Harvard Mental Health Letter

In Brief: Metformin and lifestyle changes help people taking antipsychotics lose weight

In Brief

Metformin and lifestyle changes help people taking antipsychotics lose weight

Second-generation "atypical" antipsychotic medications may cause significant weight gain and increase the risk for diabetes and heart disease. A study reports that people with schizophrenia who gained weight after taking an antipsychotic were best able to shed pounds, and improve other aspects of physical health, by combining the blood sugar–lowering drug metformin (Glucophage) with lifestyle changes.

Researchers in China studied 128 adults newly diagnosed with schizophrenia who were taking a second-generation antipsychotic and who had gained more than 10% over their pre-treatment weight. The researchers randomly assigned each patient to one of four intervention groups. Patients in one group took 750 milligrams of metformin daily; those in another group made lifestyle changes and took a placebo pill; those in a third took metformin in addition to making lifestyle changes; and the rest took only a placebo pill. Lifestyle changes included a diet advocated by the American Heart Association and at least 30 minutes of moderate exercise every day. The intervention lasted 12 weeks.

The researchers assessed insulin resistance and obtained baseline measurements of weight, body mass index (BMI, a measure of weight and height commonly used to assess overweight and obesity), and waist circumference in all participants. People who received metformin in addition to making lifestyle changes showed the most physical improvement across the board.

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