Body mass index increase in preschoolers with heterogeneous psychiatric diagnoses treated with risperidone

Matan Avrahami*, Miriam Peskin, Tyler Moore, Adi Drapisz, Jerome Taylor, Hadar Segal-Gavish, Livia Balan-Moshe, Issac Shachar, Tomer Levy, Abraham Weizman, Ran Barzilay

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: Use of risperidone in preschool-aged children is growing, with rising concerns of adverse metabolic consequences. Longitudinal data on risperidone-related weight gain in preschoolers are scarce. We aimed to evaluate changes in body mass index (BMI) that are associated with risperidone treatment in preschoolers. Method: We analyzed naturalistic, longitudinal data on 141 preschool children (112 boys, 29 girls) receiving psychiatric care. Mean patient age at baseline was 5.0 years (SD=0.8) and average follow-up period was 1.3 years (SD=0.8), with >8 mean BMI measurements per patient. We studied the effect of risperidone exposure (n=78) on age-and-sex-standardized BMI (BMI Z-score) implementing mixed models with random subject intercepts to account for repeated measures, covarying for multiple confounders including demographics, stimulant treatment and psychiatric diagnoses. We employed similar models to study dose and duration effects. Results: Risperidone treatment was significantly associated with an increase in BMI (effect size of exposure=0.45 SD (SE=0.06), t (949)=7.7, p<0.001) covarying for stimulant exposure and other confounders, independent of treatment indication. Females exhibited stronger effects (risperidone treatment × sex interaction t=2.32, p=0.02)). Risperidone daily dose was associated with increase in BMI (for each additional 1 mg, effect size=0.28 SD (SE=0.07), t(419)=3.76, p<0.001). Conclusion: Similar to older populations, risperidone treatment in preschoolers is associated with significant weight gain, with evidence for dose effects. Findings provide critical data that can inform clinicians.

Original languageEnglish
Pages (from-to)1134-1140
Number of pages7
JournalJournal of Psychopharmacology
Issue number9
StatePublished - Sep 2021


FundersFunder number
American Academy of Child
Lifespan Brain Institute of CHOP
National Institutes of HealthKL2TR001879
National Institute of Mental HealthK23MH120437
Brain and Behavior Research Foundation
University of Pennsylvania Health System


    • Preschool age
    • dose response
    • risperidone
    • weight gain


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