Drugs That Cause Weight Gain

Among drugs which cause weight gain, the tricyclic antidepressant medications are a drug class producing persistent and problematic body weight gain in many treated patients. Major depressive illness is often associated with reductions in appetite and body weight, and treatment with antidepressants effectively restores mood, appetite and weight. However, a frequent complaint of patients treated with tricyclic drugs is of excessive and unwanted weight gain, oftentimes resulting in medication noncompliance. The incidence of weight gain during acute and chronic treatment with different, frequently prescribed antidepressant drugs will be reviewed, as will the possible mechanisms by which such drugs alter caloric intake and expenditure, contributing to drug-induced weight gain.     

Attitudes Toward Weight Gain in Pregnancy

Recently, there has been increased interest in the influence of maternal prenatal nutrition on the course and outcome of pregnancy. Evidence has accumulated that a woman''s weight before pregnancy and the weight gained during pregnancy directly affect infant birth weight, incidence of neonatal mortality, and growth and development of the infant during the first year of life. Although recent recommendations for weight gain in pregnancy have been liberalized, a survey of 195 pregnant women who had prenatal visits in both clinic and private offices showed deficiencies in their understanding of the subject. Some 37 percent of women believed they should gain 20 pounds (9 kg) or less during pregnancy. Eight percent admitted to dieting before at least one antenatal visit and 54 percent thought their doctor would not be concerned about too little weight gained during pregnancy. This suggests that many women and some doctors are still ignorant of current concepts of proper nutrition during pregnancy. Apparently, increased lay and professional educational efforts are needed.     

Pregnancy Weight Gain and Childhood Body Weight: A Within-Family Comparison

Background

Excessive pregnancy weight gain is associated with obesity in the offspring, but this relationship may be confounded by genetic and other shared influences. We aimed to examine the association of pregnancy weight gain with body mass index (BMI) in the offspring, using a within-family design to minimize confounding.

Methods and Findings

In this population-based cohort study, we matched records of all live births in Arkansas with state-mandated data on childhood BMI collected in public schools (from August 18, 2003 to June 2, 2011). The cohort included 42,133 women who had more than one singleton pregnancy and their 91,045 offspring. We examined how differences in weight gain that occurred during two or more pregnancies for each woman predicted her children''s BMI and odds ratio (OR) of being overweight or obese (BMI≥85th percentile) at a mean age of 11.9 years, using a within-family design. For every additional kg of pregnancy weight gain, childhood BMI increased by 0.0220 (95% CI 0.0134–0.0306, p<0.0001) and the OR of overweight/obesity increased by 1.007 (CI 1.003–1.012, p = 0.0008). Variations in pregnancy weight gain accounted for a 0.43 kg/m² difference in childhood BMI. After adjustment for birth weight, the association of pregnancy weight gain with childhood BMI was attenuated but remained statistically significant (0.0143 kg/m² per kg of pregnancy weight gain, CI 0.0057–0.0229, p = 0.0007).

Conclusions

High pregnancy weight gain is associated with increased body weight of the offspring in childhood, and this effect is only partially mediated through higher birth weight. Translation of these findings to public health obesity prevention requires additional study. Please see later in the article for the Editors'' Summary     

