One of the significant problems people with bipolar disorder grapple with is weight gain. Many online commentators have suggested that this is due largely to the impact of certain types of medications commonly being prescribed for bipolar disorder (a class of medications called atypical antipsychotics).
However, recently published research suggests that the whole picture is a bit more complicated than laying blame on the medications alone.
First, it helps to start off by understanding America’s overall weight problem. Nearly two-thirds of all Americans are overweight (over 70% of all men and over 61% of all women), and one-third of us are considered obese (National Health and Nutrition Examination Survey). America is fat, there’s simply no easy or other way to say it. So if you’re packing a few extra pounds, you’re in the norm for America today.
Susan Simmons-Alling and Sandra Talley (2008) examined the research into the factors surrounding weight gain and bipolar disorder. They note that 35% of people with bipolar disorder are obese, the highest percentage of any psychiatric illness. They also reviewed previous research which suggested factors that may be contributing to this problem: gender, geographical location, co-existing binge-eating disorder (up to 18%), co-existing bulimia nervosa (up to 10%), higher numbers of depressive episodes, treatment with medications that cause weight gain, high carbohydrate consumption, and physical inactivity.
But research results to-date have been decidedly mixed about whether bipolar disorder (and its treatment) causes significant weight gain, or whether weight is more of a general population issue that can be magnified by the presence of bipolar disorder (and its treatment). The researchers note one study that found that 68% of people seeking treatment for bipolar disorder presented as overweight or obese (a statistic that mirrors the general population). But another study found that newly-diagnosed bipolar patients were within normal weight range, finding weight gain only occurred after diagnosis and treatment.
The researchers look at a number of possible contributing factors, including genetic and biological processes and neurotransmitter activity. Research into these areas that specifically examine weight gain in bipolar disorder simple don’t yet exist, but the authors suggested there are “similar patterns if neurochemical dysregulation between the two disorders [bipolar disorder and eating disorders] that might account for weight changes.” They also point to research that suggests that eating disorders and mood disorders may “coaggregate” in families. This begs the question, however, that if that were true, why are we not seeing a huge rise in obesity or weight problems in people taking more typical antidepressants. (While certainly weight gain may be a side effect of some antidepressants, it hasn’t garnered nearly as much attention as the weight gain experienced by people taking the newer atypical antipsychotic medications.)
When the researchers look at psychopharmalogical influences, they get to the kicker — “the pharmacological mechanisms underlying weight gain are poorly understood.” In other words, we don’t know exactly how or why these drugs may be causing weight gain in people. What they do note are possible predictors of weight gain while on the medications — gaining 4 or more pounds in the first 3 weeks of taking the medication, being younger, non-White ethnicity, having lower weight at the outset of treatment, and nonrapid cycling. Sadly, the researchers say very little else to say about the weight gain problems of many atypical antipsychotics. Given what has been published about the Zyprexa research trials in the past 2 years, I’d say this was an unfortunate choice by the authors.
They do note that metabolic syndrome has been shown to be present in up to 30% of people with bipolar disorder (metabolic syndrome is a set of health factors that increase the risk of heart disease and diabetes). What they don’t say anything about is whether this is significantly higher than the general population (it’s about 25% in the general population) and whether bipolar disorder may cause this increased risk.
Additional theories about the increased weight risk associated with bipolar disorder include a childhood history of neglect or abuse, which is reported in 36% to 49% of people with bipolar disorder. Such abuse or neglect is also highly associated with eating concerns, according to the researchers. Alcohol abuse and smoking are also singled out as possible factors, both occurring with increased prevalence within people who have bipolar disorder than those without (and both contributing to additional health concerns, such as metabolic syndrome).
Last, the authors point out that people with bipolar disorder often have lower income levels, fewer years of education and may be in poor social support situation (e.g., lack of a stable relationship). These factors may also contribute to making poorer diet choices and have worse eating habits.
