Schizophrenia Bulletin Advance Access originally published online on April 21, 2007
Schizophrenia Bulletin 2007 33(3):654-656; doi:10.1093/schbul/sbm022
© The Author 2007. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.
Interventions to Reduce Weight Gain in Schizophrenia
Guy Faulkner1,
Tony Cohn2 and
Gary Remington2
2 Department of Psychiatry, University of Toronto and the Centre for Addiction and Mental Health, Toronto, Canada
Keywords: cochrane / weight / schizophrenia
Obesity is a common problem for individuals with schizophrenia,
a problem that has been exacerbated more recently with the increased
use of second-generation antipsychotics, many of which are associated
with the risk of weight gain and metabolic disturbance. Recently,
a Cochrane review has been published examining pharmacological
and nonpharmacological (diet/exercise) interventions for reducing
and/or preventing weight gain in this population.
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Objective
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The objective of the review was to determine the effects of
both pharmacological (excluding medication switching) and nonpharmacological
strategies for reducing or preventing weight gain in individuals
with schizophrenia.
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Search Strategy
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We searched key databases and the Cochrane Schizophrenia Group's
trials register and reference sections within relevant articles,
hand searched key journals, and contacted the first author of
each relevant study and other experts to collect further information.
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Selection Criteria
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All clinical randomized controlled trials (RCTs) comparing any
pharmacological or nonpharmacological intervention for weight
gain (eg, diet and exercise counseling including elements of
cognitive and/or behavioral modification) with standard care
or other treatments for individuals with schizophrenia or schizophrenia-like
illnesses were selected.
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Data Collection and Analysis
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Studies were reliably selected, quality assessed, and data extracted.
Because weight is a continuous outcome measurement, weighted
mean differences (WMD) of the change from baseline were calculated.
Where heterogeneity existed (determined by a chi-square test),
a random-effects model was used. The primary outcome measure
was weight loss.
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Main Results
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Twenty-three RCTs met the inclusion criteria for this review.
Five trials assessed a cognitive/behavioral intervention and
18 assessed a pharmacological adjunct. In terms of prevention,
there was a significant treatment effect in trials examining
a pharmacological adjunct, demonstrating modest prevention of
weight gain (6 RCTs,
n = 274, WMD –1.16 kg, confidence
interval [CI] –1.90 to –0.41; see Figure 1). Two
cognitive/behavioral trails showed significant treatment effect
(mean weight change) at end of treatment (2 RCTs,
n = 104, WMD
–3.38 kg, CI –4.81 to –1.96; see Figure 2).
In terms of treatment, there was an overall treatment effect
in trials examining a pharmacological adjunct, (9 RCTs,
n =
273, WMD –2.97 kg, CI –4.48 to –1.46) although
caution is required in interpreting this average outcome given
significant heterogeneity (see Figure 3). Three cognitive/bahavioral
trials showed significant treatment effect at end of treatment
(3 RCTs,
n = 129, WMD –1.69 kg, CI –2.77 to –0.61;
see Figure 4).
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Reviewers' Conclusions
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Modest short-term weight loss can be achieved with selective
pharmacological and nonpharmacological interventions. However,
interpretation is limited by the small number of studies, small
sample size, short study duration, and variability of the interventions
themselves, their intensity, and duration. At this stage, no
single pharmacological agent emerges as consistently superior
in terms of weight loss efficacy. Of drugs currently in the
market, reboxetine and topiramate were effective at weight prevention
and topiramate (at 200 mg) was effective for established weight
gain, although there was only a single study for each. There
were mixed results with sibutramine, nizatidine, and amantadine
and negative results for fluoxetine (treatment and prevention
study) and famotadine and phenylpropinolamine. Nonpharmacological
interventions incorporating dietary and physical activity modifications
demonstrated promise in terms of preventing weight gain.
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Implications for Practice
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There is currently limited information in terms of RCTs to evaluate
the effectiveness and safety of interventions to moderate weight
gain. Existing data suggest that short-term modest weight loss
is possible with nonpharmacological and selective pharmacological
interventions. Given this modest weight loss, the first strategy
in preventing or alleviating weight gain is to appraise metabolic
risk when prescribing antipsychotic and other psychotropic medications,
although priority should be given to achieving good control
of the mental illness. Patients, family, and caregivers should
be educated about metabolic risks and receive lifestyle advice
regarding diet and physical activity.
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Implications for Research
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Further RCTs with larger samples and longer treatment duration
are needed to evaluate the effectiveness and safety of both
pharmacological and nonpharmacological interventions in preventing
weight gain and effecting weight loss in schizophrenia patients
treated with antipsychotic medications.
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Footnotes |
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1 To whom correspondence should be addressed; Faculty of Physical Education and Health, University of Toronto, Toronto, Canada; tel: 416 9467949; fax: 416 9712118; e-mail: guy.faulkner{at}utoronto.ca.
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Acknowledgments
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We would like to thank the Ontario Mental Health Foundation
for providing financial support for this review. We would also
like to thank Clive Adams, Tessa Grant, and Gill Rizzello of
the Cochrane Schizophrenia Group for their help and support
with this review. The full text of this review is available
in the Cochrane Library. Disclosures: None.
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