A recent study published in the Journal of Clinical Psychiatry entitled “Are Mood Disorders and Obesity Related? A Review for the Mental Health Professional” (McElroy, Susan L.; Kotwal, Renu; Malhotra, Shishuka; Nelson, Erik B.; Keck, Paul E., Jr.; Nemeroff, Charles B.) reveals a possible connection between obesity and mood disorders including major depressive disorder and bipolar disorder.

The study found that:

• Children and adolescents with major depressive disorder may be at increased risk for developing obesity.
• Patients with bipolar disorder may have elevated rates of overweight, obesity, and abdominal obesity. (Abdominal obesity is specifically related to higher risk of cardiovascular disease.)
• Persons living with obesity who seek weight-loss treatment may have elevated rates of depressive and bipolar disorders.
• Obesity is associated with major depressive disorder in females.
• Abdominal obesity may be associated with depressive symptoms in females and males.
• Most overweight and obese persons do not have mood disorders.

The study suggests an overlap between mood disorders and obesity, but does not prove a cause – effect relationship in either direction. Obesity and mood disorders are complex disorders that are caused by the interaction of many biological and environmental conditions – it is not a simple relationship between the two conditions – but the study suggests important interactions that need to be better understood.

Understanding the Complexity of Contributing Factors

What we do know is that numerous complex factors contribute to the growing epidemic of obesity, and we understand that it’s not just a problem of willpower or as simple as “eat less, exercise more.” Highly interconnected and deeply rooted neural pathways affect eating, appetite, satiety, and body composition in ways we are just starting to comprehend.

We also know that a number of medications used to treat depression and bipolar disorder compound the problem by creating significant weight gain which may worsen previously existing obesity. In addition, for people with bipolar disorder and obesity, the levels of suffering layer on top of one another and exacerbate each other.

Until we find effective treatments for the underlying cause(s), we must work toward treating the symptoms – in this case, obesity – without aggravating the mania or depression. While diet, exercise, and medication adjustments may be effective for mild to moderate weight gain, these options are not always effective in treating obesity or they may raise the risk of triggering a switch to mania.

Bariatric (Weight Loss) Surgery

Bariatric (weight loss) surgery has become an increasingly prescribed option for people whose obesity has not responded to other interventions. It can make a dramatic difference in people’s health and wellbeing. (Of course, any surgical procedure carries some risk, as well.)

I have had several patients in my practice with bipolar disorder who have had some type of bariatric surgery. They have all lost weight, and it has helped their self-esteem, health, and energy. Getting the surgery approved was somewhat of a struggle, though, because of concerns that people with bipolar disorder might not have good outcomes.

Studies Supporting Bariatric Surgery for Obesity in Bipolar

A study published last month looked at this very question and the results are similar to my clinical experiences. (Obesity Surgery, 2011 Mar 6. [Epub ahead of print] “Bariatric Surgery: 1-Year Weight Loss Outcomes in Patients with Bipolar and Other Psychiatric Disorders.” Steinmann WC, Suttmoeller K, Chitima-Matsiga R, Nagam N, Suttmoeller NR, Halstenson NA.) They retrospectively compared groups of people with bipolar disorder, other psychiatric disorders, and no psychiatric diagnosis and found that all groups did well – with substantial weight loss and no increased rates of negative outcomes.

Another recent study entitled “Surgical treatment of morbid obesity among patients with bipolar disorder: a research agenda,” (Advances in Therapy, Apr 2011, Ahmed AT, Blair TR, McIntyre RS) concludes:

The considerable hazards posed by obesity in BD, as measured by illness complexity and premature mortality, provide the basis for hypothesizing that bariatric surgery may prevent and improve morbidity in this patient population. In addition to physical health benefits, bariatric surgery may exert a robust and favorable effect on the course and outcome of BD and reduce obesity-associated morbidity, the most frequent cause of premature mortality in this patient population.

Looking Ahead to More Research

I was pleasantly surprised to see these articles, and I will use them as back-up in the future when I am asked to provide my opinion about whether my patient with bipolar disorder could safely undergo a weight loss procedure. Of course, some patients may not be stable enough for this procedure and some may pursue it out of poor judgment based on manic or depressive symptoms, so it is not a viable or recommended option in all cases. But it seems that it may be a reasonable option for those suffering with medically dangerous obesity and bipolar disorder.

I am curious to see any further studies examining psychiatric outcomes in people with bipolar disorder who undergo weight loss surgery. Plenty of questions remain to be answered, including whether the mental health of those who have the surgery is ultimately better, worse, or the same as those with bipolar and obesity who’ve elected not to have the surgery. This an interesting question. I will keep my eyes out for any studies that might be looking into this, and I will keep you posted.

Please share your experiences and insights. If you have had weight loss surgery and live with depression or bipolar disorder, are you satisfied with the results? If you lost weight as a result, did the weight loss improve your moods or your ability to maintain mood stability? Having been through it, do you have any tips or cautions to share with those who are considering it? Would you recommend it?

Photo by Cliff, available under a Creative Commons attribution license.

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Weight Loss Surgery and Bipolar Disorder | Bipolar Teen Blog (April 20, 2011)

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Weight Loss Surgery and Bipolar Disorder – PsychCentral.com (blog) | | You and Your WeightYou and Your Weight (April 20, 2011)

Weight Loss Surgery and Bipolar Disorder | Bipolar Disorder Therapy (April 21, 2011)

From Psych Central's World of Psychology:
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    Last reviewed: 20 Apr 2011