Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2007 Jan 24:(1):CD005148.
doi: 10.1002/14651858.CD005148.pub2.

Interventions to reduce weight gain in schizophrenia

G Faulkner  1 , T Cohn, G Remington
Affiliations
Meta-Analysis

Interventions to reduce weight gain in schizophrenia

G Faulkner et al. Cochrane Database Syst Rev. .

Abstract

Background: Weight gain is common for people with schizophrenia and this has serious implications for health and well being.

Objectives: To determine the effects of both pharmacological (excluding medication switching) and non pharmacological strategies for reducing or preventing weight gain in people with schizophrenia.

Search strategy: We searched key databases and the Cochrane Schizophrenia Group's trials register (April 2006), reference sections within relevant papers, hand searched key journals, and contacted the first author of each relevant study and other experts to collect further information.

Selection criteria: We included all clinical randomised controlled trials comparing any pharmacological or non pharmacological intervention for weight gain (diet and exercise counselling) with standard care or other treatments for people with schizophrenia or schizophrenia-like illnesses.

Data collection and analysis: We reliably selected, quality assessed and extracted data from studies. As weight is a continuous outcome measurement, weighted mean differences (WMD) of the change from baseline were calculated. The primary outcome measure was weight loss.

Main results: Twenty-three randomised controlled trials met the inclusion criteria for this review. Five trials assessed a cognitive/behavioural intervention and eighteen assessed a pharmacological adjunct. In terms of prevention, two cognitive/behavioural trials showed significant treatment effect (mean weight change) at end of treatment (n=104, 2 RCTs, WMD -3.38 kg CI -4.2 to -2.0). Pharmacological adjunct treatments were significant with a modest prevention of weight gain (n=274, 6 RCTs, WMD - 1.16 kg CI -1.9 to -0.4). In terms of treatments for weight loss, we found significantly greater weight reduction in the cognitive behavioural intervention group (n=129, 3 RCTs, WMD -1.69 kg CI -2.8 to -0.6) compared with standard care.

Authors' conclusions: Modest weight loss can be achieved with selective pharmacological and non pharmacological interventions. However, interpretation is limited by the small number of studies, small sample size, short study duration and by variability of the interventions themselves, their intensity and duration. Future studies adequately powered, with longer treatment duration and rigorous methodology will be needed in further evaluating the efficacy and safety of weight loss interventions for moderating weight gain. At this stage, there is insufficient evidence to support the general use of pharmacological interventions for weight management in people with schizophrenia.

PubMed Disclaimer

References

References to studies included in this review

    1. Deberdt W, Winokur A, Cavazzoni PA, Trzaskoma QN, Carlson CD, Bymaster FP, Wiener K, Floris M, Breier A. Amantadine for weight gain associated with olanzapine treatment. European Neuropsychopharmacology. 2005;15:13–21. - PubMed
    1. Graham KA, Gu H, Lieberman JA, Harp JB, Perkins DO. Double-blind, placebo-controlled investigation of amantadine for weight loss in subjects who gained weight with olanzapine. American Journal of Psychiatry. 2005;162:1744–6. - PubMed
    1. Littrell KH, Hilligoss NM, Kirshner CD, Petty RG, Johnson CG. The effects of an educational intervention on antipsychotic-induced weight gain. Journal of Nursing Scholarship. 2003;35(3):237–41. - PubMed
    1. Brar JS, Ganguli R, Pandina G, Turkoz I, Berry S, Mahmoud R. Effects of behavioral therapy on weight loss in overweight and obese patients with schizophrenia or schizoaffective disorder. Journal of Clinical Psychiatry. 2005;66:205–12. - PubMed
    1. Evans S, Newton R, Higgins S. Nutritional intervention to prevent weight gain in patients commenced on olanzapine: A randomized controlled trial. Australian and New Zealand Journal of Psychiatry. 2005;39:479–86. - PubMed

