Female belly fat and clozaril/clozapine

Hi I have a friend who wants to lose weight and has kept a stable weight while watching what she eats. She used to be extremely athletic as a kid but now doesn’t exercise. She used to be called “the body” due to her nice body but in the past few years she’s put on a lot of belly fat. She’s 33 and her arms, legs, hips, and butt are very lean (she has virtually no butt or hips).

Her “waist” (belly) measurement is 42 inches, she’s 5’8" and 200 lbs.

She’s on antipsychotic medication called clozaril/clozapine and it commonly puts weight on.

I’ve talked to a doctor and a psychiatrist but they don’t have any ideas about why her weight is in the place it is rather than the typical female areas like the hips, butt and thighs.

I suggested that it might be hormones or something…

Does anyone know of any possible causes?

I’m no expert, but isn’t it partially genetic? Honestly, she sounds somewhat fortunate if it is only in the stomach as opposed to everywhere. Obviously she should exercise along with the diet, but I’m not one to judge there. And as we age it gets harder.

I don’t know that particular drug but most psychiatric ones cause weight gain, if anything. Welbutrin I believe is a rare exception.

I’ve seen some girls/women who appear to have a different weight distribution - they put it on in the belly and as a “spare tire”, just above the hips all the way around. They have thinner legs and upper body than you would expect from the weight, and in front much of the weight is in lower abdomen.

I’ve seen this pattern on several females; I specifically remember watching one girl I knew develop this from a fairly normal thin body shape between ages of about 14 and 17 (puberty-related?). So my guess is that it’s genetic. From the small and rough sampling of large-belly females I know, I also wonder if the shape is related to PCOS?

Actually, it is better to have fat elsewhere and not all in the stomach, which is abdominal obesity and is highly correlated with adverse health outcomes, much more so than fat elsewhere:

That drug is one of the so-called “atypical antipsychotics” and is one the ones most strongly associated with “metabolic syndrome” - defined as having 3 of the following: central obesity (waist circumference over 35 inches in women); elevated triglycerides (over 150); low HDL (less than 50 in women); high BP (over 135/85); and elevated fasting plasma glucose (over 110).

Here is a good review for you. (pdf)

It may be at least partly because these meds have particular affinity for certain receptors that trigger off central obesity (5-HT2C and histamine H receptors as particular suspects). It may also be that those who are prone to the conditions that warrant atypical antipsychotic drug use are also particularly prone to develop central obesity when they gain fat mass. The article also talks up the association of schizophrenia and related conditions with lifestyles that are associated with metabolic syndrome but I cannot see that as the major factor in causing central obesity and the rest of metabolic syndrome so much more so than the level of obesity alone would more usually be associated with.

The increase in abdominal obesity associated with these medications being used does seem to occur more commonly in women than men.

I hope she is also getting her lipids and glucose checked regularly and she minimally should be strongly encouraged to take up exercising regularly again. And no smoking.


80cm - increased risk
88cm - greatly increased risk

94cm - increased risk
102cm - greatly increased risk

and my friend is about 106cm…

The question is a very interesting one.

I’ve also found this study. They studied the effects of two different antipsychotics on fat accumulation, insulin sensitivity, and pancreatic function in dogs. First it was notable that the two (risperdone and olanzapine) had very different effects. But olanzapine’s (OLZ in the study) effects were of particular note:

Since that 2005 study this one came out last year:

So the brain regulatory systems seem to be a main driver of the metabolic dydfunctions which likely include the tendency to central obesity. Which does not mean that peripheral effects cannot also be main drivers too.

Yes, your friend is at risk. There are reasons that these meds are used despite their known risks. The benefits are significant and other meds have their own risk profiles. Of course I am not her doctor and would not give anything but generic advice. Even given that I will state again, adequate monitoring for those metabolic and blood pressure issues, and adding regular exercise to her attempts at nutrition management, are unquestionably good ideas. She really should discuss this with her doctor.