Two papers published in the Lancet Psychiatry Physical Health Commission look at monitoring the physical health of people prescribed psychiatric medication and lifestyle interventions in mental health care.
Comment on the paper on physical health monitoring for people prescribed psychiatric medication*:
Dr Natalie Shoham, Senior Clinical Lecturer in the Unit for Psychological Medicine at the Centre for Psychiatry and Mental Health, QMUL, and honorary consultant psychiatrist, said:
“The second report of the Lancet Commission provides an up-to-date, comprehensive and practical guide for clinicians on how to reduce the burden of side effects caused by psychotropic medications, based on a review of a wide range of evidence. The report has direct real-world implications for healthcare provision, and potential to improve quality of life for many individuals prescribed antipsychotic medications. The challenges inherent in ensuring that all people prescribed antipsychotics benefit from the recommendations must now be addressed.”
Dr Paul Keedwell, Consultant Psychiatrist and Fellow of the Royal College of Psychiatrists, said:
“The report is a well-meaning set of recommendations for improving the physical health outcomes of people prescribed medication for mental illness. Although clients often benefit from medication from a mental health point of view, many psychotropic medications put on weight and contribute to the development of metabolic syndrome.
“Feedback from service users was included in the report. This was particularly valuable. Most individuals receive advice on diet and exercise, and even have gym memberships subsidised by the health service, but they commonly struggle to enact these for two main reasons.
“Firstly, many individuals suffer with treatment-resistant illness, including disabling depression and schizophrenia, where the symptoms deter them from exercising and planning/preparing healthy meals.
“Secondly, many medications that individuals might need to stay well provide a barrier to exercise by inducing sedation and lethargy. This is particularly true with antipsychotics like clozapine, which commonly induce weight gain.
“Until more effective and better-tolerated medications are developed for mental illness more consideration should be given to the use of additional medications like metformin which can help with weight loss, even in the absence of diabetes. Also, it seems to me that this is a population that would benefit greatly from access to GLP agonists if they have medication induced obesity, including Wegovy and Mounjaro.”
Dr Prasad Nishtala, Reader in the Department of Life Sciences, University of Bath, said:
“This report is a landmark in bringing together the best available evidence on preventing and managing the physical health side effects of psychiatric medication. Cardiometabolic and neurological complications can shorten life expectancy, while sexual health problems may reduce treatment adherence. Together, these issues significantly affect the overall quality of life. The Commission rightly emphasises proactive prevention, shared decision-making, and coordinated care, and adding a standardised psychotropic adverse event monitoring tool would further strengthen clinical monitoring. Or even better, integrated digital tools that combine intervention tracking with proactive side-effect monitoring, particularly during the early stages of treatment, would help clinicians act quickly and consistently to protect patients’ physical health.”
Comments on both papers:
Dr Jo Howe, Research Associate for the RESOLVE study, Aston University, said:
“These two reports offer an evidence-based roadmap for preventing and managing the physical health side-effects of psychotropic medication and embedding lifestyle interventions in mental health care. They highlight practical measures such as early monitoring, shared decision making, integrating lifestyle interventions like physical activity and nutrition support, and the prophylactic use of metformin for high-risk prescriptions. Our research on antipsychotic-induced weight gain reinforces the value of preventative care — acting early to anticipate risks and making interventions sustainable within routine practice. Many services still need clear guidance on when and how to initiate metformin, and clarity over responsibility for physical health. Too often, mental and physical health care are delivered in silos, meaning opportunities for prevention are missed. These reports are rigorous and grounded in current evidence, but their real-world impact will depend on breaking down these silos, alongside workforce capacity, service redesign, and policy commitment. If implemented well, they could help close the unacceptable 13–15 year life expectancy gap for people with severe mental illness.”
Prof Ian Maidment, Professor of Clinical Pharmacy, and Associate Dean Research and Enterprise (Pharmacy), Aston University, said:
“Life expectancy in people with mental illnesses such as schizophrenia is reduced by up to 20 years partly related to physical health issues; managing the physical health of people with mental illness has been an international priority for many years. Many psychotropic medications cause physical health problems for people with mental illness, for example anti-psychotics are associated with significant weight gain potentially 30kg or more. The commission has synthesised the evidence and produced clear recommendations for practice. One key challenge is implementation of the recommendations into day-to-day routine clinical care. Successful implementation will require a system wide approach working across primary, secondary and social care. In summary, we desperately need to improve the physical healthcare in people with mental illnesses; implementation of the evidence is a vital next step.”
*‘Holistic prevention and management of physical health side-effects of psychotropic medication: second report of the Lancet Psychiatry Physical Health Commission’ by Sean Halstead et al. was published in the Lancet Psychiatry at 23:30 UK time on Tuesday 12 August 2025.
DOI: 10.1016/S2215-0366(25)00162-2
‘Implementing lifestyle interventions in mental health care: third report of the Lancet Psychiatry Physical Health Commission’ by Scott B Teasdale et al. was published in the Lancet Psychiatry at 23:30 UK time on Tuesday 12 August 2025.
Declared interests
Dr Natalie Shoham: “My COI is that one author was a subsidiary supervisor for my PhD.”
Dr Paul Keedwell: “No conflicts of interest.”
Dr Prasad Nishtala: “No COI to declare.”
Dr Jo Howe: “I am a chartered psychologist and research consultant specialising in mental and physical health integration, including NIHR-funded work on antipsychotic-induced weight gain and preventative care pathways (https://doi.org/10.1111/obr.13962). I have no relevant industry funding and no current advisory roles with pharmaceutical companies.”
Prof Ian Maidment: “I’m an active researcher in this area, but don’t believe that this represents a Conflict of Interest. See: Non-pharmacologicaL InterVEntions for Antipsychotic-Induced Weight Gain (RESOLVE) in People Living With Severe Mental Illness: A Realist Synthesis. Obesity Reviews. e13962, https://doi.org/10.1111/obr.13962.”