Weight gain and increase of body mass index among children and adolescents treated with antipsychotics: a critical review

Abstract

We performed an updated review of the available literature on weight gain and increase of body mass index (BMI) among children and adolescents treated with antipsychotic medications. A PubMed search was conducted specifying the following MeSH terms: (antipsychotic agents) hedged with (weight gain) or (body mass index). We selected 127 reports, including 71 intervention trials, 42 observational studies and 14 literature reviews. Second-generation antipsychotics (SGAs), in comparison with first-generation antipsychotics, are associated with a greater risk for antipsychotic-induced weight gain although this oversimplification should be clarified by distinguishing across different antipsychotic drugs. Among SGAs, olanzapine appears to cause the most significant weight gain, while ziprasidone seems to cause the least. Antipsychotic-induced BMI increase appears to remain regardless of the specific psychotropic co-treatment. Children and adolescents seem to be at a greater risk than adults for antipsychotic-induced weight gain; and the younger the child, the higher the risk. Genetic or environmental factors related to antipsychotic-induced weight gain among children and adolescents are mostly unknown, although certain genetic factors related to serotonin receptors or hormones such as leptin, adiponectin or melanocortin may be involved. Strategies to reduce this antipsychotic side effect include switching to another antipsychotic drug, lowering the dosage or initiating treatment with metformin or topiramate, as well as non-pharmacological interventions. Future research should avoid some methodological limitations such as not accounting for age- and sex-adjusted BMI (zBMI), small sample size, short period of treatment, great heterogeneity of diagnoses and confounding by indication.

Commentary: A Randomized, Double-Blind, Placebo-Controlled Trial of Metformin Treatment of Weight Gain Associated with Initiation of Atypical Antipsychotic Therapy in Children and Adolescents

“…While weight gain in all age groups is a common adverse drug effect, youth are more vulnerable to this effect relative to adults (7). For example, aripiprazole, considered by some to be weight neutral in adults, causes significant weight gain in children and adolescents (7). SGA-induced weight gain contributes to non-compliance with medication (8).…”

Risk Factors for Weight Gain and Metabolic Syndrome in Adolescents with Psychiatric Disorders: A Historical Prospective Study

“…The previous few reports on gender difference in weight gain among adolescent patients varied in methodology (some cohorts included children mixed with teens), focused almost entirely on SGAs, and yielded conflicting findings (Martínez-Ortega et al 2013). Female gender has been associated with a higher probability of antipsychoticinduced weight gain in several studies McIntyre and Jerrell 2008).…”

Treatment of Obesity Among Youth With Intellectual and Developmental Disabilities: An Emerging Role for Telenursing

“…For example, clozapine, an atypical antipsychotic used to treat aggression, depression, and anxiety, poses risk for weight gain (Gressier, Porcelli, Calati, & Serretti, 2016). Other commonly prescribed atypical antipsychotics include olanzapine and quetiapine, and both are also associated with risk of weight gain (Martínez-Ortega et al, 2013). Antidepressant (Serretti & Mandelli, 2010) and anticonvulsant medications (Tanamachi et al, 2015; Wirrell, 2003) have been associated with weight gain as well.…”