References to studies excluded from this review

    1. Archie S, Wilson JW, Osborne S, Hobbs H, McNiven J. Pilot study: Access to fitness facility and exercise levels in olanzapine-treated patients. Candian Journal of Psychiatry. 2003;48:628–32. - PubMed
    1. Harmatz MG, Lapuc P. Behavior modification of overeating in a psychiatric population. Journal of Consulting and Clinical Psychology. 1968;32(5):583–87. - PubMed
    1. McCreadie RG, Kelly C, Connolly M, Williams S, Baxter G, Lean M, Paterson JR. Dietary improvement in people with schizophrenia. British Journal of Psychiatry. 2005;187:346–51. - PubMed
    1. Morrison JA, Cottingham EM, Barton BA. Metformin for weight loss in pediatric patients taking psychotropic drugs. American Journal of Psychiatry. 2002;159:655–57. - PubMed
    1. Nickel MK, Nickel C, Muehlbacher M, Leiberich PK, Kaplan P, Lahmann C, Tritt K, Krawczyk J, Kettler C, Egger C, Rother WK, Loew TH. Influence of topiramate on olanzapine-related adiposity in women: A random, double-blind, placebo-controlled study. Journal of Clinical Psychopharmacology. 2005;25:211–17. - PubMed

References to studies awaiting assessment

    1. Alvarez-Jimenez M, Gonzalez-Blanch C, Vazquez-Barquero JL, Perez-Iglesias R, Martinez-Garcia O, Perez-Pardal T, Ramirez-Bonilla ML, Crespo-Facorro B. Attenuation of antipsychotic-induced weight gain with early behavioral intervention in drug-naive first-episode psychosis patients: A randomized controlled trial. Journal of Clinical Psychiatry. 2006;67:1253–260. - PubMed
    1. Brown S, Chan K. A randomized controlled trial of a brief health promotion intervention in a population with serious mental illness. Journal of Mental Health. 2006;15:543–49.
    1. Ganguli R, Brar JS. Prevention of weight gain by behavioral interventions in patients starting novel antipsychotics. Schizophrenia Bulletin. 2005;Vol. 31:561–62.
    1. McKibbin CL, Patterson TL, Norman G, Patrick K, Jin H, Roesch S, Mudalier S, Barrio C, O’Hanlon K, Griver K, Sirkin A, Jeste DV. A lifestyle intervention for older schizophrenia patients with diabetes mellitus: A randomized controlled trial. Schizophrenia Research. 2006;86:36–44. - PubMed

References to ongoing studies

    1. Bristol-Meyer Squibb. Otsuka America Pharmaceutical. Effects of aripiprazole in overweight patients treated with olanzapine for schizophrenia or schizoaffective disorder. Clinical Trials.gov. 2004.
    1. Ritchie C. The efficacy of pindolol in reducing weight gain associated with the use of olanzapine. NHS Trusts Clinical Trials Register. 2003.

Additional references

    1. American Diabetes Association. the American Psychiatric Association. the American Association of Clinical Endocrinologists. the North American Association for the Study of Obesity Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes. Diabetes Care. 2004;27:596–601. - PubMed
    1. Allison DB, Mentore JL, Heo M, et al. Antipsychotic-induced weight gain: A comprehensive research synthesis. American Journal of Psychiatry. 1999;156:1686–9. - PubMed
    1. Allison DB, Mackell JA, McDonnell DD. The impact of weight gain on quality of life among persons with schizophrenia. Psychiatric Services. 2003;54:565–67. - PubMed
    1. Altman DG, Bland JM. Detecing skewness from summary information. BMJ. 1996;313:1200. [: OLZ020600] - PMC - PubMed
    1. Ananth J, Venkatesh R, Burgoyne K, Gadasalli R, Binford R, Gunatilake S. Atypical antipsychotic induced weight gain: pathophysiology and management. Annals of Clinical Psychiatry. 2004;16:75–85. - PubMed