Category: Eating Disorders

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How to Talk to Your Child About Eating Disorders: A Compassionate Guide for Parents

By Dawn Anderson LPCCS, Lindner Center of Hope

Discovering that your child may be struggling with an eating disorder is a heavy realization. It’s natural to feel a mix of fear, confusion, and the urgent desire to “fix” it. However, the first conversation is less about providing a solution and more about opening a door. Early intervention is the strongest predictor of recovery, and that begins with a compassionate, non-judgmental approach.

Setting the Stage for Connection

Before you speak, choose a time when emotions aren’t already high. Avoid bringing it up during or immediately after a meal, as these are often high-stress windows. Your goal is to be a calm anchor for them.

Use “I” Statements to Reduce Defensiveness

Focus on what you have observed rather than labeling their behavior. This reduces defensiveness.

  • Instead of: “You’re not eating enough.”
  • Try: “I’ve noticed you seem more stressed lately during dinner, and I’m concerned about how you’re feeling.”

Focus on Feelings, Not Food

Eating disorders are often a coping mechanism for underlying emotional pain. Talk about their mood, isolation, or anxiety rather than just calories or weight.

  • Example: “I’ve noticed you’ve been spending more time alone lately and seem a bit down. I want you to know I’m here to listen without judgment.”

Tailoring the Conversation to Your Child’s Age

The way a child processes their relationship with food and their body changes significantly as they grow. Your approach should shift accordingly:

Talking to Young Children (Ages 5–12) About Eating Concerns

At this age, children often lack the vocabulary to describe an eating disorder. They may experience it as “tummy aches” or fear. A helpful approach is to externalize the problem.

  • Example: “It seems like a ‘worry thought’ is making it hard for you to enjoy your favorite foods. Let’s talk about that bully in your head.”

Approaching Adolescents (Ages 13–17) with Eating Disorder Concerns

Teens value autonomy and may view the disorder as their only source of control. It can help to acknowledge their need for independence while remaining firm on health.

  • Example: “I know you want to handle things on your own, but I’ve seen some things that worry me. As your parent, I need to make sure your body is getting what it needs to grow.”

Supporting Young Adults (Ages 18+) Without Overstepping

For adult children, you are more of a consultant than a manager. Focus on how the struggle impacts their life goals (college, career, relationships).

  • Example: “I love you and want to see you thrive in your new job, and I’m worried this struggle is draining the energy you need to succeed.”

Is It Disordered Eating or a Phase? How to Tell the Difference

It can be difficult to distinguish between a teenager’s newfound interest in “clean eating” and the early stages of a clinical disorder. The table below highlights key differences between functional behaviors and concerning red flags that may warrant professional evaluation.

Distinguishing Functional vs. Concerning Symptoms

AreaFunctional/Typical BehaviorConcerning/Disordered Symptoms
Social EatingMay prefer certain foods but can still eat at a restaurant or a friend’s house with minimal stress.Avoids social gatherings involving food; experiences high anxiety or “meltdowns” if they can’t control the menu.
Dietary ChangesExpresses interest in vegetarianism or “healthy” eating for ethical reasons while maintaining caloric needs.Abruptly cuts out entire food groups (carbs, fats, dairy) specifically to lose weight; obsessed with “purity” in food.
Physical GrowthWeight stays relatively stable or follows their established growth curve, even with picky eating.Significant, rapid weight loss; “plateauing” or failing to gain height/weight as expected for their age.
MovementEnjoys sports or exercise for fun, social connection, or skill-building.Exercises compulsively, even when tired, injured, or in bad weather; feels intense guilt if a workout is missed.
Food RitualsMay have a “favorite” bowl or occasional picky habits (e.g., not liking foods to touch).Develops rigid rituals like cutting food into tiny pieces, excessive chewing, or hiding food in napkins/pockets.

When to Seek Professional Help for an Eating Disorder

If you notice multiple red flags or escalating distress, professional support is essential. Early treatment significantly improves outcomes and helps families feel less alone.

Trusted Resources for Parents and Caregivers

  • Lindner Center of Hope – Specialized care for children, adolescents, and adults with eating disorders
  • National Eating Disorders Association (NEDA) – Screening tools and helpline support
    (nationaleatingdisorders.org)
  • F.E.A.S.T. – Parent-focused education and “first aid” for families navigating eating disorders
    (feast-ed.org)

You Don’t Have to Have All the Answers

Showing Up, Listening, and Taking the Next Step Together

You don’t need to have all the answers. You don’t need to say everything perfectly. What matters most is showing up, listening, and letting your child know they don’t have to carry this alone.

That first conversation isn’t the solution—it’s the beginning of support, connection, and healing.

