Bipolar and Obese, What Can I do?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Bipolar disorder is associated with obesity. This is more true for women than men, as studies suggest obesity is more common in women with bipolar disorder. A troubling finding is that obesity in bipolar disorder is associated with greater illness burden and lower response to treatment. Depressive symptoms are more common in obese bipolar patients and women with bipolar disorder report the fear of weight gain as the most worrisome medication side effect.

How does bipolar disorder cause obesity?

There are many good guesses including overeating, physical inactivity, and disturbed sleep. The obesity among women is related to episodes of major depression occurring in bipolar I disorder. Other parallels with obesity in patients with bipolar disorder include binge eating and treatment with psychotropics associated with weight gain. However, studies have shown the relationship between bipolar disorder and obesity persists after controlling for psychotropic drug exposure.

Bipolar meds and weight gain:

The psychotropics used for bipolar disorder can lead to weight gain. Valproate is associated with weight gain, birth defects, and possibly polycystic ovarian syndrome. Olanzapine (Zyprexa) is also associated with weight gain. In some studies as many as 19 percent of olanzapine-treated patients had weight gain of 7 percent or more.

Meds used for the treatment of depression in bipolar patients include Symbyax (olanzapine/fluoxetine) which is associated with substantial weight gain, with 20% of patients having significant weight gain. The generic Seroquel (quetiapine) is associated with less weight gain but more sedation. A benefit of Latuda, another choice here, is very little weight gain and sedation. Before you blame all of your weight gain on your meds, however, remember that studies show that the association between bipolar disorder and obesity persists after controlling for the weight-gaining medications. So something else is also going on.

Bipolar disorder and binge eating disorder (BED):

Binge eating behavior is common in bipolar obese patients. Women with bipolar disorder have a higher rate of BED compared to men with bipolar disorder. Although lithium does not appear to worsen BED, clozapine and olanzapine may cause binge eating behavior. Bipolar patients with BED also have more severe and complex bipolar disorder. Vyvanse (lisdexamfetamine) has just been approved for BED, yet no studies have included patients with bipolar disorder so it’s unclear whether its safe or not.

What about weight loss meds in bipolar patients?

Anti-obesity medications have not been tested in bipolar disorder so the safety of Qsymia, Belviq and Contrave is unknown in bipolar patients. Zonegran (zonisamide) may cause weight loss and is currently being studied in bipolar disorder.

What other options exist for weight loss in bipolar patients?

Behavioral weight loss therapy helps. Then, don’t forget the option of weight loss surgery (bariatric surgery). It surprises people to hear that neither bipolar disorder nor BED is a contraindication for weight loss surgery. Ask your doc about it.

Dr O.

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