Weight gain, raised glucose and dyslipidaemia are common on second-generation antipsychotics, especially olanzapine and clozapine, and often begin within the first weeks. People with severe mental illness already die years earlier than the general population, much of it from cardiovascular disease.
A practical schedule is a baseline weight, waist, blood pressure, fasting glucose or HbA1c and lipids; weight monthly for the first three months; then glucose and lipids at three months and yearly. In Indian patients, central adiposity and diabetes appear at lower body weight, so waist circumference is worth recording each time.
- Record weight, waist, blood pressure, glucose or HbA1c and lipids before starting an antipsychotic
- Weigh monthly for the first three months
- Repeat glucose and lipids at three months, then at least yearly
- Act early on weight gain of 5% or more with lifestyle support, a switch or metformin where appropriate
Why it matters
Most excess mortality in severe mental illness is physical, and it starts with unmonitored weight gain.
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