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By Nicole Mori, RN, MSN, APRN-BC
Psychiatric Mental Health Nurse Practitioner, Lindner Center of Hope

 

 

 

The prevalence of obesity and metabolic disorders is significantly higher among people with bipolar disorder than in the general population (McElroy and Keck, 2012; Taylor et al., 2012). In addition to contributing to medical comorbidities (such as cardiovascular and metabolic disease) and early mortality, obesity and excessive weight gain are associated with higher psychiatric morbidity and unfavorable clinical course and outcomes (Calkin et al., 2009). The problem of excessive weight gain in the bipolar population is exacerbated by the metabolic adverse effects of mood stabilizing medications that are commonly used to treat bipolar disorder (e.g., lithium, valproate, and second-generation antipsychotic agents), which often induce significant weight gain and/or metabolic abnormalities such as hyperglycemia and dyslipidemia (Correll et al., 2015). Conversely, loss of excess weight has been associated with improved mood, adherence, and increased patient satisfaction (McElroy, et al, 2016).

Psychiatric prescribers face the challenge of managing bipolar disorder symptoms while attempting to mitigate or reverse excessive weight gain in their patients. Treatment options for obesity and excessive weight gain in bipolar disorder remain limited. Behavioral interventions have modest results, at best, and the use of anti-obesity medications is limited by the risk for mood destabilization associated with stimulants (phentermine) and antidepressants (bupropion) in some patients. The introduction of GLP1-RAs (glucagon-1 peptide-1 receptor agonist), and GIPs (gastric inhibitory polypeptides) in recent years, show promise as highly efficacious treatments. Psychiatric providers are aware of the importance of treating excessive weight gain in their patients but perceive a lack of efficacious options or a lack of practice guidelines on how to use novel agents in a safe manner that does not compromise the patients’ psychiatric health.

The literature shows that even though psychiatric providers are aware of the impact of excessive weight gain in their patients, the problem is not consistently addressed during outpatient visits. A cross-sectional study published by Mojtabal et al. in 2017 shows that weight and metabolic concerns are only addressed in a minority of outpatient psychiatry visits, and that only a subset of psychiatrists are likely to address medical issues in their patients. A study published in 2022 surveyed a group of outpatient psychiatrist and identified common barriers that prevent providers from addressing weight and metabolic abnormalities in this population, including lack of knowledge in this area and administrative support. In addition, there is a lack of coordination between psychiatry and primary care. The authors conclude that supportive chart auditing and additional education for psychiatrists and staff as a possible solution (Aouira et al., 2022).

Managing excessive weight gain in people with chronic psychiatric illness remains a challenge. Weight management is significantly more difficult for this group than the general population, and the treatment options currently available fail to meet the patients’ special needs. The features associated with many psychiatric illnesses and the use of medications conductive to weight gain and metabolic abnormalities call for a systematic approach focused on prevention, monitoring, early intervention. These patients would also benefit from adjunctive treatment that incorporates pharmacological and behavioral interventions, as well as monitoring of metabolic measures and better coordination with primary care. Psychiatric prescribers can monitor the stability of their mental health as they undergo treatment for obesity, and in some cases, willing to prescribe anti-obesity medications but additional training on the use of new medications and support are needed if their efforts are to make a positive impact on this population. Patients would also benefit from access to learning materials that are tailored to their needs and to ongoing support to sustain healthy lifestyle changes. There is a need for an integrated protocol to manage excessive weight gain and metabolic risk in this populations, that supports both clinicians and patients in meeting their treatment goals.

References

Aouira, N., Khan, S., Heussler, H., Haywood, A., Karaksha, A., & Bor, W. (2022). Practitioners’ Perspective on Metabolic Monitoring of Second-Generation Antipsychotics: Existing Gaps in Knowledge, Barriers to Monitoring, and Strategies. Journal of Child and Adolescent Psychopharmacology, 32(5), 296-303.

Calkin, C., Van De Velde, C., Růžičková, M., Slaney, C., Garnham, J., Hajek, T., … & Alda, M. (2009). Can body mass index help predict outcome in patients with bipolar disorder? Bipolar disorders, 11(6), 650-656.

Correll, C. U., Detraux, J., De Lepeleire, J., & De Hert, M. (2015). Effects of antipsychotics, antidepressants, and mood stabilizers on risk for physical diseases in people with schizophrenia, depression, and bipolar disorder. World psychiatry, 14(2), 119-136.

McElroy, S. L., Kemp, D. E., Friedman, E. S., Reilly-Harrington, N. A., Sylvia, L. G., Calabrese, J. R., … & Shelton, R. C. (2016). Obesity, but not metabolic syndrome, negatively affects outcome in bipolar disorder. Acta Psychiatrica Scandinavica, 133(2), 144-153.

Mojtabai, R., & Oleson, M. (2018). Management of common medical conditions by office-based psychiatrists. Psychiatric Services, 69(4), 410-423.

Taylor, V. H., McIntyre, R. S., Remington, G., Levitan, R. D., Stonehocker, B., & Sharma, A. M. (2012). Beyond pharmacotherapy: understanding the links between obesity and chronic mental illness. The Canadian Journal of Psychiatry, 57(1), 5-12.

