MADRID – The weight gain most patients have when first starting treatment with antipsychotic medications is not inevitable.
A 12-week intervention program designed to promote exercise and a healthy diet largely blunted a big weight gain by 16 adolescents and young adults starting treatment after an initial diagnosis of psychosis in a controlled study at a single Australian center. Later follow-up further showed that a majority of participants in the program remained mostly free of excess weight 2 years after the life-style intervention, Dr. Philip B. Ward said at the meeting sponsored by the European Psychiatric Association.
Implementing this type of intervention is very important because antipsychotic-induced weight gain launches young psychiatric patients into a middle age that often includes metabolic syndrome, type 2 diabetes, and a significantly increased risk for cardiovascular disease events, said Dr. Ward, a psychiatrist at the University of New South Wales in Sydney.
He reported results from a pilot program, Keeping the Body in Mind, run at one of the university’s community clinics that gave newly-diagnosed psychiatric patients aged 15-25 years regular instruction in diet, food shopping, and cooking and in an exercise class that included individualized coaching over the course of 12 weeks. At the end of the program, average weight gain relative to baseline weight was 1.8 kg among 16 patients in the intervention group and 7.8 kg among 12 patients who received standard care at a different community clinic. (Early Interv Psychiatry. 2015. doi: 10.1111/eip.12230).
Expressed another way, 2 of the 16 participating patients (13%) had a clinically significant (at least 7%) weight gain during the 12-week program, compared with 9 of the 12 (75%) of patients with a significant weight gain in the control group.
To assess the durability of this effect, Dr. Ward and his associates did follow-up 2 years later on 12 of the participants, who showed an average 1.3-kg weight gain after 2 years, compared with their weight at the time they entered the program, Dr Ward reported. Based on this success, the university’s psychiatric clinics are now expanding the program to make it available to all patients starting treatment on antipsychotic medications, about 80 patients a year, Dr. Ward said in an interview.
Although Dr. Ward stressed the importance of lifestyle intervention, he noted that the antipsychotic drug selected for treatment can also affect the magnitude of acute weight gain. Two drugs that seem to pose some of the lowest weight-gain risks are aripiprazole and ziprasidone.
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