Antipsychotic Induced Weight Gain and Metabolic Dysfunction – A Review of Pathophysiology and Management Strategies
Obesity is a critical public health problem predictive of the development of cardiovascular disease, metabolic syndrome, and type II diabetes. Obesity is more prevalent in people with a mental illness and contributes to the reduced life expectancy of this population. [Holt and Peveler, 2009]
Individuals with psychotic disorders have high rates of Obesity and Metabolic Syndrome (MetS). [Galletly et al., 2012]
MetS is associated with a doubling of the risk of developing cardiovascular disease within 5-10 years and up to five times greater risk of developing Type 2 diabetes which contributes to early mortality in patients with psychosis.
Below are the criteria for metabolic syndrome. [Alberti et al., 2006]
In patients with psychotic disorders, obesity has been shown to affect treatment adherence [Weiden et al., 2004], quality of life [Allison et al., 2003] and cardiovascular morbidity and mortality risk. [Newcomer, 2005]
Many of the available antipsychotic drugs are often associated with significant weight gain, often early in treatment. A recent meta-analysis by Tarricone and colleagues showed that in antipsychotic-naïve patients, body mass index (BMI) increased with antipsychotic use [Tarricone et al., 2010]; long-term use of antipsychotics was associated with more weight gain in comparison to short-term use. [Parsons et al., 2009]
Second-generation antipsychotics associated with extensive weight gain are also associated with most metabolic alterations, with weight gain reported in up to 72% of all antipsychotic-receiving patients. [Fonseka et al., 2016]
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