Appropriate intervention strategies for weight gain induced by olanzapine: A randomized controlled study

Abstract

Weight gain induced by antipsychotics is the second most frequently given reason for noncompliance with pharmacologic therapy; excessive sedative effects rank first, with extrapyramidal side effects ranking third. Frequently, weight gain leads to inconsistent pharmacologic treatment; this exposes patients to the risk of recurrent symptoms. In fact, one of the key contributors to good clinical outcomes in schizophrenic patients is compliance with pharmacologic treatment. The goals of this study were to evaluate weight gain in a group of patients treated with olanzapine, diet modifications, and moderate physical activity and to compare the findings with those from a second group of patients who were given only olanzapine treatment. For 8 wk, investigators followed 2 groups of patients suffering from schizophrenia and hypomania in bipolar disorder, according to the nosographic criteria of The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The first group (A) of 18 patients (9 female, 9 male) affected by manic episodes in bipolar disorder received olanzapine (10-20 mg/d), jogged lightly for 30 min 3 times a week, and complied with a diet that consisted of 500 kcal/d less than usual. The second group (B) of 10 patients (4 female, 6 male) with schizophrenia received only olanzapine (10-20 mg/d). All patients from both groups were weighed at the beginning of the observation period and weekly thereafter for 2 mo. After 2 mo of observation, group A showed a mean weight gain of 1.47 kg, whereas group B exhibited a mean weight gain of 3.5 kg; the difference between the 2 groups was almost 2 kg (P<.005). Group A showed a statistically significant reduction in weight gain compared with group B, clearly demonstrating the effectiveness of moderate physical activity and diet therapy in reducing weight gain in atypical antipsychotic treatment. Therefore, patient weight and body mass index must be monitored during the first weeks of antipsychotic treatment, with the goals of avoiding significant weight gain and treatment interruption.

Health promotion lifestyle interventions for weight management in psychosis: a systematic review and meta-analysis of randomised controlled trials

“…However, only 4 studies were excluded [18,27-29] because in one case [26] the authors supplied the missing data. For one study we had to impute SDs from the pool of data [30]. Therefore, 13 RCTs were eligible for inclusion [12-17,19-21,26,30-32].…”

“…For one study we had to impute SDs from the pool of data [30]. Therefore, 13 RCTs were eligible for inclusion [12-17,19-21,26,30-32]. More details on the screening process can be found in Figure 1.…”

“…Four studies report only data for completers [14,17,19,21] and thus do not address incomplete data adequately. Seven studies included all the subjects in the analyses or provided intention-to-treat analysis [12,13,15,16,26,30,32]. It should be noted that poor quality randomisation can produce unequal groups at baseline: Such might be the case of some studies in this review [20,26].…”

“…One study included subjects with a mean BMI in the normal category [15]. In Milano et al [30], Forsberg et al [31] and Khazaal et al [20], the control group falls into a lower category of BMI when compared to the experimental group. In the remaining study mean BMI at baseline is not known [13], but one of the inclusion criteria is BMI > 26.…”

Neuroleptic Drugs Affect Sympathetic and Thermogenic Reactions to Orexin A

“…We can suppose that the body weight gain could be caused, at least in part, by a decrease in the thermogenic changes due to orexin A. Because weight gain due to antipsychotic drugs is a frequent reason for noncompliance with pharmacological treatment [38], studies on mechanisms affecting obesity are very important in the management of psychiatric therapy.…”