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By Lauren Neiser, MSN, APRN, PMHNP-BC

Keto. Atkins. South Beach. NutriSystem. Weight Watchers. Intermittent Fasting. Paleo. Low-Carb. The HCG Diet. Raw. Jenny Craig. Slim Fast. What do all these diets have in common? They are all ineffective and potentially harmful.

We live in a diet culture driven society that celebrates thinness and is abundant with internalized fat phobia. In the United States (US), the diet industry capitalizes on our society’s obsession with thinness, generating, in 2023 alone, $90 billion dollars in profit (Research and Markets, 2024). Within the US, there is a constant captivation and fixation related to body weight, shape, and size, “healthy” eating, and exercise. This diet driven culture keeps many individuals stuck in a yo-yo dieting cycle, often leading to malnutrition, preoccupation with food, poor body image, and potentially developing a disordered relationship with food. So, if diets are effective, why is the diet industry continually growing?

 

The short answer is diets do not work and are unsuccessful because they are often very restrictive and therefore, not sustainable.

Many diets villainize whole food groups, such as carbohydrates or sugars, which is not feasible for long term health or overall well-being.

As humans, we need a variety of foods to function, including glucose and carbohydrates, for our brains to function. Our brain solely utilizes glucose, and we cannot produce glucose ourselves, resulting in a need to obtain glucose directly from food sources (Wolrich, 2021). The best source of glucose? Carbohydrates. If we completely cut out this category of food or are following a very restrictive diet, this limits our brain’s ability to function at its highest capacity. This often leads to difficulty concentrating, inattentiveness, irritability, lower mood, heightened anxiety, fatigue or low energy levels, and poorer sleep. Another often vilified food component is fat. Fat, however, is essential to many bodily functions, including absorbing micronutrients, such as vitamin D or E, forming cells, and for overall energy (Wolrich, 2021). Therefore, if we moderately or severely limit our fat intake, we may become deficient in vitamins essential for bone health and experience weakness or lethargy. Additionally, anytime we are assigning a food item or food group a label such as “unhealthy” or “bad”, we begin to appoint morality to food. This, in turn, can lead to disordered eating. The truth is food has no morality. Food cannot be “good” or “bad”, it is simply food, a collection of nutrients. We need a vast variety of foods, including fats, sugar, carbohydrates and proteins, in order to allow our body to operate at its full capacity for overall well-being, both physically and mentally.

Research has shown that less than 10% of dieting individuals are able to keep the weight they lost off for over a year (Kraschnewski, 2010). Part of this is simply due to biology because every individual has their own set point. Set point theory suggests “that body weight is regulated at a predetermined, or preferred, level by a feedback control mechanism” within the brain (Harris, 1990, p.3310). This means your body has a weight that keeps its homeostasis or “happy place” and will adjust in any way it can to maintain the weight where it feels safest. When we engage in purposeful restriction in order to lose weight, our brains cannot recognize whether this is intentional or unintentional, leading to a starvation state. This results in our body beginning to try and conserve the energy or food nutrients it currently has. This results in a slower metabolism, changes in the way your body absorbs nutrients, and storing fat to mitigate the risk of starvation (Harris, 1990). This is the science behind why 90% of individuals who diet gain most, if not all, the weight back within one year (Research and Markets, 2024).

In the end, an individual’s weight is not simply a factor of will power. Weight stems from many different, predetermined aspects, including biological, environmental, economic, behavioral, and genetics. This is a small glimpse into why diets do not work and how they are harmful for our bodies, our minds, and our relationship with food and movement. If you are struggling with body image, disordered eating, or anxiety related to food or your body, please call the Lindner Center of Hope at 513-536-HOPE to get connected with a clinician or provider who can help.

References:

Harris, Ruth. (1990). Role of set-point theory in regulation of body weight. The FASEB Journal. 4(15), 3310-3318. https://doi.org/10.1096/fasebj.4.15.2253845

Kraschnewski JL, Boan J, Esposito J, Sherwood N, Lehman EB, Kephart DK, Sciamanna CN. (2010). Longterm weight loss maintenance in the United States. International Journal of Obesity, 34, 1644-1654. https://www.nature.com/articles/ijo201094

Research and Markets. (2024). The U.S. Weight Loss Market: 2024 Status Report & Forecast. Marketdata LLC. 

Wolrich, Joshua. (2021). Food isn’t medicine. Random House. 

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BY: Anna Guerdjikova, PhD, LISW, CCRC, Lindner Center of HOPE
Director of Administrative Services, Harold C. Schott Foundation Eating Disorders Program
University of Cincinnati, Department of Psychiatry, Research Assistant Professor

 

An estimated 45 million Americans diet each year and spend $33 billion annually on weight loss products. WebMD lists over 100 different diets, starting with the African Mango diet, moving on to the South Beach and Mediterranean diets and ending up with the Zone. Most diets, regardless of their particular nature, result in short-term weight loss that is not sustainable.

What is Weight Cycling?

