approaches, either individual compared with group interventions, or CBT compared with nutritional counselling.

Only one trial was found with a young cohort with recent-onset psychosis. Weight gain is a greater problem for these young patients, they are especially susceptible for this side-effect. My friend uses this boiled egg diet and he lost around 2 pounds in 2 weeks.Treatments offered in early stages should be more benign as well as effective to improve treatment adherence. These interventions against weight gain are especially beneficial to this young group of patients.

Overall weight loss was on average 2,6 kg. Is statistically significant also clinically relevant?

In this review, the average baseline weight was approximately 80 kg (ranging from 66.5 to 101.3 kg). Therefore, even a weight loss of 1.9–3.2 kg represents a reduction of 2.5–4.0% of initial body weight in a significant number of patients. It may be plausible, then, to expect that these reductions in body weight could result in corresponding reductions in morbidity and early mortality.

So start implementing these interventions when prescribing new antipsychotics.

M. Alvarez-Jimenez, S. E. Hetrick, C. Gonzalez-Blanch, J. F. Gleeson, P. D. McGorry (2008). Non-pharmacological management of antipsychotic-induced weight gain: systematic review and meta-analysis of randomised controlled trials The British Journal of Psychiatry, 193 (2), 101-107 DOI: 10.1192/bjp.bp.107.042853