Can body mass index help predict outcome in patients with bipolar disorder?

Obesity is common in patients with bipolar disor- der (BD), with a prevalence of 20% to 49% (1-3), compared to 18% in the general US population (4). There are a number of possible causes of obesity in BD, including lifestyle, medication exposure, binge-eating comorbidity, neuroendocrine and neurotransmitter dysfunctions, comorbid meta- bolic syndrome, and genetic predisposition. The growing evidence of obesity in patients with BD and its correlation with increased morbidity and mortality led us to study the association between the two disorders more systematically, with the hypothesis that body mass index (BMI) is related to prognosis and outcome. In this paper, we examine differences in sociodemographic, clinical, and medical characteristics of BD patients with elevated BMI. Calkin C, van de Velde C, RuzickovaM, Slaney C, Garnham J, Hajek T, ODonovan C, Alda M. Can body mass index help predict outcome in patients with bipolar disorder? Bipolar Disord 2009: 11: 650-656. a 2009 The Authors. Journal compilation a 2009 John Wiley & A ⁄ S. Objective: Several studies have reported higher prevalence of obesity in patients suffering from bipolar disorder (BD). To study the relation of elevated body mass index (BMI) in patients with BD more closely, we investigated differences in sociodemographic, clinical, and medical characteristics with respect to BMI, with the hypothesis that BMI is related to prognosis and outcome. Methods: We measured the BMI of 276 subjects of a tertiary care sample from the Maritime Bipolar Registry. Subjects were 16 to 83 years old, with psychiatric diagnoses of bipolar I disorder (n = 186), bipolar II disorder (n = 85), and BD not otherwise specified (n = 5). The registry included basic demographic data and details of the clinical presentation. We first examined the variables showing a significant association with BMI; subsequently, we modeled the relationship between BMI and psychiatric outcome using structural equation analysis. Results: The prevalence of obesity in our sample was 39.1%. We found higher BMI in subjects with a chronic course (p < 0.001) and longer duration of illness (p = 0.02), lower scores on the Global Assessment of Functioning Scale (p = 0.02), and on disability (p = 0.002). Overweight patients had more frequent comorbid subthreshold social (p = 0.02) and generalized anxiety disorders (p = 0.05), diabetes mellitus type II (p < 0.001), and hypertension (p = 0.001). Subjects who achieved complete remission of symptoms on lithium showed significantly lower BMI (p = 0.01). Conclusions: Our findings suggest that BMI is associated with the prognosis and outcome of BD. Whether this association is causal remains to be determined.