Weight cycling is recurrent weight loss through dieting and subsequent weight gain (yo-yo effect). It can be harmful for mental and physical health for both healthy weight and overweight individuals. Furthermore, weight fluctuations have been related to increased risk of development of cardiovascular disease, Type 2 diabetes, and high blood pressure.

What is Dieting?

The word “diet” originates from the Greek word “diaita”, literally meaning “manner of living”. In the contemporary language, dieting is synonymous with a quick fix solution for an overwhelming obesity epidemic. Dieting implies restriction, limitation of pleasurable foods and drinks, and despite of having no benefits, the omnipresent dieting mentality remains to be the norm.

Understanding Diet Failure

Most diets fail most of the time. Repeated diet failure is a negative predictor for successful long term weight loss. Chronic dieters consistently report guilt and self-blame, irritability, anxiety and depression, difficulty concentrating and fatigue. Their self-esteem is decreased by continuous feelings of failure related to “messing my diet up again”, leading to feelings of lack of control over one’s food choices and further … life in general. Dieting can be particularly problematic in adolescents and it remains a major precursor to disordered eating, with moderate dieters being five times more likely to develop an eating disorder than those who do not diet at all.

How Dieting Can Impact Base Metabolic Rate

Aggressive dieting lowers the base metabolic rate, meaning one burns less energy when resting, resulting in significantly lower daily needs in order to sustain achieved weight after the diet is over. Returning to normalized eating habits at this lower base metabolic rate results in commonly seen post dieting weight gain. Biologically, dieting is perceived as harmful and physiology readjusts trying to get back to initial weight even after years since the initial rapid weight loss. 

Recent data examining 14 participants in the “Biggest Loser” contest showed they lost on average 128 pounds and their baseline resting metabolic rates dropped from 2,607 +/-649 kilocalories/ day to 1,996 +/- 358 kcal/day at the end of the 30 weeks contest. Those that lost the most weight saw the biggest drops in their metabolic rate. Six years after the show, only one of the 14 contestants weighed less than they did after the competition; five contestants regained almost all of or more than the weight they lost, but despite the weight gain, their metabolic rates stayed low, with a mean of 1,903 +/- 466 kcal/day. 

Proportional to their individual weights the contestants were burning a mean of ~500 fewer kilocalories a day than would be expected of people their sizes, leading to steady weight gain over the years. Metabolic adaptation related to rapid weight loss thus persisted over time suggesting a proportional, but incomplete, response to contemporaneous efforts to reduce body weight from its defined “set point”.

The Potential Harmful Effects of Dieting

Diets imply restriction. Psychologically, dietary restraint can lead to greater reactivity to food cues, increased cravings and disinhibition, and overeating and binge eating. Biologically, dieting can lead to unhealthy changes in body composition, hormonal changes, reduced bone density, menstrual disturbances, and lower resting energy expenditure.

Dieting emphasizes food as “good” or “bad”, as a reward or punishment, and increases food obsessions. It does not teach healthy eating habits and rarely focuses on the nutritional value of foods and the benefit of regulated eating. Unsatisfied hunger increases mood swings and risk of overeating. Restricting food, despite drinking enough fluids, can lead to dehydration and further complications, like constipation. Dieting and chronic hunger tend to exacerbate dysfunctional behaviors like smoking cigarettes or drinking alcohol.

A Healthier Alternative to Dieting

Complex entities like health and wellness cannot be reduced to the one isolated number of what we weigh or to what body mass index (BMI) is. Purpose and worth cannot be measured in weight. Dieting mentality tempts us into “If I am thin- I will be happy” or “If I am not thin-I am a failure” way of thinking but only provides a short term fictitious solution with long term harmful physical and mental consequences. Focusing on sustainable long term strategies for implementing regulated eating habits with a variety of food choices without unnecessary restrictions will make a comprehensive diet and maintaining healthy weight a true part of our “manner of living”.

 

Reference: Obesity (Silver Spring). 2016 May ;Persistent metabolic adaptation 6 years after “The Biggest Loser” competition.; Fothergill E, Guo J, Howard L, Kerns JC, Knuth ND, Brychta R, Chen KY, Skarulis MC, Walter M, Walter PJ, Hall KD.

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By: Heather Connor, LISW-S

At times it can feel like it’s impossible to have a positive relationship with our body image. We are inundated with ads that encourage us to lose weight via this supplement or that diet/wellness program, guaranteed to give you results. Diet Culture is a multibillion-dollar industry and it’s been around for generations. However, a fact to consider is that diets do not work. In a large-scale 2015 study of 278,000 people, it showed within 5 years, 95-98% regained all the lost weight (or more) (Fildes et al, 2015). Diets are designed to fail and instead of taking responsibility for that failure, they turn the blame onto the dieter. The reality too, is that even when the weight is lost, most of us still don’t feel confident in our bodies. Fatphobia is a driving force for the diet culture industry. The more afraid we are of fat bodies, the more we subscribe and pay into the thin ideal. Fatphobia is woven into the fabric of our culture, and it’s become so commonplace, we may not even notice when it’s present. For years we have rarely seen fat bodies on television or in ads and when we do, these characters are shown as the butt of the joke, the silly friend, or the lazy one who is always eating but almost never the main character or the one who finds love. We live in a world in which certain seats or devices do not accommodate larger bodies. We have until very recently, forced those in larger bodies to shop at specialty stores or online for clothes that can accommodate their size.

