How do you manage fatty liver disease in patients on olanzapine who are reluctant to change meds?  

I have several forensic patients who have elevated LFTs and fatty liver on ultrasound, at least in part due to long-term olanzapine use. They are all reluctant to change meds, for fear of destabilizing and having to return to state forensic hospitals, where they have typically already spent more than a decade of their lives. Some are on metformin, but it doesn’t seem to help, at least not enough. For many, there are limitations on what food they have access to, so their diets are not ideal.