New research suggest medications alone do not increase the risk of being overweight or developing obesity among adolescents with bipolar disorder. But there appears to be a direct relationship between obesity and greater severity of bipolar disorder.
The relationship is complex and the new study is the first to examine the relationship in teens between being overweight and bipolar disorder.
Bipolar disorder is one of the most disabling medical conditions among adolescents worldwide. Similarly, being overweight or obese is common in adolescents and is known to confer risk for cardiovascular disease and other poor health outcomes in adulthood.
Previous studies have demonstrated that obesity and being overweight are more prevalent among adults with bipolar disorder as compared to the general population. The conditions also are associated with proxies of increased bipolar disorder severity, such as suicide attempts and greater symptom burden.
The new study, published in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), is the first to examine this topic in a large, representative sample of the U.S. adolescent population. The NCS-A is a face-to-face survey of mental disorders in a representative sample of adolescents 13-17 years old. Participants included 295 adolescents with bipolar disorder, 1,112 with major depressive disorder, and 8,716 with neither of these conditions.
Researchers discovered 37.9 percent of adolescents with bipolar disorder were also overweight, compared to 32.4 percent of adolescents with major depressive disorder, and 32 percent of adolescents with neither of these conditions. Although differences present, they were not determined to be statistically significant.
“We were somewhat surprised about the fact that obesity was not more prevalent among the adolescents with bipolar disorder compared to their peers. But this is good news, as it confirms that there is a window of opportunity to intervene in order to prevent the increased risk of obesity that is evident in adults and in clinical samples of adolescents with bipolar disorder,” said Dr. Benjamin Goldstein.
Goldstein director of the Centre for Youth Bipolar Disorder in Toronto’s Sunnybrook Health Sciences Centre, and lead author of the study.
Although being overweight is not more common among bipolar teens, overweight adolescents with bipolar disorder showed signs of increased illness severity. This included more suicide attempts, psychiatric hospitalizations for depression, co-occurring conduct disorder and bulimia/binge-eating, and history of physical or sexual abuse.
“It is concerning that despite the fact that this a non-clinical sample, the links between obesity and indicators of greater bipolar disorder severity are already evident. Some have wondered whether these links are secondary to greater exposure to psychiatric medications, some of which confer risk of weight gain, among adolescents with greater severity of bipolar disorder,” added Goldstein.
“Our findings, based on a community sample with low rates of medication use, confirm that there is more to the story than medications — there appears to be a direct relationship between obesity and greater severity of bipolar disorder.”
Asked what next steps should be taken, Goldstein responded, “The main clinical question now becomes: what strategies are most effective for preventing obesity in this specific group of teens, for whom the risks of obesity in terms of both physical and mental health may be especially significant?
The answer to that question will require additional research, informed in part by the findings of this study. In addition, there are scientific questions about the biological, psychological, and environmental factors that explain the increased severity of bipolar disorder among obese teens with bipolar disorder.”
To that end, Goldstein and his team are studying how overweight is associated with brain structure, cognition, and blood markers of inflammation and other processes, among adolescents with bipolar disorder.
Goldstein is planning to study intervention strategies to prevent and treat overweight among adolescents with bipolar disorder, and is hopeful that if successful these strategies will improve mental as well as physical health.
“Wouldn’t it be interesting, and efficient, if an intervention focused on optimizing weight could also yield mental health benefits?” he concluded.