Rapid weight gain in young people with newly diagnosed schizophrenia is a common phenomenon that increases cardio-metabolic risk profile and contributes to risk of premature death. This was the universal scene-setting message from all of the speakers at a symposium called ‘It’s about time! Improving physical health outcomes in young people prescribed antipsychotic medications’.

But what each of the presenters wanted to convey to delegates was a positive message of hope: namely that obesity is a modifiable risk factor and that there is a particular opportunity in young, newly diagnosed patients to intervene before obesity and its ensuing metabolic risks become entrenched.

Dr Christoph Correll, Professor of Psychiatry and Molecular Medicine at the Hostra North Shore-LIJ School of Medicine, New York, said that when patients start on antipsychotic treatment, modulation of neurotransmitter pathways can affect appetite control and energy homeostasis, leading to weight gain.

Dr Correll and other speakers pointed out that weight gain in patients receiving antipsychotics typically follows a particular trajectory – where weight gain is greatest in the first months following treatment initiation. Dr Correll said that even in this early phase of weight gain, it can be shown that many patients have increases in fasting glucose and changes in their plasma lipid profile. He said there is a need to identify those patients for whom early excessive weight gain and metabolic changes then pose particular risk for later progression to states such as prediabetes, the metabolic syndrome and diabetes.

One of the pioneers of study in this area, Professor John Newcomer of the Washington University School of Medicine, St Louis, USA, highlighted that in any individual, rapid and high gains in weight, and in particular increases in central adiposity, are linked with insulin resistance. He added that weight, insulin resistance and dyslipidaemia are each modifiable risk factors.

Don’t miss the boat

Endocrinologist Professor Katherine Samaras of the University of New South Wales (UNSW) in Australia, believes that it is time to afford young people with schizophrenia the same opportunities for and support in achieving good physical health as would be offered to their peers with other chronic disease diagnoses.

She reminded delegates that the longer a person is overweight, the harder it becomes to lose that weight and she said that a weight gain of >7% from initial body weight is considered a level at which metabolic risks increase. She also said that algorithms and models of care already exist for complication-screening and goal setting – models developed for diabetes prevention and useable in patients with schizophrenia to assist in physical health screening.

Screen and intervene

Dr Jackie Curtis, also from UNSW, and Clinical Director of the Bondi Centre Youth Mental Health Programme and Prof Samaras have been involved in developing and implementing a programme of structured lifestyle support to young people with psychosis. This includes weekly individual counseling sessions with a dietician and exercise physiologist, daily access to clinic-based gym facilities and regular exercise training sessions, and life and health coaching sessions where young people learn to budget for, shop for and cook healthy meals.

Prof Samamas said that although this approach may sound more like social work than medicine – this mental-health centre programme addresses a very real issue relating to physical health and disease prevention.

Dr Curtis reported data comparing outcomes at 12 weeks among young people with psychosis who took part in the lifestyle programme at Bondi, with outcomes for a similar cohort who did not undergo screening or receive lifestyle support following their psychiatric diagnoses. Weight gain in the intervention group was a quarter of that seen in the standard of care group and only 13% of intervention patients versus 35% had clinically significant weight gain.

Any type of exercise plus healthy food

Dr Curtis and Prof Samamas both stressed that any physical activity is good in young people with schizophrenia. They said the objective was not to become ‘gym-buff’ but take exercise of any form.  Prof Newcomer also highlighted that exercise helps counter insulin resistance and is important even when patients are overweight or don’t lose weight readily. Prof Samamas has similar simple advice about diet which she passes to young patients with schizophrenia – no soda, no energy-rich snacks and eat something fresh today.