Summary: In Medicaid-insured youth newly started on second-generation antipsychotics, home-delivered water plus parental phone coaching increased water intake and briefly reduced sugary-drink consumption compared with education alone, but produced no significant BMI z-score advantage over six months.
PICO Summary
| Element | Detail |
|---|---|
| Population | 148 Medicaid-insured youth aged 8–17 recently started on a second-generation antipsychotic. |
| Intervention | Biweekly home delivery of bottled water plus parental phone support from a family navigator. |
| Comparison | Basic healthy-lifestyle education emphasising water and reduced sugary drinks. |
| Outcome | Greater water intake at 3 and 6 months (p=0.006; p=0.002) and reduced SSB at 3 months (p=0.004), not sustained. No between-group BMI z-score difference; control rose within-group at 3 months (p=0.029). Neither group crossed the unhealthy-gain threshold. |
Water delivery to curb antipsychotic weight gain
RCT · youth on antipsychotics · 6 months
Water delivery plus coaching shifted beverage habits but did not change BMI z-score versus education alone over six months. Neither group crossed the unhealthy-gain threshold.
Expert Commentary
Antipsychotic-related weight gain in children is one of those problems where I badly want a simple, low-risk fix, so I came to this trial hoping the water-and-coaching idea would land. The honest verdict is that it half worked, and the half that failed is the half that matters. Yes, the intervention durably increased water intake and briefly cut sugary drinks, which tells me beverage behaviour is genuinely modifiable in this group. But it did not move BMI z-score, the outcome I actually care about, and that null result is consistent with the broader and slightly deflating literature showing behavioural measures alone make only modest dents in this particular weight gain. I take the reassurance that neither group gained unhealthily, while noting six months is short and the beverage data were parent-reported. Can I use this with my patients? Yes, as one sensible, cheap component of metabolic protection from the day I prescribe, but not as the strategy. The realistic lesson is that preventing this weight gain needs sustained multimodal effort, metabolic monitoring, and sometimes metformin, not hydration alone.
References
Bussell K, Wehring H, dosReis S, et al. Mitigating weight gain side effects by reducing sugar-sweetened beverage consumption in youth newly prescribed second-generation antipsychotic medication. Nutrients. 2025;18(1):24. doi:10.3390/nu18010024