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Bipolar Disorder and Obesity: Contributing Factors, Impact on Clinical Course, and the Role of Bariatric Surgery

  • Psychological Issues (V Drapeau and S Sogg, Section Editors)
  • Published:
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Abstract

Purpose of Review

Bipolar disorder (BD) is a severe, common, and chronic affective disorder. This review highlights the BD and obesity connection and the role of treatments for obesity in this population.

Recent Findings

Patients with BD are at a significantly increased risk for obesity, as compared to those without BD, with obesity serving as a proxy for severity and predictor of poorer outcome. BD is characterized by substantial medical burden, with obesity-related conditions contributing to premature mortality. Pharmacotherapy for BD can cause weight gain and may be moderated by binge eating behavior. Bariatric surgery may be the most robust intervention for weight loss in patients with stable BD, but access may be limited.

Summary

There is a greater need for interventions to prevent weight gain in BD, the development weight-neutral medications for BD, and more research into the role of bariatric surgery for patients with BD.

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References

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  1. Merikangas KR, Jin R, He J-P, Kessler RC, Lee S, Sampson NA, et al. Prevalence and correlates of bipolar Spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry. 2011;68:241–51. https://doi.org/10.1001/archgenpsychiatry.2011.12.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Isometsä E. Suicidal behaviour in mood disorders-who, when, and why? Can J Psychiatr. 2014;59:120–30.

    Article  Google Scholar 

  3. Tondo L, Baldessarini RJ. Suicidal behavior in mood disorders: response to pharmacological treatment. Curr Psychiatry Rep. 2016;18:88.

    Article  Google Scholar 

  4. Köhler-Forsberg O, Madsen T, Behrendt-Møller I, Sylvia L, Bowden CL, Gao K, et al. Trajectories of suicidal ideation over 6 months among 482 outpatients with bipolar disorder. J Affect Disord. 2017;223:146–52. https://doi.org/10.1016/j.jad.2017.07.038.

    Article  PubMed  Google Scholar 

  5. Deckersbach T, Nierenberg AA, McInnis MG, et al. Baseline disability and poor functioning in bipolar disorder predict worse outcomes: results from the bipolar CHOICE study. J Clin Psychiatry. 2016;77:100–8. https://doi.org/10.4088/JCP.14m09210.

    Article  PubMed  Google Scholar 

  6. Ferrari AJ, Stockings E, Khoo J-P, Erskine HE, Degenhardt L, Vos T, et al. The prevalence and burden of bipolar disorder: findings from the global burden of disease study 2013. Bipolar Disord. 2016;18:440–50. https://doi.org/10.1111/bdi.12423.

    Article  PubMed  Google Scholar 

  7. McElroy SL, Keck PE Jr. Obesity in bipolar disorder: an overview. Curr Psychiatry Rep. 2012;14:650–8. https://doi.org/10.1007/s11920-012-0313-8.

    Article  PubMed  Google Scholar 

  8. Sicras A, Rejas J, Navarro R, Serrat J, Blanca M. Metabolic syndrome in bipolar disorder: a cross-sectional assessment of a health management organization database. Bipolar Disord. 2008;10:607–16. https://doi.org/10.1111/j.1399-5618.2008.00599.x.

    Article  CAS  PubMed  Google Scholar 

  9. Weber NS, Fisher JA, Cowan DN, Niebuhr DW. Psychiatric and general medical conditions comorbid with bipolar disorder in the National Hospital Discharge Survey. Psychiatr Serv. 2011;62:1152–8. https://doi.org/10.1176/appi.ps.62.10.1152.

    Article  PubMed  Google Scholar 

  10. Kemp DE, Sylvia LG, Calabrese JR, Nierenberg AA, Thase ME, Reilly-Harrington NA, et al. General medical burden in bipolar disorder: findings from the LiTMUS comparative effectiveness trial. Acta Psychiatr Scand. 2013;129:24–34. https://doi.org/10.1111/acps.12101.

    Article  PubMed  Google Scholar 

  11. •• Mcelroy SL, Kemp DE, Friedman ES, et al. Obesity, but not metabolic syndrome, negatively affects outcome in bipolar disorder. Acta Psychiatr Scand. 2016;133:144–53. https://doi.org/10.1111/acps.12460 In patients with bipolar disorder who were randomized to lithium or quetiapine, baseline obesity was shown to be associated with less global improvement and less total improvement in total mood and depressive symptoms, suicidality, functioning and life satisfaction after 6 months of treatment. The association of obesity with poorer outcome remained, even after other correlates of obesity were controlled for, including binge eating disorder and treatment with weight inducing medications.

    Article  CAS  PubMed  Google Scholar 

  12. Hales CM, Carroll MD, Fryar CD, Ogden CL (2017) Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS Data Brief 288

  13. Goldstein BI, Birmaher B, Axelson DA, Goldstein TR, Esposito-Smythers C, Strober MA, et al. Preliminary findings regarding overweight and obesity in pediatric bipolar disorder. J Clin Psychiatry. 2008;69:1953–9. https://doi.org/10.4088/JCP.v69n1215.

    Article  PubMed  PubMed Central  Google Scholar 

  14. • Shapiro J, Mindra S, Timmins V, et al. Controlled study of obesity among adolescents with bipolar disorder. J Child Adolesc Psychopharmacol. 2017;27:95–100. https://doi.org/10.1089/cap.2015.0154 Adolescent patients with bipolar disorder had a significantly higher rate of obesity (18%) compared to healthy controls (4%). Among adolescents with bipolar disorder, obesity was significantly associated with a history of suicide attempt, self-injurious behavior, and oppositional defiant disorder.

    Article  CAS  PubMed  Google Scholar 

  15. Maina G, Salvi V, Vitalucci A, D'Ambrosio V, Bogetto F. Prevalence and correlates of overweight in drug-naïve patients with bipolar disorder. J Affect Disord. 2008;110:149–55. https://doi.org/10.1016/j.jad.2007.12.233.

    Article  PubMed  Google Scholar 

  16. Sylvia L, Shelton R, Kemp D, et al. Medical burden in bipolar disorder: findings from the clinical and health outcomes initiative in comparative effectiveness for bipolar disorder study (bipolar CHOICE). Bipolar Disord. 2015;17:212–23.

    Article  CAS  Google Scholar 

  17. • Hayes JF, Miles J, Walters K, et al. A systematic review and meta-analysis of premature mortality in bipolar affective disorder. Acta Psychiatr Scand. 2015;131:417–25. https://doi.org/10.1111/acps.12408 Medical conditions that are obesity related (e.g., circulatory disorders) have been shown to contribute to premature mortality in patients with bipolar disorder.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Fagiolini A, Kupfer DJ, Houck PR, Novick DM, Frank E. Obesity as a correlate of outcome in patients with bipolar I disorder. Am J Psychiatry. 2003;160:112–7. https://doi.org/10.1176/appi.ajp.160.1.112.

    Article  PubMed  Google Scholar 

  19. Mora E, Portella MJ, Martinez-Alonso M, Teres M, Forcada I, Vieta E, et al. The impact of obesity on cognitive functioning in euthymic bipolar patients: a cross-sectional and longitudinal study. J Clin Psychiatry. 2017;78:e924–32. https://doi.org/10.4088/JCP.16m10968.

    Article  PubMed  Google Scholar 

  20. Abosi O, Lopes S, Schmitz S, Fiedorowicz JG (2018) Cardiometabolic effects of psychotropic medications. Horm Mol Biol Clin Invest

  21. Hasnain M, Vieweg WVR. Weight considerations in psychotropic drug prescribing and switching. Postgrad Med. 2013;125:117–29.

    Article  Google Scholar 

  22. Rummel-Kluge C, Komossa K, Schwarz S, Hunger H, Schmid F, Lobos CA, et al. Head-to-head comparisons of metabolic side effects of second generation antipsychotics in the treatment of schizophrenia: a systematic review and meta-analysis. Schizophr Res. 2010;123:225–33.

    Article  Google Scholar 

  23. Citrome L. Cariprazine for the treatment of schizophrenia: a review of this dopamine D3-preferring D3/D2 receptor partial agonist. Clin Schizophr Relat Psychoses. 2016;10:109–19. https://doi.org/10.3371/1935-1232-10.2.109.

    Article  PubMed  Google Scholar 

  24. Gafoor R, Booth HP, Gulliford MC. Antidepressant utilisation and incidence of weight gain during 10 years’ follow-up: population based cohort study. BMJ. 2018;361:k1951. https://doi.org/10.1136/bmj.k1951.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Boulanger H, Tebeka S, Girod C, Lloret-Linares C, Meheust J, Scott J, et al. Binge eating behaviours in bipolar disorders. J Affect Disord. 2018;225:482–8. https://doi.org/10.1016/j.jad.2017.08.068.

    Article  PubMed  Google Scholar 

  26. Gebhardt S, Haberhausen M, Krieg JC, Remschmidt H, Heinzel-Gutenbrunner M, Hebebrand J, et al. Clozapine/olanzapine-induced recurrence or deterioration of binge eating-related eating disorders. J Neural Transm. 2007;114:1091–5. https://doi.org/10.1007/s00702-007-0663-2.

    Article  CAS  PubMed  Google Scholar 

  27. Kluge M, Schuld A, Himmerich H, Dalal M, Schacht A, Wehmeier PM, et al. Clozapine and olanzapine are associated with food craving and binge eating: results from a randomized double-blind study. J Clin Psychopharmacol. 2007;27:662–6. https://doi.org/10.1097/jcp.0b013e31815a8872.