Metabolic Determinants of Weight Gain in Humans

One of the fundamental challenges in obesity research is to identify subjects prone to weight gain so that obesity and its comorbidities can be promptly prevented or treated. The principles of thermodynamics as applied to human body energetics demonstrate that susceptibility to weight gain varies among individuals as a result of interindividual differences in energy expenditure and energy intake, two factors that counterbalance one another and determine daily energy balance and, ultimately, body weight change. This review focuses on the variability among individuals in human metabolism that determines weight change. Conflicting results have been reported about the role of interindividual differences in energy metabolism during energy balance in relation to future weight change. However, recent studies have shown that metabolic responses to acute, short‐term dietary interventions that create energy imbalance, such as low‐protein overfeeding or fasting for 24 hours, may reveal the underlying metabolic phenotype that determines the degree of resistance to diet‐induced weight loss or the propensity to spontaneous weight gain over time. Metabolically “thrifty” individuals, characterized by a predilection for saving energy in settings of undernutrition and dietary protein restriction, display a minimal increase in plasma fibroblast growth factor 21 concentrations in response to a low‐protein overfeeding diet and tend to gain more weight over time compared with metabolically “spendthrift” individuals. Similarly, interindividual variability in the causal relationship between energy expenditure and energy intake (“energy sensing”) and in the metabolic response to cold exposure (e.g., brown adipose tissue activation) seems, to some extent, to be indicative of individual propensity to weight gain. Thus, an increased understanding and the clinical characterization of phenotypic differences in energy metabolism among individuals (metabolic profile) may lead to new strategies to prevent weight gain or improve weight‐loss interventions by targeted therapies on the basis of metabolic phenotype and susceptibility to obesity in individual persons.     

Psychosocial Determinants of Adequacy of Gestational Weight Gain

Pregnancy is a critical time window for evaluating weight gain on subsequent risk for obesity among women of childbearing age. The purpose of this investigation was to determine whether symptoms of depression, anxiety, stress, self‐esteem, and fetal health locus of control (FHLC) beliefs were significant risk factors for adequacy of gestational weight gain (GWG) when maternal sociodemographic characteristics and health behaviors were considered. A total of 1,605 women were prospectively followed from ≤20 weeks' gestation through delivery. Participants completed standard self‐report questionnaires. Adequacy of GWG was expressed as the ratio of observed/expected weight gain based on Institute of Medicine recommendations. Multivariate ANOVA models were conducted and generalized linear models were performed to calculate risk ratios. Higher depressive symptoms reported throughout pregnancy were significantly associated with higher adequacy ratios. Stronger beliefs in chance in determining fetal health predicted inadequate relative to adequate GWG and was positively associated with larger GWG ratios overall. Several relationships were attenuated when adjusted for covariates. The relationship between psychosocial status and adequacy of GWG is significantly impacted by maternal sociodemographic factors and health practices engaged in during pregnancy. Women who tend to believe that external factors primarily determine fetal health appear to be more vulnerable to nonadherence to clinical GWG guidelines. These results have important implications for targeting prevention and intervention efforts for improving maternal and fetal outcomes secondary to GWG patterns.     

Inflammation Markers Predict Increased Weight Gain in Smoking Quitters

Objective: Undesirable weight gain often follows smoking cessation. We investigated whether weight gain after smoking cessation is greater in those with higher levels of inflammatory markers. Research Methods and Procedures: We studied weight gain and risk of a large gain (≥90th percentile) over 3 years in a cohort study of 11, 687 U.S. men and women, 45 to 64 years old, with focus on the 2664 who continued and the 493 who quit smoking. Results: Among new quitters, adjusted weight gain for those in the highest (vs. lowest) quartile of leukocytes was 0.56 kg/yr more (95% confidence interval, 0.17 to 0.95); for those in the highest (vs. lowest) quartile of fibrinogen, 0.60 kg/yr more (95% confidence interval, 0.27 to 0.92; p = 0.02 and 0.001 for adjusted smoking status by leukocyte and smoking status by fibrinogen interaction terms, respectively). In adjusted analyses, the odds ratio for a large gain associated with quitting (vs. continuing) was 6.2 for those in the highest quartile of leukocytes vs. 2.2 for those in the lowest leukocyte quartile (p = 0.03 for smoking status by inflammatory marker interaction). Similarly, the odds ratio for a large gain associated with quitting was 4.5 in the highest fibrinogen quartile vs. 2.5 in the lowest (p = 0. 09 for the interaction term). Discussion: Weight gain after smoking cessation is increased in those with higher baseline levels of leukocytes and fibrinogen. These findings suggest a close relationship between inflammatory mediators and regulators of energy balance that may have important clinical implications.     