The assessment the authors provided was a basic review of the literature, and as such, couldn’t come to any smoking-gun conclusions. What they found was a pretty complex picture with no obvious answers to the problem of increased weight gain in people with bipolar disorder. They do suggest strategies, however, to try and address the issue head-on, by having the physician carefully monitor the person’s health and weight, and provide dietary education as needed. The lack of a more in-depth look of the issue of the atypical antipsychotics and weight gain was disappointing. But what they did find points to the need for far more refined and focused research into this area.
Interested in keeping up with the latest advances in bipolar disorder research and treatments? Consider subscribing to our bipolar blog, Bipolar Beat, hosted by Candida Fink, M.D. and Joe Kraynak.
Reference:
Simmons-Alling, S. & Talley, S. (2008). Bipolar Disorder and Weight Gain: A Multifactorial Assessment. J Am Psychiatr Nurses Assoc., 13, 345.
The researchers made no disclosures of any conflicts of interest in the publication of this article.
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Links to This Article
Preventing weight Gain | Big2Fit.com (10/8/2008)
Preventing weight Gain | Big2Fit.com (10/8/2008)
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11 Comments to
“Bipolar Disorder and Weight Gain”
I am 5′10″ and I used to weigh 125 lbs. I work out regularly. I was a size 6 until I took Abilify and within two months I gained 25 pounds and am now a size 12. My doctor put me on Geodon instead and I haven’t taken it yet because I am afraid of gaining more weight. Not everyone with bipolar disorder is overweight to begin with. Gaining this weight has caused me to become more depressed…what’s the point of taking this garbage medicine? I’m sticking to my zoloft and lamictal for now, thank you very much.
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Olanzipene seems to cause weight gain - probably because for better or worse I do not care about anything when I am on it.
Who is paying for this ‘new research’ - follow the money….
Gained 50 lbs. on Abilify in 10 yrs. Normal weight to begin with. Now have high blood pressure, high cholesterol & am now in the range of high blood sugar for diabetes.
I was thin my whole life until I attempted suicide in 1999, the doctors put me on 6 different medications. I can’t remember all of them but Neurontin, Risperidal, Tegretol, and Remeron were some of them. I gained 60lbs in 3 months! Since then I lost 45lbs of it, kept it off for a year then in 2005, with no change in medication, eating habits, or lifestyle I gained the 45lbs back. Have not been able to lose it, no matter how much exercise I get or what I eat. Also, I stopped taking those initial 6 meds years ago and have only been on Cymbalta for 3 years.
I agree with Michelle, not everyone with Bipolar Disorder is overweight to begin with. I was 25 when this happened, I used to be a ballet dancer!
I agree-follow the money! For YEARS patients have said their meds are making them gain weight. They doctors and pharma companies continue to claim we’re just eating more. The associations they are making with poverty, family abuse, etc are flawed,. If us bipoars are infact from crazy families, too poor to eat right, etc then WE WERE THAT WAY BEFORE THE MEDS. I too was thin before the meds. I
I agree-follow the money! For YEARS patients have said their meds are making them gain weight. They doctors and pharma companies continue to claim we’re just eating more. The associations they are making with poverty, family abuse, etc are flawed,. If us bipoars are infact from crazy families, too poor to eat right, etc then WE WERE THAT WAY BEFORE THE MEDS. I too was thin before the meds. I
Recently diagnosed. My weight has fluctuated throughout my life. Manic - I was thin. Depressed - I was heavy. This is generally a 60 lb. swing to match my mood. On Trileptal now and it seems to be weight neutral as I’m losing the weight I gained during a recent depressed cycle.
I think the researchers might reach more definitive conclusions if they went on these meds, themselves and monitored their own weight.
I’m so sick of these “experts” putting the weight gain blame on the patients! I never had a weight problem until I started with the meds.
I Finally got the weight off when I was switched to Lamictal and Wellbutrin.
Im worried that my sister has bipolar, because my dad was diagnosed with it three years ago. In fact im surly definate that she does because she has a sporadic mood all the time. Then second of all she use to be fit and average, now she is pushing (i want to say over 200 pds). I love my sister and I dont want to see her in bad health. What or how do i aproach her without offending her and getting on her bad side about seeing a doctor?
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Last reviewed: By John M. Grohol, Psy.D. on 7 Oct 2008
