Obesity in Patients With Bipolar Disorder: A Biopsychosocial-Behavioral Model
J Clin Psychiatry 2006;67(6):904-915
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Objective: We provide a model to
explicate how factors representing different levels of
analysis (i.e., biology, psychology,
sociodemographics, and behavior) interact to influence the onset
and maintenance of obesity in bipolar disorder.
Data Sources: We conducted
MEDLINE (1966-2005) and PsycInfo (1872-2005)
searches of all English-language articles using the
keywords obesity, body weight, weight
gain, and metabolic syndrome combined with
bipolar disorder, depression, atypical
depression, binge eating, and
Study Selection: Studies were selected if
they provided data regarding (1) the prevalence of obesity in patients with bipolar disorder, (2)
correlates of obesity in patients with bipolar
disorder, or (3) evidence that a clinical feature(s)
or correlate(s) of bipolar disorder is associated
with obesity. Ninety-two studies were reviewed.
Data Synthesis: Obesity is prevalent in
patients with bipolar disorder and is associated
with increased medical morbidity and poorer
psychiatric outcome. Variables that may interact to
influence the onset and maintenance of obesity in
bipolar disorder include genetic factors, neurotransmitter abnormalities, atypical
depression, eating behaviors, pharmacotherapy,
age, gender, socioeconomic status, and physical
Conclusions: Although the exact causes
of obesity in bipolar disorder undoubtedly vary across patients, the etiologic cascade, which
includes biological, psychological, and sociodemographic variables, ultimately directly or
indirectly affects levels of physical activity and eating
behavior, leading to obesity in this population.
Behavioral interventions aimed at targeting
physical inactivity and overeating in bipolar disorder
patients are needed, as are better screening and treatment for binge eating. Finally, there is a
clear need for ongoing research to explicate the
causes and consequences of obesity across levels