Do You Gain Weight if You Have Schizophrenia?

Summary: If you have schizophrenia, you may gain weight or be overweight before your diagnosis, but gaining weight is not a feature of schizophrenia: it’s a result of factors associated with schizophrenia and treatment for schizophrenia.

Key Points:

• Symptoms of schizophrenia are primarily emotional, behavioral, and psychological.
• Gaining weight is not a symptom of schizophrenia.
• Gaining weight is a common side effect of psychiatric medications used to treat schizophrenia.
• Additional factors associated with gaining weight in schizophrenia include a sedentary lifestyle, decreased motivation, and withdrawal from engagement in core social and vocational activity.
• Managing weight while in treatment for schizophrenia is possible by taking proactive steps at the beginning of the treatment process.

Weight Gain and Schizophrenia: Is There Really a Connection?

Yes, there really is, but the reasons people with schizophrenia gain weight are complex.

Studies show that obesity is “twice as common in people with schizophrenia compared to the general population.” Overweight and obesity are risk factors for a wide variety of physical problems, including cardiovascular disease, diabetes, stroke, and are associated with premature mortality.

This is one reason why people wonder if you gain weight if you have schizophrenia. If they receive a diagnosis for schizophrenia, they’re not only worried about their mental health, but also their physical health. However, it’s important to understand this fact:

Schizophrenia itself does not cause weight gain.

Gaining weight is a common problem for people with mental health disorders. While there’s no guarantee it will happen, a study on 286 people with schizophrenia showed the following weight-related outcomes in the six months following a schizophrenia diagnosis:

Among all study participants:

• No gain: 56%
• 1-10 pounds: 19%
• 11-20 pounds: 12%
• Over 20 pounds: 14%

Among those who gained weight after diagnosis:

• 42% gained less than 10 pounds
• 27% gained 11-20 pounds
• 31% gained more than 20 pounds

The concern is real, when taking into account the negative physical and mental health outcomes for people with overweight and obesity. In addition to the physical problems we mention in the previous section, the study we cite above indicates significant increases in weight within six months of diagnosis is often associated with decreases in:

• Life satisfaction
• Quality of life
• Self-esteem
• Sense of vitality

The evidence is there to see: there is definitely a connection between weight gain and schizophrenia. But why?

What Causes You to Gain Weight if You Have Schizophrenia?

We’ll repeat that it’s not schizophrenia itself, but rather factors associated with schizophrenia. Evidence from decades of research details the causes. We’ll report what we learned from these five resources, which include four peer reviewed studies and one information page from the nonprofit organization Living With Schizophrenia:

1. Controlled study: The Clinical Implications of Weight Gain in Schizophrenia
2. Cross-sectional study: Association of Daily-life Functioning and Obesity in Individuals With Schizophrenia and Controls
3. Controlled study: The Impact of Weight Gain on Quality of Life Among Persons With Schizophrenia
4. Review study: Metformin for the Prevention of Antipsychotic-Induced Weight Gain: Guideline Development and Consensus Validation
5. Information/Help Page: Physical Health and Schizophrenia

We reviewed these resources and identified the following reasons people with schizophrenia often gain weight.

Weight Gain in Schizophrenia: Four Common Causes

1. Antipsychotic medication. Research shows that roughly half of patients who take first- and second-generation antipsychotics report unwanted weight gain. In addition, studies show that antipsychotic medication can increase cravings for carbohydrates. Excess consumption of carbohydrates can result in rapid weight gain.
2. Sedentary lifestyle. Research shows that people with schizophrenia spend between 8-13 waking hours per day engaging in sedentary behavior, compared to about 6-8 hours per day for people without schizophrenia. In addition, people with schizophrenia experience higher levels of unemployment and underemployment, both of which increase levels of sedentary behavior.
3. Poor diet. Research indicates people with schizophrenia eat fewer fresh fruits and vegetables and more foods high in sugar and fat, compared to people without schizophrenia. This increases risk of weight gain, and increases risk of metabolic disorders.
4. Disengagement/withdrawal from interactions with others. The positive and negative symptoms of schizophrenia can act as barriers for interaction with others, and complications associated with cognition and cognitive deficits can significantly reduce the desire for a person with schizophrenia to participate in social activity, individual and group exercises.

We understand that someone reading this article may respond by saying something like this:

All these things are the result of schizophrenia, so how can you say schizophrenia doesn’t cause weight gain?

We’ll explain below.

Addressing Weight Gain in Schizophrenia: What We Cand Do

It’s true that the reasons for weight gain in schizophrenia are associated with the presence of the disorder. However, this doesn’t mean they’re caused by the disorder. Research demonstrates they’re the result of our human responses to the symptoms and the treatment of the symptoms, rather than the disorder itself.

To control and/or reduce risk of weight gain in schizophrenia, mental health professionals can take the following steps (adapted from “The Clinical Implications of Weight Gain in Schizophrenia,” cited above)

1. Educate patients about the risk of gaining weight during treatment for schizophrenia, with a focus on people with new diagnoses who may take antipsychotic medication.
2. Conduct a complete physical exam and screen for risk factors for weight gain, such as sedentary behavior, poor diet, tobacco use, and alcohol/drug use.
3. Discuss risk of weight gain associated with antipsychotic medication, and plan for potential changes in dosage or changes in medication.
4. Emphasize the importance of a healthy lifestyle as part of mental health treatment, including a healthy diet, daily exercise and activity, and consistent social connection.

That last point may be the most important. Since symptom reduction improves quality of life, and the best medications for symptom reduction may cause an increase in weight, it’s important to implement lifestyle changes early in treatment in order to counter the potential weight gain connected to schizophrenia treatment. These changes can improve long-term outcomes for people with schizophrenia independent of the type of medication they take, and – despite the complex and difficult side effects – are part of a holistic, integrated, whole-patient approach for the treatment of schizophrenia that includes antipsychotic medication.