Weight change by baseline BMI from three-year observational data: findings from the Worldwide Schizophrenia Outpatient Health Outcomes Database

Abstract

The aim was to explore weight and body mass index (BMI) changes by baseline BMI in patients completing three years of monotherapy with various first- and second-generation antipsychotics in a large cohort in a post hoc analysis of three-year observational data. Data were analyzed by antipsychotic and three baseline BMI bands: underweight/normal weight (BMI <25 kg/m²), overweight (25-30 kg/m²) and obese (>30 kg/m²). Baseline BMI was associated with subsequent weight change irrespective of the antipsychotic given. Specifically, a smaller proportion of patients gained ≥7% baseline bodyweight, and a greater proportion of patients lost ≥7% baseline bodyweight with increasing baseline BMI. For olanzapine (the antipsychotic associated with highest mean weight gain in the total drug cohort), the percentage of patients gaining ≥7% baseline weight was 45% (95% CI: 43-48) in the underweight/normal weight BMI cohort and 20% (95% CI: 15-27) in the obese BMI cohort; 7% (95% CI: 6-8) of the underweight/normal cohort and 19% (95% CI: 13-27) of the obese cohort lost ≥7% baseline weight. BMI has an association with the likelihood of weight gain or loss and should be considered in analyses of antipsychotic weight change.

Weight gain and obesity in schizophrenia: epidemiology, pathobiology, and management

“…Iloperidone, quetiapine, risperidone, paliperidone, sertindole, and zotepine confer an intermediate risk, whereas amisulpride, aripiprazole, asenapine, lurasidone, and ziprasidone are generally associated with small increases in body weight . A post hoc analysis of 4626 patients with schizophrenia, who had completed 3 years of naturalistic antipsychotic monotherapy with clozapine, olanzapine, quetiapine, risperidone, amisulpride, and oral and depot first‐generation antipsychotics , indicated that the mean weight gain was highest with olanzapine (4.2 kg) and lowest with amilsulpride (1.8 kg). Weight accrual was fastest during the first 6 months of treatment and, depending of the drug, 7–15% of patients moved from normal weight to the overweight or obese status .…”

Factors related to malnutrition in community‐dwelling patients with schizophrenia

“…The nutritional status of schizophrenia patients was previously measured using anthropometric parameters such as body weight and BMI, rather than through the use of multifaceted tools such as the MNA . However, it has been reported that a single indicator such as an anthropometric or biochemical parameter does not accurately reflect nutritional status in other chronic diseases; so, the determination of nutritional status using tools reflecting various aspects has been emphasized .…”

“…The nutritional status of schizophrenia patients was previously measured using anthropometric parameters such as body weight and BMI, rather than through the use of multifaceted tools such as the MNA. 10,11,38 However, it has been reported that a single indicator such as an anthropometric or biochemical parameter does not accurately reflect nutritional status in other chronic diseases; so, the determination of nutritional status using tools reflecting various aspects has been emphasized. 23,26 The MNA is a multidimensional assessment tool including information on food intake due to appetite or swallowing difficulty, anthropometric measurements including weight loss, and physical and mental functions 21,22 and has been validated in patients with schizophrenia.…”

“…In addition, the prevalence of underweight, hypoproteinemia, and hypocholesterolemia was significantly higher in patients with schizophrenia in the general population . In a 3‐year observational study, baseline body mass index (BMI) was associated with subsequent weight change, irrespective of antipsychotic treatment in the Worldwide Schizophrenia Outpatient Health Outcomes Database . These findings indicate that undernutrition is an important issue to be considered along with obesity and overweight for care patients with schizophrenia.…”

Risperidone stimulates food intake and induces body weight gain via the hypothalamic arcuate nucleus 5‐HT2c receptor—NPY pathway

“…Compared to first‐generation antipsychotics, second‐generation antipsychotics cause fewer extra‐pyramidal problems, but they present new challenges because they often lead to metabolic disorders. For example, risperidone increases food intake and induces weight gain, glucose intolerance, hypertriglyceridemia, and hyperprolactinemia . Previous research has suggested that risperidone induces weight gain by upregulating the expression of hypothalamic histaminergic H1 receptors and neuropeptide Y (NPY) .…”