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.