Schizophrenia and weight management: a systematic review of interventions to control weight. Introduction. Individuals with a severe mental illness, such as.
Copyright Ó Blackwell Munksgaard 2003
Acta Psychiatr Scand 2003: 108: 324–332 Printed in UK. All rights reserved
ACTA PSYCHIATRICA SCANDINAVICA
Review article
Schizophrenia and weight management: a systematic review of interventions to control weight Faulkner G, Soundy AA, Lloyd K. Schizophrenia and weight management: a systematic review of interventions to control weight. Acta Psychiatr Scand 2003: 108: 324–332. Ó Blackwell Munksgaard 2003. Objective: Weight gain is a frequent side effect of antipsychotic medication which has serious implications for a patient’s health and well being. This study systematically reviews the literature on the effectiveness of interventions designed to control weight gain in schizophrenia. Method: A systematic search strategy was conducted of major databases in addition to citation searches. Study quality was rated. Results: Sixteen studies met the inclusion criteria. Five of eight pharmacological intervention studies reported small reductions in weight (30 kg/m2) or overweight (BMI of >27 kg/m2) with additional co-morbidities like type 2 diabetes, hypertension and hyperlipidaemia (35, 61, 62). Given the inconsistent results reported here, and a lack of understanding of the potential exacerbation of psychotic symptoms through the use of antiobesity agents (63), this updated review supports the conclusion that the general use of pharmacological interventions for overweight individuals with schizophrenia cannot be supported although some individuals may benefit (11). More recently, the selective norepinephrine reuptake inhibitor reboxetine was found to attenuate olanzapine-induced weight gain in a double-blind study of 26 patients with schizophrenia (64). If pharmacotherapy is considered however it should be seen as a last resort (8).
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Faulkner et al. The intriguing possibility of pharmacological treatments controlling weight while also targeting other behaviors such as smoking cessation (24) or preventing metabolic disturbances such as diabetes deserves further consideration. For example, metformin has been found to reduce weight in pediatric patients treated with neuroleptics (26) but not adults (40). Metformin has also been found to reduce the incidence of type 2 diabetes in the general population (65). However, lifestyle interventions in this latter study were found to be more effective than metformin administration in reducing diabetes incidence while metformin can only be seen as a medium term solution to such incidence (66). Critically, to maximize the benefits of such pharmacological adjunctive treatments, the use of other lifestyle strategies is necessary (62).
Table 4. The key components for the management of overweight and obesity [adapted from ACSM (34)] Component
Requirement
Diet
Energy intake restriction of 500–1000 kcal/day Dietary fat reduced to
