If the p-doc did not stop you somewhere mid-way between 170 lbs and 286 lbs, well, maybe you need another p-doc. Weight gain is THE major side effect of AP's (and psych drugs in general) and monitoring for weight gain comes with the territory if you make your living as a p-doc. My p-doc weighs me at every visit. Also, at 286 lbs you are already at risk for diabetes hence I strongly suggest Metformin not just to control weight but as assurance against diabetes. Diabetes is a really horrible thing with multiple disastrous complications, so the first step now is to ensure you do not get it, hence I suggest Metformin first, and Topamax second. Also, Topamax is expensive and Metformin is cheap, in case you do not have insurance.