NS480 Unit 2 Antipsychotic Weight Gain Assessment Example

Five Domains, One Medication History: A Unit 2 Nutrition Assessment of Weight Gain After Starting an Antipsychotic

[Student Name]

Purdue University Global

NS480: Medical Nutrition Therapy I

Unit 2 Nutrition Assessment

[Instructor Name]

[Date]

The patient and all of her values are composite; the care process update, the antipsychotic consensus, the weight-gain meta-analysis, the metabolic syndrome criteria and the diabetes standards cited are real.

Referral and Purpose

Dana, 36, was referred by her psychiatric nurse practitioner for nutrition assessment after gaining weight steadily since starting olanzapine two years ago. The purpose of this assessment is to organize her data into the five domains of the nutrition care process, compare each finding with an accepted standard, and identify the problems a nutrition diagnosis should address (Swan et al., 2017). Her psychiatric medicine is not a nutrition decision and is not questioned here; the assessment describes its likely effects so the team can plan around them.

Domain 1: Food and Nutrition-Related History

Dana describes a large increase in appetite since starting her medicine, especially in the evening. A 24-hour recall and a usual-intake interview show three meals plus two evening snacks, often chips or cookies, and about four 12-ounce regular sodas a day, supplying roughly 560 kcal from sugary drinks alone. She eats two to three servings of fruit and vegetables a week. She buys most food at a corner store near her supported housing, which has a limited fresh selection. She smokes about a pack a day and drinks no alcohol. Her physical activity is mostly walking to the store.

Standard: federal guidance caps added sugars at under a tenth of daily energy, a ceiling her sodas alone would break at almost any plausible calorie intake.

Domain 2: Anthropometric Measurements

Height 165 cm. Current weight 92 kg; weight two years ago 74 kg, a gain of 18 kg, or about 24 percent. Body mass index 33.8, which falls in the class I obesity range. Waist circumference 104 cm.

Standard: in the harmonized metabolic syndrome criteria, a waist circumference of 88 cm or more is the threshold commonly used for women in the United States (Alberti et al., 2009). Her waist exceeds it by 16 cm.

Domain 3: Biochemical Data, Medical Tests and Procedures

Fasting labs from last month: glucose 108 mg/dL, hemoglobin A1C 5.9 percent, triglycerides 210 mg/dL, HDL cholesterol 42 mg/dL, LDL cholesterol 128 mg/dL. Blood pressure 132/84 mm Hg.

Standards: her fasting glucose and her A1C both sit inside the ranges the diabetes standards use to define prediabetes (American Diabetes Association Professional Practice Committee, 2025). The harmonized criteria count raised triglycerides, low HDL for a woman, raised blood pressure and raised fasting glucose as separate components, and her values cross each cutoff (Alberti et al., 2009).

Dana meets at least five of the metabolic syndrome criteria, waist, triglycerides, HDL, glucose and blood pressure, which places the weight gain within a pattern of cardiometabolic risk rather than a cosmetic concern.

Her blood pressure meets the systolic threshold but not the diastolic one; under the harmonized criteria, either part qualifies.

Domain 4: Nutrition-Focused Physical Findings

Thick, darkened skin with a velvet texture on her neck and under both arms, consistent with acanthosis nigricans, which is associated with insulin resistance. No signs of muscle or fat wasting. No edema. Teeth show some decay, which she attributes to sodas.

Domain 5: Client History

Dana has schizoaffective disorder, stable for eighteen months on olanzapine 15 mg daily. Before olanzapine she tried a different medicine that did not control her symptoms. She lives in supported housing with a shared kitchen, receives disability income and SNAP benefits, and has a case manager. Her mother has type 2 diabetes. She says she wants to "stop gaining" and is worried about developing diabetes like her mother.

Second-generation antipsychotics as a group are associated with weight gain and metabolic changes, and a consensus statement from diabetes, psychiatric and obesity organizations recommends regular monitoring of weight, waist, blood pressure, glucose and lipids in people taking them (American Diabetes Association et al., 2004). A meta-analysis of antipsychotic studies found that almost all of these medicines lead to weight gain with prolonged use, with the effect most pronounced in people starting a medicine for the first time (Bak et al., 2014). Her pattern of gain fits that evidence.

Summary of Findings

The assessment identifies several problems a nutrition diagnosis could address:

1. High intake of sugar-sweetened beverages, about 560 kcal a day.

2. Increased appetite and evening snacking, likely related to her medicine.

3. Low fruit and vegetable intake, shaped by limited food access.

4. Obesity with central fat distribution.

5. Prediabetes and metabolic syndrome.

The last two are medical diagnoses made by her care team. The first three are nutrition-related problems within the dietitian's scope and could form the basis of a diagnosis statement.

How the Domains Fit Together

Read one at a time, each domain gives part of the story. Read together, they describe a sequence. The medicine raised her appetite, especially in the evening. Her food environment offered mostly packaged snacks and sodas to meet it. The extra intake, about 560 kcal a day from drinks alone, matches the scale of her weight gain over two years. The gain settled around her waist, and her labs and skin now show the insulin resistance that often follows. That sequence matters for planning. Changing the medicine is not nutrition's decision, but her drinks, her evening eating and her access to food are areas where nutrition care can act directly, and they sit early in the chain where a change could slow everything after it.

Strengths and Barriers

Strengths: she is motivated by her mother's diabetes, she has stable psychiatric symptoms, a case manager and SNAP benefits, and she has a shared kitchen. Barriers: limited food access near her housing, medicine-related appetite, smoking, and limited cooking experience.

Coordination With the Care Team

The assessment will be shared with her nurse practitioner and case manager. Her prescriber may wish to consider her metabolic findings when reviewing her treatment, a decision outside nutrition's scope. Her primary care provider should know about her prediabetes and acanthosis nigricans so that diabetes risk can be followed.

Limitations

Diet history depends on self-report, and the 24-hour recall may not reflect a typical day. Waist measurement was taken once, by one assessor, over light clothing, so a repeat reading at the next visit would make the value more reliable. Her activity level was estimated from conversation rather than measured with a step counter or log. Lab values are from a single draw. Her weight before olanzapine came from a clinic record rather than a measured trend.

References

Alberti, K. G. M. M., Eckel, R. H., Grundy, S. M., Zimmet, P. Z., Cleeman, J. I., Donato, K. A., Fruchart, J.-C., James, W. P. T., Loria, C. M., & Smith, S. C. (2009). Harmonizing the metabolic syndrome. Circulation, 120(16), 1640-1645. https://doi.org/10.1161/CIRCULATIONAHA.109.192644

American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, & North American Association for the Study of Obesity. (2004). Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care, 27(2), 596-601. https://doi.org/10.2337/diacare.27.2.596

American Diabetes Association Professional Practice Committee. (2025). 2. Diagnosis and classification of diabetes: Standards of care in diabetes 2025. Diabetes Care, 48(Suppl. 1), S27-S49. https://doi.org/10.2337/dc25-S002

Bak, M., Fransen, A., Janssen, J., van Os, J., & Drukker, M. (2014). Almost all antipsychotics result in weight gain: A meta-analysis. PLOS ONE, 9(4), e94112. https://doi.org/10.1371/journal.pone.0094112

Swan, W. I., Vivanti, A., Hakel-Smith, N. A., Hotson, B., Orrevall, Y., Trostler, N., Beck Howarter, K., & Papoutsakis, C. (2017). Nutrition care process and model update: Toward realizing people-centered care and outcomes management. Journal of the Academy of Nutrition and Dietetics, 117(12), 2003-2014. https://doi.org/10.1016/j.jand.2017.07.015