title: Second-generation antipsychotic use in schizophrenia and associated weight gain: a critical review and meta-analysis of behavioral and pharmacologic treatments.
abstract: BACKGROUND
  Weight gain in schizophrenia, particularly secondary to second-generation antipsychotic (SGA) use, is a common adverse effect and often is associated with significant physical and psychological morbidity.
  
  
  METHODS
  We performed a critical literature review of all controlled clinical trials for pharmacologic and/or behavioral management of SGA-induced weight gain in schizophrenia patients by searching PubMed and Google Scholar. A meta-analysis was performed to estimate and compare weight changes for various medications and behavioral interventions.
  
  
  RESULTS
  Sample sizes generally were small. Clinical trials were 6 weeks to 1 year, and weight loss was modest with any treatment. Although several adjunctive pharmacologic treatments showed no weight loss, sibutramine, metformin, and topiramate showed some benefit. Amantadine and orlistat were somewhat less effective and had lower rates of tolerability. Among the behavioral therapies, nutritional counseling combined with exercise showed the most benefit. Behavioral therapies, although modest, showed the most consistent benefits compared with controls.
  
  
  CONCLUSIONS
  Scheduled pharmacologic treatment to prevent weight gain or promote weight loss in schizophrenia patients on SGA therapy is limited based on current studies. Switching antipsychotic agents has not been established as a long-term solution. Additional long-term studies are required to influence clinical practice.
authors.affiliation: Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, USA.
authors.forename: Chandan
authors.initials: C
authors.lastname: Das
authors.forename: Guillermo
authors.initials: G
authors.lastname: Mendez
authors.forename: Sonal
authors.initials: S
authors.lastname: Jagasia
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Labbate
mesh_terms: D019440:Anti-Obesity Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D009765:Obesity / Q000139:chemically induced* / Q000628:therapy*; D012559:Schizophrenia / Q000188:drug therapy*; D015430:Weight Gain / Q000187:drug effects; D061217:Weight Reduction Programs / Q000379:methods*
chemical_list: D019440:Anti-Obesity Agents; D014150:Antipsychotic Agents