 

It’s become commonplace to gab to our friends about which “program” we are trying this week and we might even find community in joining along. We regularly talk negatively about our bodies or praise others for looking “great” after some noticeable weight loss without stopping to consider how this weight loss was achieved. We make unprovoked comments about other people’s bodies and children and even adults are often bullied relentlessly if they exist in a larger body. And with each time we make these comments we reinforce the narrative again and again that fat is bad and thin is the goal.

And it’s not just our culture that contributes to our unhappiness with our bodies. With our healthcare system waging war on obesity, it’s no surprise that many of us will search out any means to lose weight in the name of health. The BMI continues to be used to determine who is at risk even though BMI only accounts for our height and weight and no other measurement of health. While thin is often promoted at “healthy” for a large portion of the population, working tirelessly to achieve this goal, is anything but health-promoting. If we consider the steps we often take to achieve the thin ideal, we have to acknowledge that most of these involve hurting our bodies. These include everything from denying ourselves basic needs like nutrition to invasive surgeries, all in the name of health. Not to mention the shame and ridicule we often experience not only from others but from our own internal dialogue as well.

“While it is well established that obesity is associated with increased risk for many diseases, causation is less well-established. Epidemiological studies rarely acknowledge factors like fitness, activity, nutrient intake, weight cycling, or socioeconomic status when considering connections between weight and disease. Yet all play a role in determining health risk. When studies do control for these factors, increased risk of disease disappears or is significantly reduced.” (Bacon & Aphramor, 2011) In other words, living in a larger body does not automatically mean that one is “unhealthy”.

While we are on the topic of health, let’s also consider that dieting is a major risk factor for the development of eating disorders. The National Association of Anorexia Nervosa and Associated Disorders (ANAD) reports that 9% of the US population will develop an eating disorder in their lifetime and only 6% of those who are diagnosed are considered “underweight”. Eating disorders also have the highest mortality rate of all other mental health disorders, 2nd only to opioid overdoses and this is true for people, regardless of their size.

As a result of these experiences, we all have certain internalized biases surrounding weight which also contribute to our body image. We might make assumptions of someone’s health, intelligence, willpower, or overall lifestyle based solely on their body shape and size. The reality is however that we cannot determine any of these above traits just by looking at someone.

So if we can accept that all bodies are not meant to be thin and thinness does not equal health, then perhaps we could forge a different relationship with our bodies. When we focus on listening to our bodies instead of on external rules, we naturally lean into behaviors that are health promoting. Such behaviors include eating a variety of foods, engaging in joyful moment, and practicing a relationship with our bodies that prioritizes taking care of ourselves in the way we might care for a good friend. When we are not focused on losing weight, we are able to make decisions based on trust and our own internal wisdom.

The following are some strategies one might consider to begin the journey of moving away from diet culture and fatphobia and into a place of peace, trust, and an overall more friendly relationship with our bodies.

  1. Grieve the “ideal” body. In order to improve your relationship with your body, we have to first begin to let go of the “ideal” and accept the wonderful body you have. This may involve some of the phases of grief such as denial, anger, bargaining, and depression, before achieving acceptance.
  2. Ditch the negative self-talk. Every time you notice yourself calling yourself names and making negative comments about your appearance, stop, put your hand on your heart, and give yourself a compliment, body-focused or otherwise. You might even consider writing a few compliments down and posting them up as easy reminders that you are more than your body. A good rule of thumb here is begin to talk to yourself in the same manner you would a good friend.
  3. Practice Body Gratitude. Take 5 minutes each day, find a quiet place, close your eyes, and scan down through your body. Notice any sensations, thoughts, or feelings that you notice as you bring awareness to your body. If you are finding a lot of negative energy around one or more parts of your body, begin to shift that focus to what that part of your body does for you. Begin relating to your body as a good friend who trying to take care of you.
  4. Listen to your body and start rebuilding body trust. Start making it habit to begin to check in with your body regularly. This is a practice that is often lost for those that have been chronic dieters because dieting relies on rules rather than our body for what we can eat or how to move. As you check in, begin to respond according to your body’s signals such as eating when you are hungry, moving when you feel restless, or resting when you are tired.

If you continue to struggle with your relationship with your body, consider talking to a therapist who has experience with body image and who is familiar with Health At Every Size (HAES) or the practice of Intuitive Eating in order to help guide you even further in your journey towards body acceptance.

