Being overweight is common in people with a serious mental illness, the cause of which may be attributable to lifestyle factors such as poor diet and physical inactivity, and also due to medication side effects. Weight gain is a well-documented side effect of many antipsychotic medications, particularly the newer second-generation medications. This could in part be a result of the wide mode of action of antipsychotic drugs, including disruption of metabolic pathways.

Excessive weight gain is a serious health concern, it is associated not only with reduced quality of life and social stigma, but can affect treatment adherence and increase morbidity (both physical and psychological) and mortality. Obesity is reported to double the risk of all-cause mortality, as well as related diseases such as coronary heart disease, stroke and type-2 diabetes.

Pharmacological strategies are at best only moderately effective for weight management, thus the ideal non-pharmacological strategies for weight management should combine diet, exercise and psychological/behavioural components. Weight management is important to ensure that the benefits of medications are not outweighed by the increased risk of physical disease.

What is the evidence for treatments for weight gain?

Moderate to high quality evidence suggests lifestyle interventions are effective for weight reduction in people with any severe mental illness. Moderate to low quality evidence suggests lifestyle interventions also reduces body mass and improves depressed mood.

November 2021

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