    Article  CAS  PubMed  Google Scholar 

  28. Yaramala SR, McElroy SL, Geske J, et al (2018) The impact of binge eating behavior on lithium- and quetiapine-associated changes in body weight, body mass index, and waist circumference during 6 months of treatment: findings from the bipolar CHOICE study. J Affect Disord.

  29. Franz MJ, VanWormer JJ, Crain AL, et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc. 2007;107:1755–67. https://doi.org/10.1016/j.jada.2007.07.017.

    Article  PubMed  Google Scholar 

  30. Naslund JA, Whiteman KL, McHugo GJ, et al. Lifestyle interventions for weight loss among overweight and obese adults with serious mental illness: a systematic review and meta-analysis. Gen Hosp Psychiatry. 2017;47:83–102.

    Article  Google Scholar 

  31. Bauer IE, Gálvez JF, Hamilton JE, Balanzá-Martínez V, Zunta-Soares GB, Soares JC, et al. Lifestyle interventions targeting dietary habits and exercise in bipolar disorder: a systematic review. J Psychiatr Res. 2016;74:1–7. https://doi.org/10.1016/j.jpsychires.2015.12.006.

    Article  PubMed  Google Scholar 

  32. Gillhoff K, Gaab J, Emini L, Maroni C., Tholuck J., Greil W. (2010) Effects of a multimodal lifestyle intervention on body mass index in patients with bipolar disorder: a randomized controlled trial. Prim Care Companion J Clin Psychiatry 12:PCC.09m00906. https://doi.org/10.4088/PCC.09m00906yel

  33. Kilbourne AM, Goodrich DE, Lai Z, Post EP, Schumacher K, Nord KM, et al. Randomized controlled trial to assess reduction of cardiovascular disease risk in patients with bipolar disorder: the self-management addressing heart risk trial (SMAHRT). J Clin Psychiatry. 2013;74:e655–62. https://doi.org/10.4088/JCP.12m08082.

    Article  PubMed  PubMed Central  Google Scholar 

  34. • Frank E, Wallace ML, Hall M, et al. An Integrated Risk Reduction Intervention can reduce body mass index in individuals being treated for bipolar I disorder: Results from a randomized trial. Bipolar Disord. 2015;17:424–37. https://doi.org/10.1111/bdi.12283 A randomized trial of an integrated risk reduction intervention, which included a healthy lifestyle program, compared to a control, led to a greater rate of weight loss in patients with bipolar I disorder and overweight or obesity.

    Article  PubMed  Google Scholar 

  35. Evans S, Newton R, Higgins S. Nutritional intervention to prevent weight gain in patients commenced on olanzapine: a randomized controlled trial. Aust N Z J Psychiatry. 2005;39:479–86. https://doi.org/10.1111/j.1440-1614.2005.01607.x.

    Article  PubMed  Google Scholar 

  36. Fiedorowicz JG, Miller DD, Bishop JR, et al. Systematic review and meta-analysis of pharmacological interventions for weight gain from antipsychotics and mood stabilizers. Curr Psychiatr Rev. 2012;8:25–36. https://doi.org/10.2174/157340012798994867.

    Article  CAS  Google Scholar 

  37. Gierisch JM, Nieuwsma JA, Bradford DW, Wilder CM, Mann-Wrobel MC, McBroom AJ, et al. Pharmacologic and behavioral interventions to improve cardiovascular risk factors in adults with serious mental illness. J Clin Psychiatry. 2014;75:e424–40. https://doi.org/10.4088/JCP.13r08558.

    Article  PubMed  Google Scholar 

  38. Dayabandara M, Hanwella R, Ratnatunga S, Seneviratne S, Suraweera C, de Silva V. Antipsychotic-associated weight gain: management strategies and impact on treatment adherence. Neuropsychiatr Dis Treat. 2017;13:2231–41.

    Article  Google Scholar 

  39. Boyda HN, Procyshyn RM, Tse L, Hawkes E, Jin C, Pang C, et al. Differential effects of 3 classes of antidiabetic drugs on olanzapine-induced glucose dysregulation and insulin resistance in female rats. J Psychiatry Neurosci. 2012;37:407–15. https://doi.org/10.1503/jpn.110140.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Fountoulakis KN, Yatham L, Grunze H, et al. The international college of neuro-psychopharmacology (CINP) treatment guidelines for bipolar disorder in adults (CINP-BD-2017), part 2: review, grading of the evidence, and a precise algorithm. Int J Neuropsychopharmacol. 2017;20:121–79.