References:

Anorexia Nervosa and Associated Disorders (n.d.) Eating Disorder Statistics. https://anad.org/eating-disorders-statistics/

Bacon, L., & Aphramor, L. (2011). Weight science: Evaluating the evidence for a paradigm shift. Nutrition Journal, 10, 9.

Fildes, A., Charlton, J., Rudisill, C., Littlejohns, P., Prevost, A.T., &Gulliford. M.C. (2015). Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records. Am J Public Health, 105, 9, e54-9. doi: 10.2105/AJPH.2015.302773. Epub 2015 Jul 16. PMID: 26180980; PMCID: PMC4539812

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If you’re living with bipolar disorder, you may have noticed changes in your weight since starting treatment. You’re not alone. Many people with bipolar disorder experience weight gain as a side effect of their medication, which can impact both physical health and emotional well-being. Understanding why this happens and what you can do about it is an important part of managing your overall treatment plan.

Do mood stabilizers cause weight gain?

One of the biggest challenges in treating bipolar disorder is that many of the medications used to stabilize mood can cause significant weight gain. This includes mood stabilizers like lithium and valproate, as well as a group of medications called atypical antipsychotics. These medications are often essential for managing bipolar symptoms, but they can also lead to changes in metabolism and increased appetite, making weight gain more likely.

Which bipolar disorder medications are most likely to cause weight gain?

While most mood stabilizers carry some risk of weight gain, atypical antipsychotics are especially known for this side effect. These medications can also lead to other metabolic issues, such as changes in blood sugar and cholesterol levels.

Is weight gain in bipolar disorder a cause for concern?

Weight gain isn’t just a cosmetic issue. It’s linked to a higher risk of heart disease and other metabolic conditions, which are already more common in people with bipolar disorder. On top of that, gaining too much weight can be emotionally distressing and may make people feel less satisfied with their treatment—sometimes leading them to stop taking their medications. In fact, studies suggest that weight gain, especially when it involves weight cycling (repeated loss and regain of weight) and central obesity (fat around the abdomen), can make bipolar symptoms worse and contribute to a more difficult overall illness course.

Solutions for Bipolar Disorder Weight Gain

Lifestyle Interventions

Until recently, interventions for weight gain were mostly limited to lifestyle interventions.  Inactivity and dietary choices are significant contributors to metabolic abnormalities seen in patients with bipolar disorder, and although dietary and lifestyle changes have the potential for improving the overall quality of life, the results from these interventions often fail to keep up with the accelerated weight gain seen with psychotropics.  Clinicians have also attempted to select medications with lesser potential for metabolic dysfunction and increased appetite, but this is not always a viable option.  

Bariatric Surgery

Bariatric surgery can be a powerful tool for weight loss, and some research shows that it may also help improve mood. However, it hasn’t been specifically studied in people with bipolar disorder. If you are living with bipolar disorder and are considering bariatric surgery, it’s important to know that this option is generally recommended only for individuals who are in a stable, well-managed phase of their illness (called “euthymia”). It’s a major decision that should involve careful planning and close coordination with both your mental health and medical care teams.

Medications for Mitigating Bipolar Disorder Weight Gain

The use of off-label adjunctive medications for mitigating weight gain has had mixed results. Weight mitigation has been modest, and efficacious medications have produced significant adverse events leading to discontinuation or the cost to the patient has been prohibitive. 

Topiramate and Zonisamide

Topiramate and zonisamide are antiepileptic drugs with data suggesting efficacy in weight mitigation.  Topiramate has shown significant efficacy in weight mitigation (3.1kg over 6-26 week, according to a meta-analysis), but it is poorly tolerated and is associated with significant cognitive adverse events and paresthesia.  The estimated cost for a month’s supply of topiramate ranges from $40-$250.  Data suggest that zonisamide also has a significant effect on weight gain mitigation with similar, but milder adverse events. 

Naltrexone and Samidorphan

Opioid receptor antagonists like naltrexone and samidorphan have demonstrated modest efficacy in mitigating weight gain associated with olanzapine.  Samidorphan, the best-studied opioid antagonist, is associated with modest weight mitigation (1kg with olanzapine), is well-tolerated and is available on the market as part of a proprietary combination with olanzapine with an estimated cost of $1000/month.

Metformin and GLP-1 RAs

Antidiabetic drugs like metformin and glucagon-like peptide-1(GLP-1 RA) receptor agonists have  potential for weight mitigation and improvement of metabolic parameters such as dyslipidemia and insulin resistance.  Metformin is a popular option for medication-induced weight gain.  In patients treated with atypical antipsychotics, the estimated weight mitigation with metformin is 2-3kg and it is generally, well-tolerated.  The average estimated monthly cost of Metformin ER 2000mg/daily ranges from $27 to $50.  

