Estimating the consequences of anti-psychotic induced weight gain on health and mortality rate

Many anti-psychotic medications produce marked weight gain. In this study, we estimate the expected impact of degrees of antipsychotic-induced weight gain on selected mortality rate and incidence rates of impaired glucose tol erance (IGT) and hypertension (HTN) among US adults. Using raw data from 52 09 respondents from the Framingham Heart Study's public use data set and na tional statistics on population demographics, we estimated the expected eff ect of weight gain on number of deaths and incident cases of IGT and HTN fo r a 10-year period commencing in 1999. Results indicated that the estimated deleterious effects of weight gain were greater for people with higher BMI s at baseline, for greater degrees of weight gain, for men than women, and for older than younger persons. Because there is a 'U-shaped' relation betw een BMI and mortality rate, small to moderate weight gains among people wit h baseline BMIs less than 23 were predicted to decrease mortality rates, wh ereas weight gains among people with baseline BMIs above that level were ex pected to increase mortality rates. However, the relations of IGT and HTN w ith BMI are monotonically increasing. Thus, the anticipated effect of weigh t gain on IGT and HTN is deleterious regardless of baseline BMI. Because it is unclear whether the beneficial effects of the atypical agents on, for e xample, reducing suicide mortality, outweigh the putative increase in morta lity due to weight gain, we estimate the beneficial effects due to decrease d death from suicide with the potential deleterious effects due to a 10-kg weight gain. We found that 492 suicide deaths per 100 000 schizophrenic pat ients would be prevented over 10 years with the use of clozapine compared t o 416 additional deaths due to antipsychotic induced weight gain. Although this estimate is rather crude and should be seen only as offering a sense o f the likely situation, results suggest that the lives saved via clozapine may essentially be offset by the deaths due to weight gain. As we discuss, it is not possible to provide definitive estimates of the effect of antipsy chotic-induced weight gain on health and mortality, but our findings sugges t that the magnitude of weight gains induced by many antipsychotic agents i s likely to have important deleterious effects on mortality and health. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.