Circadian Timing of Food Intake Contributes to Weight Gain

Studies of body weight regulation have focused almost entirely on caloric intake and energy expenditure. However, a number of recent studies in animals linking energy regulation and the circadian clock at the molecular, physiological, and behavioral levels raise the possibility that the timing of food intake itself may play a significant role in weight gain. The present study focused on the role of the circadian phase of food consumption in weight gain. We provide evidence that nocturnal mice fed a high‐fat diet only during the 12‐h light phase gain significantly more weight than mice fed only during the 12‐h dark phase. A better understanding of the role of the circadian system for weight gain could have important implications for developing new therapeutic strategies for combating the obesity epidemic facing the human population today.     

Non Linear Weight Gain with Long Term Overfeeding in Man

This study deals with the pattern of body weight gain during an overfeeding period with a constant energy intake, in order to assess whether total daily energy expenditure (TEE) increased with body weight and thus could account for the progressive slow down in body weight gain over time. Twenty-four young adult males (12 pairs of identical twins) were overfed by 4.2 MJ per day, six days a week, for a total of 84 days during a 100-day overfeeding period. The total excess amount each man consumed was 353 MJ. It was assumed that, at a given time, the TEE increase (E) was dependent on body weight gain and energy cost (C) was proportional to the daily body weight gain. Results show an exponential increase in body weight, fat free mass, and fat mass (with half-times of 86, 57, and 84 days, respectively) that allows the calculation of E (246 ± 37 kJ*kg^?1 d^?1, mean ± SE) and C (32.3 ± 2.4 MJ kg^?1). Energy expenditure from other sources besides resting metabolic rate, such as physical activity and thermic effect of food, may represent as much as 65% of E. At the beginning of the overfeeding period, almost all the energy surplus was recovered as body substances but this proportion decreased to 60% after 100 days of overfeeding. It is concluded that 1) TEE changes were related to body weight change, 2) about 65% of E were accounted for by physical activity, thermic effect of food, or some other components, and 3) the fraction of the energy surplus stored as body substances decreased with the duration of overfeeding.     

Are Breaks in Daily Self-Weighing Associated with Weight Gain?

Regular self-weighing is linked to successful weight loss and maintenance. However, an individual''s self-weighing frequency typically varies over time. This study examined temporal associations between time differences of consecutive weight measurements and the corresponding weight changes by analysing longitudinal self-weighing data, including 2,838 weight observations from 40 individuals attending a health-promoting programme. The relationship between temporal weighing frequency and corresponding weight change was studied primarily using a linear mixed effects model. Weight change between consecutive weight measurements was associated with the corresponding time difference (β = 0.021% per day, p<0.001). Weight loss took place during periods of daily self-weighing, whereas breaks longer than one month posed a risk of weight gain. The findings emphasize that missing data in weight management studies with a weight-monitoring component may be associated with non-adherence to the weight loss programme and an early sign of weight gain.     

Almost All Antipsychotics Result in Weight Gain: A Meta-Analysis

Introduction

Antipsychotics (AP) induce weight gain. However, reviews and meta-analyses generally are restricted to second generation antipsychotics (SGA) and do not stratify for duration of AP use. It is hypothesised that patients gain more weight if duration of AP use is longer.

Method

A meta-analysis was conducted of clinical trials of AP that reported weight change. Outcome measures were body weight change, change in BMI and clinically relevant weight change (7% weight gain or loss). Duration of AP-use was stratified as follows: ≤6 weeks, 6–16 weeks, 16–38 weeks and >38 weeks. Forest plots stratified by AP as well as by duration of use were generated and results were summarised in figures.

Results

307 articles met inclusion criteria. The majority were AP switch studies. Almost all AP showed a degree of weight gain after prolonged use, except for amisulpride, aripiprazole and ziprasidone, for which prolonged exposure resulted in negligible weight change. The level of weight gain per AP varied from discrete to severe. Contrary to expectations, switch of AP did not result in weight loss for amisulpride, aripiprazole or ziprasidone. In AP-naive patients, weight gain was much more pronounced for all AP.

Conclusion

Given prolonged exposure, virtually all AP are associated with weight gain. The rational of switching AP to achieve weight reduction may be overrated. In AP-naive patients, weight gain is more pronounced.