GLP-1 RAs and similar drugs have the potential for significant mitigation of weight gain associated with psychotropics, and in some cases, weight loss.  These drugs are better tolerated than topiramate but additional research on the effects of these drugs on patients with bipolar disorder is needed to determine efficacy and safety.  GLP-1 RAs decrease glucagon secretion, have the potential for decreasing insulin resistance and delay gastric emptying, therefore decreasing appetite.  In addition, GLP-1 RAs have been shown to improve glucose regulation, lipid levels, and reduce cardiovascular risk.  Although GLP-1 agonists have demonstrated effectiveness in inducing weight loss and improving metabolic parameters in type 2 diabetes mellitus and obesity, data shows that only 10% patients eligible for treatment take these medications due to the high cost.

The Path Forward: Addressing Weight Gain in Bipolar Disorder

As we have seen, there are a few options for treatment of excessive weight gain associated with psychotropics, which can be used in addition to lifestyle interventions.  Limitations include the modest results seen with some interventions, intolerable adverse events with more effective options or high cost.  Additional, affordable treatment options are needed.

Learn more about Bipolar Disorder research and clinical trials at the Lindner Center of HOPE.Works consulted:

Laguado SA, Saklad SR. Opioid antagonists to prevent olanzapine-induced weight gain: A systematic review. Ment Health Clin. 2022 Aug 23;12(4):254-262. doi: 10.9740/mhc.2022.08.254. PMID: 36071739; PMCID: PMC9405627.

Mangge H, Bengesser S, Dalkner N, Birner A, Fellendorf F, Platzer M, Queissner R, Pilz R, Maget A, Reininghaus B, Hamm C, Bauer K, Rieger A, Zelzer S, Fuchs D, Reininghaus E. Weight Gain During Treatment of Bipolar Disorder (BD)-Facts and Therapeutic Options. Front Nutr. 2019 Jun 11;6:76. doi: 10.3389/fnut.2019.00076. PMID: 31245376; PMCID: PMC6579840.

Wang Y, Wang D, Cheng J, Fang X, Chen Y, Yu L, Ren J, Tian Y, Zhang C. Efficacy and tolerability of pharmacological interventions on metabolic disturbance induced by atypical antipsychotics in adults: A systematic review and network meta-analysis. J Psychopharmacol. 2021 Sep;35(9):1111-1119. doi: 10.1177/02698811211035391. Epub 2021 Jul 27. PMID: 34311625.

 

By Nicole Mori, RN, MSN, APRN-BC, Lindner Center of HOPE Psychiatric Nurse Practitioner

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Elizabeth Mariutto, PsyD, CEDS

 

 

 

 

When the average person is asked to describe eating disorders, body image concerns are one of the most identified symptoms.  However, not everyone with an eating disorder struggles with body image.  Those with Avoidant and Restrictive Food Intake Disorder (ARFID) avoid or restrict certain foods, but do not do so out of fear of weight gain, desire to lose weight, or body dissatisfaction. Instead, those with ARFID limit their eating based on sensory features of the food, fear of something bad happening when one eats, or a lack of interest in eating (Thomas & Eddy, 2019).

However, ARFID is more than picky eating. Those with ARFID are highly selective in what they eat, and this selectivity leads to some type of impairment in their lives (American Psychiatric Association, 2013). Children or teenagers may not grow as expected, leading to pediatricians being concerned that they have not followed the typical growth curve that had been evidenced earlier in their lives. Those with ARFID may lose a significant amount of weight unintentionally. Others end up needing to rely on oral supplements or nasogastric tube feedings to get in sufficient energy, and those with ARFID may display nutritional deficiencies.  Additionally, many with ARFID struggle socially (American Psychiatric Association, 2013). Many get-togethers, holidays, and celebrations with family and friends revolve around food, which can be anxiety and shame-inducing for those that eat more selectively, often leading to avoidance of such social gatherings and consequently, problems in relationships.

The same factors that lead to the onset of ARFID are worsened by its symptoms, which creates a cyclical pattern. Those who develop ARFID may experience more intense sensory experiences (Thomas & Eddy, 2019). They may be more sensitive to textures and/or may be a “supertaster” and pick up on more subtle variations of flavor than others. However, eating the same few foods repeatedly can lead to sensory-specific satiety, leading to those few foods becoming more aversive with time. Furthermore, if nutritional deficiencies develop, the taste of new foods can be altered, thus leaving someone to feel they have very few tolerable options. Others with ARFID may start out simply not having much interest in eating. When they eat less as a natural result, their fullness cues start kicking in prematurely and hunger cues dissipate, leading to eating even less.  Lastly, those who develop ARFID after having some type of aversive experience around food (i.e., choking) start to avoid the food that led to the negative experience hoping to avoid the same event. This expands into avoidance of similar foods as well.  The avoidance of these foods reinforces the fear, as these individuals do not have recent fear-countering experiences to teach them that they can safely consume these foods. Avoidance leads to increased anxiety, making the fear more entrenched.