    PubMed  Google Scholar 

  41. Kramer CK, Leitão CB, Pinto LC, Canani LH, Azevedo MJ, Gross JL. Efficacy and safety of topiramate on weight loss: a meta-analysis of randomized controlled trials. Obes Rev. 2011;12:e338–47. https://doi.org/10.1111/j.1467-789X.2010.00846.x.

    Article  CAS  PubMed  Google Scholar 

  42. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: cosponsored by American association of clinical endocrinologists, the obesity society, and American society for metabolic & bariatric surgery. Obesity. 2013;9:159–91. https://doi.org/10.1002/oby.20461.

    Article  CAS  Google Scholar 

  43. Neovius M, Bruze G, Jacobson P, Sjöholm K, Johansson K, Granath F, et al. Risk of suicide and non-fatal self-harm after bariatric surgery: results from two matched cohort studies. Lancet Diabetes Endocrinol. 2018;6:197–207. https://doi.org/10.1016/S2213-8587(17)30437-0.

    Article  PubMed  Google Scholar 

  44. • Friedman KE, Applegate K, Portenier D, McVay MA. Bariatric surgery in patients with bipolar spectrum disorders: selection factors, postoperative visit attendance, and weight outcomes. Surg Obes Relat Dis. 2017;13:643–51. https://doi.org/10.1016/j.soard.2016.10.009 This retrospective review found that patients seeking bariatric surgery who had bipolar disorder were less likely to be initially recommended for surgery. Those who were recommended had a less severe psychiatric course than those not recommended, and patients with bipolar disorder who had surgery were less likely to attend follow-up visits than matched controls, although weight losses were similar.

    Article  PubMed  Google Scholar 

  45. Fuchs HF, Laughter V, Harnsberger CR, Broderick RC, Berducci M, DuCoin C, et al. Patients with psychiatric comorbidity can safely undergo bariatric surgery with equivalent success. Surg Endosc. 2016;30:251–8. https://doi.org/10.1007/s00464-015-4196-8.

    Article  PubMed  Google Scholar 

  46. Shelby SR, Labott S, Stout RA. Bariatric surgery: a viable treatment option for patients with severe mental illness. Surg Obes Relat Dis. 2015;11:1342–8. https://doi.org/10.1016/j.soard.2015.05.016.

    Article  PubMed  Google Scholar 

  47. Steinmann WC, Suttmoeller K, Chitima-Matsiga R, Nagam N, Suttmoeller NR, Halstenson NA. Bariatric surgery: 1-year weight loss outcomes in patients with bipolar and other psychiatric disorders. Obes Surg. 2011;21:1323–9. https://doi.org/10.1007/s11695-011-0373-6.

    Article  PubMed  Google Scholar 

  48. Grothe KB, Mundi MS, Himes SM, Sarr MG, Clark MM, Geske JR, et al. Bipolar disorder symptoms in patients seeking bariatric surgery. Obes Surg. 2014;24:1909–14. https://doi.org/10.1007/s11695-014-1262-6.

    Article  PubMed  Google Scholar 

  49. Ahmed AT, Warton EM, Schaefer CA, Shen L, McIntyre RS. The effect of bariatric surgery on psychiatric course among patients with bipolar disorder. Bipolar Disord. 2013;15:753–63. https://doi.org/10.1111/bdi.12109.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Mizock L. The double stigma of obesity and serious mental illnesses: promoting health and recovery. Psychiatr Rehabil J. 2012;35:466–9. https://doi.org/10.1037/h0094581.

    Article  PubMed  Google Scholar 

  51. Corrigan PW, Watson AC. Understanding the impact of stigma on people with mental illness. World Psychiatry. 2002;1:16–20 https://doi.org/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/pdf/wpa010016.pdf.

    PubMed  PubMed Central  Google Scholar 

  52. Druss BG, Bradford DW, Rosenheck RA, Radford MJ, Krumholz HM. Mental disorders and use of cardiovascular procedures after myocardial infarction. JAMA. 2000;283:506–11.

    Article  CAS  Google Scholar 

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  1. Massachusetts General Hospital and Harvard Medical School, 50 Staniford Street, 4th Floor, Boston, MA, 02114, USA

    Noreen A. Reilly-Harrington, Emily H. Feig & Jeff C. Huffman

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  1. Noreen A. Reilly-Harrington
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Correspondence to Noreen A. Reilly-Harrington.

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Noreen A. Reilly-Harrington has received royalties from New Harbinger, Oxford University Press, and the American Psychological Association.

Emily H. Feig declares that she has no conflict of interest.

Jeff C. Huffman declares that he has no conflict of interest.

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Reilly-Harrington, N.A., Feig, E.H. & Huffman, J.C. Bipolar Disorder and Obesity: Contributing Factors, Impact on Clinical Course, and the Role of Bariatric Surgery. Curr Obes Rep 7, 294–300 (2018). https://doi.org/10.1007/s13679-018-0322-y

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