WEIGHT MANAGEMENT AND PSYCHOTROPIC MEDICATION
Highlights of a lecture by Issie Greenberg, Ph.D.
Psychologist, Nutrition Unit, Beth Israel Deaconness Hospital.
Wednesday, October 27, 1999

Low metabolic rates, high fat diets, and minimal energy expenditures have all been implicated in one way or another for the growing obesity problem in this country and our inability to lose weight and keep it off. A chronic disease, obesity is defined as body weight greater than 30% of the ideal body weight.

Body weight gain has also been reported as an adverse result of many psychotropic medications. Dr. Greenberg reviewed the weight gain properties of the major categories of psychiatric meds, including benzodiazepines, mood stabilizers, antidepressants, and anti-psychotics. He found that the new atypical antipsychotics like clozapine and olanzapine (Zyprexa) resulted in the largest weight gains. Weight gain from psychiatric medications is independent of how effective they are at treating the psychiatric condition.

Dr. Greenberg stated that, in general, a 5 pound weight gain in the first month of medication usage may be a clue to a developing medically significant weight problem ahead.

The basic treatment components for obesity:

1. Exercise = best predictor of weight loss success. Ideal prescription is a cumulative 45 minutes per day of walking beyond current levels of activity.
2. Diet = lots of choices from Weight Watchers to Atkins.
3. Medications = new approach. Two meds now on the market: Meridia (Sibutramine) or Zenical (Orlistat)
4. Behavior Modification/lifestyle changes that support weight loss. Everything from exercise to food record keeping to cognitive changes.
5. Gastric bypass surgery for morbid obesity (BMI >40, twice ideal body weight, comorbidities).

You can order an audio tape of this lecture, which includes a review of all the major classes of pyschiatric meds and their effect on weight gain, by calling 617-855-2795.