Weight gain and metabolic disturbances are well-known side effects of antipsychotic

medications, including olanzapine. However, the role of appetite in olanzapine-induced

weight gain in first-episode schizophrenia patients remains understudied. This study aimed to

fill this knowledge gap by investigating the relationship between increased appetite and

weight gain in a drug-naïve patient population.

A prospective study design was employed, enrolling drug-naïve first-episode

schizophrenia patients initiating olanzapine treatment. Changes in appetite, weight, and

metabolic parameters were monitored at various time points over a 12-week period. Linear

regression analysis was performed to evaluate the association between increased appetite and

weight gain, controlling for relevant variables.

During the 12-week olanzapine treatment, 77.4% (24/31) patients had increased

appetite with 58.1% (18/31) patients having increased appetite within the first 4 weeks. The

mean time for increased appetite was 20.3 days. More patients in the increased appetite group

increased their initial body weight by more than 7% after 12 weeks when compared to

patients with unchanged appetite (22/24 [91.7%] vs. 3/7 [42.9%], p = 0.004). Earlier

increased appetite led to more weight gain during the following month. Overall, 50% of

patients in the increased appetite group had dyslipidemia after 12 weeks.

The study highlights the clinical significance of assessing appetite changes as an early

predictor of weight gain in first-episode schizophrenia patients receiving olanzapine

treatment. Monitoring and addressing increased appetite can provide clinicians with

opportunities for timely interventions to prevent excessive weight gain. The gender

differences observed in weight gain emphasize the need for tailored approaches in managing

weight-related effects of olanzapine, particularly in female patients.

Increased appetite plays a crucial role in olanzapine-induced weight gain in drug-

naïve first-episode schizophrenia patients. Evaluating appetite changes provides clinicians

with a practical tool for predicting and managing weight gain, with a particular focus on early

interventions. The findings of this study have implications for developing strategies to

prevent and mitigate olanzapine-induced weight gain in schizophrenia patients, especially

considering gender-specific factors. Further research is warranted to elucidate the underlying

mechanisms of appetite modulation and its relationship with metabolic changes in response to

olanzapine treatment.