Which of the following is a sign to monitor as part of metabolic syndrome in patients on second-generation antipsychotics?

• A. Elevated liver enzymes
• B. Weight gain
• C. Hearing loss
• D. Blood in stool

Answer: (B)

Monitoring metabolic risk in patients taking second-generation antipsychotics focuses on weight gain because these medications commonly drive metabolic changes that raise cardiovascular risk. Weight gain reflects increasing adiposity, which is a key driver of insulin resistance and dyslipidemia—the hallmarks of metabolic syndrome. While the full syndrome is diagnosed by a combination of abdominal obesity, high triglycerides, low HDL, elevated fasting glucose, and hypertension, weight gain is an accessible, early sign that prompts further evaluation and intervention. Regularly tracking weight, BMI, and waist circumference helps clinicians detect rising metabolic risk and decide on steps like lifestyle support, adjusting the antipsychotic regimen, or ordering labs (fasting glucose, lipid panel, blood pressure) as needed. Elevated liver enzymes point to possible hepatotoxicity, hearing loss is unrelated to metabolic syndrome, and blood in stool indicates GI bleeding, not metabolic risk.