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To the Editor: In the report of their randomized controlled trial, Dr Wu and colleagues¹ concluded that lifestyle intervention and metformin alone and in combination demonstrated efficacy for weight reduction in patients taking antipsychotic medications. The rationale for their study was based on the assumption that weight loss in this population is beneficial to health and that the "induction of obesity by antipsychotic agents" is linked with greater morbidity and mortality.

However, in this study the majority of participants were not obese or even overweight by conventional body mass index (BMI) cut points, and the generalizability of the findings to overweight or obese populations is unclear. Given that there may be ethnic differences in what is considered to be a normal or healthy BMI, the authors could have argued that the treatment groups were overweight relative to a lower cut point that is appropriate to the Chinese population. However, Gu . . . [Full Text of this Article]

David J. Llewellyn, PhD
dl355@medschl.cam.ac.uk

Felix Naughton, MSc
Department of Public Health and Primary Care
University of Cambridge
Cambridge, United Kingdom

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