Interventions to prevent antipsychotic-induced weight gain and metabolic complications in individuals with a first-episode psychosis and minimal antipsychotic exposure: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: 3.05 kg less weight gain with behavioral interventions

• Primary Outcome: Weight gain prevention in first-episode psychosis patients

• Nnt Or Sensitivity: Clinically meaningful weight reduction of approximately 3 kg in critical early treatment period

• Confidence Interval: 95% CI: 1.36 kg to 4.73 kg

Clinical Application

Multidisciplinary team approaches align with existing Australian mental health service models but require dedicated resources Relevant to RANZCP guidelines for early psychosis intervention; could inform PBS criteria for metabolic monitoring; aligns with National Mental Health Commission priorities for early intervention Patients with first-episode psychosis initiating antipsychotic treatment in Australian mental health services

Abstract

BACKGROUND: Rapid weight gain commonly occurs following the onset of first-episode psychosis (FEP), leading to cardiometabolic disease. Most weight gain in FEP occurs in the first 3 months of treatment, offering a critical window for prevention. Despite this, most studies aiming to prevent antipsychotic-induced weight gain include people with chronic illness or people who have had lengthy exposure to antipsychotic medication. We aimed to synthesize and analyze the literature on interventions aimed at preventing antipsychotic-induced weight gain. METHODS: We conducted a systematic review in PsycInfo, MEDLINE, CINAHL, and EMBASE of studies that examined the effectiveness of interventions in preventing antipsychotic-induced weight gain in FEP. We examined their effect on weight gain and a range of cardiometabolic markers. RESULTS: We screened 2,092 articles, 13 of which were eligible. Behavioral interventions, all three of which consisted of a multidisciplinary team approach, resulted in a mean of 3.05 kg less weight gain than treatment-as-usual (95% CI 1.36 kg to 4.73 kg). Pharmacological interventions displayed marked clinical and statistical heterogeneity, with each of the seven trials in adults using a different pharmacological intervention. Few studies collected comprehensive data on metabolic health. Only two pharmacological studies, and five studies in total, have been published since 2010. CONCLUSIONS: Despite the importance of preventing weight gain in FEP, there have been few recent studies investigating this topic. Our results indicate that multidisciplinary team interventions are effective in preventing weight gain in FEP and should be offered to all patients.

References

1. 1.O'Mahony, B. W., Burke, T., Hamill, R., Gannon, L., Perry, B. I., Siskind, D., Pawełczyk, T., O'Shea, D., & O'Donoghue, B. (2026). Interventions to prevent antipsychotic-induced weight gain and metabolic complications in individuals with a first-episode psychosis and minimal antipsychotic exposure: a systematic review and meta-analysis. *Psychological Medicine*. https://doi.org/10.1017/S0033291726104139