Why Your Prescriber May Check Weight, Blood Sugar and Cholesterol

If you take certain psychiatric medications, you may notice your prescriber asking about your weight, checking your blood pressure or ordering blood work. It can feel unexpected. You came in for your mood or your thinking, so why is anyone asking about cholesterol?

The answer is that mental health and physical health are closely connected, and some medications that help with mental health conditions can also affect how the body handles sugar, fat and weight. Keeping an eye on these changes is called metabolic monitoring. It is a routine, preventive part of good psychiatric care.

This article explains the idea in general terms. Your prescriber will decide what monitoring makes sense for you.

What "metabolic" means here

Metabolism is how your body turns food into energy and stores it. In the context of psychiatric care, metabolic monitoring usually focuses on a handful of measurements:

• Weight and body mass index (BMI)
• Waist circumference, which reflects fat stored around the abdomen
• Blood pressure
• Blood sugar, through tests such as fasting glucose or A1C
• Cholesterol and triglycerides (a lipid panel)

Together, these give a picture of your risk for problems such as type 2 diabetes, heart disease and stroke.

Which medications are involved

Metabolic changes are best known with some second-generation (atypical) antipsychotic medications. These medications are used for a range of conditions, including schizophrenia, bipolar disorder and sometimes depression, so many people take them even without a psychotic disorder.

Some mood stabilizers and certain antidepressants can also be associated with weight or appetite changes. The level of risk varies a great deal between individual medications, and between people taking the same medication.

Your prescriber can tell you whether the medications you take are ones that call for regular metabolic monitoring, and how often.

Why it matters

Metabolic changes can develop quietly. A gradual increase in weight or blood sugar may not cause any symptoms for a long time. By the time someone notices, a condition like diabetes may already be established.

Regular monitoring helps catch changes early, when there are more options. It also matters because people living with serious mental illness can face higher rates of some physical health problems, for many reasons, including medication effects, access to care, stress and lifestyle factors. Paying attention to physical health is part of treating the whole person.

What monitoring usually involves

Monitoring commonly includes a baseline, a set of measurements taken before or around the time a medication is started, followed by periodic checks over time. Checks may be more frequent in the first months of a new medication, then spaced out if things are stable.

In practice, that might mean:

• Being weighed and having your blood pressure taken at visits
• Answering questions about appetite, activity, sleep and family history of diabetes or heart disease
• Getting blood drawn for glucose and lipid tests at intervals your prescriber recommends

Some blood tests are more accurate after fasting. Your care team will tell you whether you need to skip eating beforehand.

What happens if something changes

If monitoring shows an increase in weight, blood sugar or cholesterol, it does not automatically mean a medication must stop. Your prescriber will look at the full picture, including how well the medication is helping your mental health. Options they may discuss include:

• Watching the trend more closely for a period of time
• Practical changes to eating, activity and sleep, with support
• Adjusting or switching the medication
• Coordinating with your primary care provider about treatment for the physical health issue

Please do not stop or change a psychiatric medication on your own because of a lab result or weight change. Talk with your prescriber first so any change can be made safely.

Your role in monitoring

You are an active partner in this process. You can help by:

• Keeping your lab appointments. It is easy to let blood work slide, but the results are only useful if they happen.
• Mentioning appetite changes early. If you notice you are hungrier, snacking more or craving sweets after a medication change, say so.
• Sharing your family history. Diabetes, heart disease or high cholesterol in close relatives is useful information.
• Asking for your numbers. You are entitled to understand your results. Ask what they mean and what the goal ranges are for you.
• Connecting your care. Let your psychiatric prescriber and primary care provider know about each other, and consider signing a release so they can share results.

Small, realistic steps

If you are working on metabolic health, small and sustainable changes tend to be easier to stick with than dramatic ones. Ideas people often find manageable include:

• A short daily walk, even for 10 minutes
• Keeping regular meal times rather than skipping meals and overeating later
• Swapping sugary drinks for water or unsweetened options
• Keeping a consistent sleep schedule
• Planning snacks ahead if a medication increases appetite

A therapist, dietitian or primary care provider can help you build a plan that fits your life. Mental health symptoms can make change harder, so be patient with yourself.

Questions to ask your prescriber

• Does my medication need metabolic monitoring?
• Which tests will I have, and how often?
• Do I need to fast before any blood work?
• What changes would make you want to revisit my medication?
• Who will share these results with my primary care provider?

Care that looks at the whole person

At SOS Wellness, our services include psychiatric medication management and metabolic testing, so physical health can be considered alongside mental health. Our psychiatrists and psychiatric nurse practitioners see patients at our Middletown and Norwood offices and by telehealth across Ohio. If you would like to talk about your medication care, you can request an appointment or contact us with questions.