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Preliminary Findings Regarding Overweight and Obesity in Pediatric Bipolar Disorder

Benjamin I. Goldstein, M.D., Ph.D.; Boris Birmaher, M.D.; David A. Axelson, M.D.; Tina R. Goldstein, Ph.D.; Christianne Esposito-Smythers, Ph.D.; Michael A. Strober, Ph.D.; Jeffrey Hunt, M.D.; Henrietta Leonard, M.D.†; Mary Kay Gill, R.N., M.S.N.; Satish Iyengar, Ph.D.; Colleen Grimm, B.A.; Mei Yang, M.Sc.; Neal D. Ryan, M.D.; and Martin B. Keller, M.D.

Objective: Overweight/obesity is highly prevalent among adults with bipolar disorder and has been associated with illness severity. Little is known regarding overweight/obesity among youth with bipolar disorder.

Method: Subjects were 348 youths aged 7 to 17 years who met DSM-IV criteria for bipolar I or bipolar II disorder or study-operationalized criteria for bipolar disorder not otherwise specified and were enrolled in the Course and Outcome of Bipolar Illness in Youth study. Age- and sex-adjusted body mass index was computed according to International Obesity Task Force cut points, based on self- and parent-reported height and weight, to determine overweight/obesity. The study was conducted from October 2000 to July 2006.

Results: Overweight/obesity was prevalent among 42% of subjects. The most robust predictors of overweight/obesity in a logistic regression model were younger age, nonwhite race, lifetime physical abuse, substance use disorders, psychiatric hospitalizations, and exposure to >= 2 medication classes associated with weight gain.

Conclusions: The prevalence of overweight/obesity among youth with bipolar disorder may be modestly greater than in the general population. Moreover, similar to adults, overweight/obesity among youth with bipolar disorder may be associated with increased psychiatric burden. These preliminary findings underscore the importance of early identification of overweight/obesity among youth with bipolar disorder. Future studies are needed to clarify the direction of the associations between overweight/obesity and the identified predictors and to compare the prevalence of overweight/obesity among youth with bipolar disorder versus other psychiatric disorders.


(J Clin Psychiatry 2008;69:1953-1959. Online Ahead of Print November 18, 2008.)

See also Commentary on page 1948.

Received Nov. 27, 2007; accepted May 16, 2008. From the Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pa. (Drs. B. I. Goldstein, Birmaher, Axelson, T. R. Goldstein, and Ryan and Mss. Gill, Grimm, and Yang); the Department of Psychiatry and Butler Hospital, Brown University School of Medicine, Providence, R.I. (Drs. Esposito-Smythers, Hunt, Leonard, and Keller); the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles (Dr. Strober); and the Department of Statistics, University of Pittsburgh, Pittsburgh, Pa. (Dr. Iyengar).


The project described was supported by grants MH59929 (Dr. Birmaher), MH59977 (Dr. Strober), and MH59691 (Dr. Keller) from the National Institute of Mental Health.

Preliminary findings were presented at the 5th annual NIMH Pediatric Bipolar Disorder Conference, March 2007, Bethesda, Md., and the 7th International Conference on Bipolar Disorder, June 2007, Pittsburgh, Pa.

The authors acknowledge the contributions of Course and Outcome of Bipolar Illness in Youth (COBY) faculty: Kristin Bruning, M.D.; Jennifer Dyl, Ph.D.; and Sylvia Valeri, Ph.D. Raters: Mathew Arruda, B.A.; Mark Celio, B.A.; Jennifer Fretwell, B.A.; Michael Henry, B.S.; Risha Henry, Ph.D.; Norman Kim, Ph.D.; Marguerite Lee, B.A.; Marilyn Matzko, Ed.D.; Heather Schwickrath, M.A.; Anna Van Meter, B.A.; and Matthew Young, B.A. Data personnel: Amy Broz, A.S.; Jeffrey Ryan, B.A.; and Nicole Ryan, B.A.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.

Dr. Keller has been a consultant to or has received honoraria from Cenerex, Cephalon, Cypress, Cyberonics, Forest, Janssen, JDS, Organon, Novartis, Pfizer, and Wyeth; has received grant/research support from Pfizer; and has served on the advisory boards of Abbott, Bristol-Myers Squibb, Cenerex, Cyberonics, Cypress, Forest, Janssen, Novartis, Organon, and Pfizer. The other authors report no competing interests.

Corresponding author and reprints: Benjamin I. Goldstein, M.D., Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15213 (e-mail: