Body weight is a constant subject in world news and social media. There are relentless references to “the obesity epidemic,” so much that even our pets can’t escape it. There is both body shaming and the positive body image movement. These are good conversations to have. As a society, we need to understand health and human kindness. However, all of this talk can have a severely negative impact on people with mental illness. Weight change is a prevalent symptom of depression in bipolar disorder, and so is guilt.
Here is something everyone should know: Do not comment on someone’s weight. Ever. Don’t tell someone they look “so good.” Don’t mention weight loss or gain. Don’t compliment a woman on her ability to lose her baby weight. You have no idea what’s going on with people’s bodies or their minds.
More than 10% of Americans deal with at least one eating disorder at some point in their lives. That’s over 30 million people. Of those, at least 4% will die because of complications associated with their disorder. Odds are you know someone who is suffering from anorexia, bulimia or binge eating disorder. They’re just not telling you.
Fourteen percent of bipolar disorder patients also have a diagnosable eating disorder, with binge eating being the most common. Bipolar depression often comes with significant weight fluctuation on its own, more than 5% loss or gain of body weight in one month. So, a person weighing 165lbs would gain or lose over 2lbs a week.
Typical bipolar depression often comes with weight loss. This is not necessarily on purpose. Depression also comes with fatigue and loss of interest. When someone has zero energy and plenty of apathy, eating may not exactly be a top priority. This scenario becomes much more likely for patients who have bipolar disorder with “melancholic features.”
Individuals with “melancholic features” endure extraordinarily deep depressive episodes. They only slightly respond to positive events, if they respond at all. It’s complete despondency. Appetite drops off and patients might not have the self-motivation to eat at all, causing extreme weight loss.
More common with bipolar disorder is weight gain. In atypical depression, patients may fall into a habit of emotional eating. The brain is programmed to think that food is good. People need food to survive. When a person is depressed and seeking something good, food can sometimes provide that pleasure.
The problem is, atypical depression still comes with a decreased response to anything positive. So, more food is needed to provide the same amount of satisfaction. Add to this the sedentary lifestyle that can come with depression, and it’s a great recipe for weight gain.
Medication is actually a huge culprit in weight gain with bipolar disorder. Some drugs used to treat bipolar disorder can slow metabolism. Mood stabilizers like lithium, valproic acid (Depakene), and carbamazepine (Tegregol) are known to cause weight gain. Lamotrigine (Lamictal) is the only mood stabilizer that does not tend to have this effect.
Antipsychotics like risperidone (Risperdal), quetiapine (Seroquel) and olanzapine (Zyprexa) can also cause weight gain. Aripiprazole (Abilify), ziprasidone (Geodon) and lurasidone (Latuda) are antipsychotics that are less likely to do so.
The effects of medication on weight are important to note. A significant number of bipolar patients stop using medication, even when it is effective, because they do not like the side effects- like weight gain.
So, just remember, the person you’re talking to may be dealing with a mental illness whether an eating disorder, major depressive disorder or bipolar disorder or a combination of these. Even if you mean your comment as a compliment, it may not be taken that way. It’s possible for the depressed brain to take your happiness now and twist it to mean you were not happy with how the person was before.
At that point, it becomes easy to tie self-worth with weight and body type. Having excessive feelings of guilt is part of bipolar disorder. Feeling guilty for being too fat or too thin. Feeling guilty for not being good enough. Feeling guilty for feeling guilty or being sick in the first place.
This is all part of what it means to live with bipolar disorder.
Image credit: Christy Mckenna