Weight, waist circumference, blood pressure, fasting glucose or HbA1c and a lipid profile are worth almost nothing measured three months after starting an antipsychotic, because by then you cannot tell what the drug did. Measured before the first dose, they are the whole basis of the conversation you will have a year later.
Do it on the day you prescribe. If a fasting sample is impractical, take HbA1c, which does not need fasting and is available almost everywhere. Weigh the patient yourself rather than asking; the reported weight in a first episode is usually the weight before the illness started.
Then set the repeat at 12 weeks, not at the annual review. Most antipsychotic weight gain happens in the first three months, and that is the window in which switching or adding metformin is still working with the trajectory rather than against it. In young people with a first episode, where the metabolic consequences will run for decades, this single habit does more than most of what follows it.
- Record weight, waist, blood pressure, HbA1c and lipids before the first dose, not after it.
- Use HbA1c where fasting is impractical; it needs no preparation.
- Weigh the patient rather than accepting a reported weight.
- Book the repeat at 12 weeks, when most of the gain has already happened.
- Write the baseline numbers somewhere the next clinician will find them.
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