Letters to the editor.

Sir: Your recent publication (JCP Visuals, January 1999) unfairly characterizes some atypical antipsychotics as more likely to produce weight gain than risperidone. Weight gain is a side effect of the atypicals, but our work with olanzapine, clozapine, and risperidone demonstrates that a patient’s diet is a better predictor of weight gain than a physician’s selection of a particular atypical antipsychotic medication. Contrary to the view expressed in JCP Visuals—that weight gain is unmanageable—our work tells quite the opposite story. With nutritional counseling and dietary changes, patients in our study who gained weight were able to shed that weight and keep it off. This was true for each drug and contradicts JCP Visuals, which infers that once weight is added (my receptors made me eat it!), it never comes off. Having followed the individuals in our study for 2 years, we conclude that while symptoms and medications can complicate the process of weight management, the critical variables are more likely to be healthy eating habits and dietary education. Interestingly, prior to starting atypical medications in our study, patients who were apathetic, with little or no motivation to attend programs or work outside the residence, gained the most weight. We attribute the atypicals’ efficacy in treating negative symptoms to successful weight management in these patients. As evidence continues to mount that atypicals can lead to higher productivity and greater self-sufficiency, we regard the JCP Visuals publication on weight gain to be misleading and an impediment to greater prescription of these newer agents.