Weight gain from novel antipsychotic drugs: Need for action

Obesity is common in schizophrenia, and people with schizophrenia appear to be at increased risk for certain obesity-related conditions, such as type 2 diabetes and cardiovascular disease. Antipsychotic drugs, used chronicall y to control symptoms of schizophrenia, are associated with often-substanti al weight gain, a side effect that is a special concern with the latest gen eration of highly effective "novel" agents. That the mo,st effective (e.g., novel) antipsychoric medications lead to substantial weight gain presents the field with a critical public health problem. Although preliminary data have been reported regarding the beneficial use of behavior therapy program s for short-term weight control in patients with schizophrenia, the availab le data are quite limited, anti there are no data regarding the long-term b eneficial effects of these programs in this population. The obesity field r ecently has developed programs emphasizing "lifestyle changes" (e.g., diet, exercise, and problem-solving skills) to successfully manage weight in pat ients without schizophrenia. Such programs can be adapted for patients with schizophrenia through the use of highly structured and operationalized mod ules emphasizing medication compliance, social skills development, and part icipation DI outpatient programs. Moreover, these programs can potentially be combined with the use of adjunctive pharmacotherapy to maximize and main tain weight loss. The field must solve the paradox that some of our most ef fective medications for schizophrenia produce substantial weight gain and i ts associated troubling health risks. (C) 2000 Elsevier Science Inc.