ARFID treatment approaches resemble those for other forms of eating disorders but may include some modifications that more closely resemble the exposure treatment that is often used for obsessive compulsive disorder and anxiety disorders.  A treatment provider will likely do a thorough evaluation and case formulation of what factors need addressed in treatment.  First and foremost, patients may require medical stabilization to manage any of the acute health concerns that have risen with malnutrition.  Second, to prevent further medical problems from occurring and to begin the process of nutritional stabilization, clients often need to increase the overall volume of food.

There has not been much research on treatment for ARFID, although a modified version of cognitive behavioral therapy, CBT-AR, is being researched for ARFID and is showing promise (Thomas et al., 2020; Thomas et al., 2021). CBT-AR pulls from existing eating disorder, obsessive compulsive disorder, and anxiety disorder treatments and extensively educates the patient on how the disorder develops and is maintained, nutritional deficiencies and the importance of volume and variety, then gradually helps patients expose themselves to the foods that they have been avoiding (Thomas & Eddy, 2019).  Furthermore, Family-Based Treatment, which is a front-line treatment for adolescents with eating disorders, has been recently modified to address ARFID more specifically, also showing promising results (Lock, Sadeh-Sharvit, & L’Insalata, 2019). This treatment, which addresses the eating behaviors directly and conveys the seriousness of the eating disorder, empowers parents to refeed their child, takes a non-blaming approach to the illness, and helps parents and patients separate the illness from their identity (Lock et al., 2018).

Getting professional support can help patients with ARFID improve medically, nutritionally, psychologically, and socially. While therapists can provide support and teach specific techniques, the patient ultimately has a significant say into what foods to incorporate, when, and how.  With persistence, those with ARFID can eat with much greater variety and flexibility.

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Publishing, Inc.

Lock. J., Robinson, A., Sadeh-Sharvit, S., Rosania, K., Osipov, L et al. (2018). Applying family-based treatment (FBT) to three clinical presentations of avoidant/restrictive food intake disorder: Similarities and differences from FBT for anorexia nervosa. International Journal of Eating Disorders, 52, 439-446. doi: 10.1002/eat.22994

Lock, J., Sadeh-Sharvit, S., L’Insalata, A. (2019). Feasibility of conducting a randomized clinical trial using family-based treatment for avoidant/restrictive food intake disorder. International Journal of Eating Disorders, 52, 6, 746-751. doi: 10.1002/eat.23077

Thomas, J. J., Becker, K. R., Kuhnle, M. C., Jo, J. H., Harshman, S. G. et al (2020). Cognitive-behavioral therapy for avoidant/restrictive food intake disorder (CBT-AR): Feasibility, acceptability, and proof-of-concept for children and adolescents. International Journal of Eating Disorders, 53, 10, 1636-1646. doi: 10.1002/eat.23355

Thomas, J. J., Becker, K. R., Breithaupt, L., Burton Murray, H., Jo, J. H., et al. (2021). Cognitive-behavioral therapy for adults with avoidant/restrictive food intake disorder. Journal of Behavioral and Cognitive Therapy, 31, 1, 47-55. doi: 10.1016/j.jbct.2020.10.004

Thomas, J. J., & Eddy, K. T. (2019). Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults. Cambridge: University Printing House.

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Julie Foster, LISW-S, RN, MEd

There are many types of eating disorders. The most commonly talked about eating disorders are anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant restrictive food intake disorder. National Eating Disorders Awareness Week (NEDAW) is an observance to bring awareness to the seriousness of eating disorders across the United States. It is estimated that over 28 million Americans will have an eating disorder in their lifetime. (https://www.womenshealth.gov/nedaw).

So, what can employers and leaders do to help?

Fatphobia and body shaming are so woven into our workplaces that often it goes unchecked. In fact, it is a microaggression normalized by “wellness” programs in the workplace that encourage weight and calorie tracking, weight loss incentives, and “Biggest Loser” competitions.

There is “evidence that weight stigma is a bigger risk to people’s health than weight itself and what they eat.” (Harrison, 2021)

Weight-loss challenges can actually be one manifestation of a hostile work environment.

And anyway, dieting does not work! 95% of those who diet may lose weight in the short term, but they gain that weight back and more within 1 to 5 years. (Fildes et al., 2015)

Instead of weight loss competitions, how about implementing “No diet/body talk zones” and including weight discrimination in workplace diversity and inclusion efforts. Workplace leaders can start to change the office culture by modeling zero tolerance for body shaming and also by  supporting employees who are actively fighting against diet culture. Leaders can fight weight discrimination by examining their hiring practices and normalize not just Health at Every Size (HAES) but also leaning into the truth that size has no bearing on one’s intelligence or work ethic.

How can you shut down body-shaming? Start with yourself. What kind of things do you say, out loud, at work, about your body and what you are, and are not, eating? Change the narrative and speak up when others are making fatphobic comments. What others are eating or not eating is no one’s business. Commenting on someone’s weight in any fashion is not appropriate any more than commenting on anything else about their body.

You wouldn’t agree with   a colleague  making racist or homophobic remarks, so the same should be true if employees are body shaming. Here’s how you could respond:

“Why would you think it’s okay to say something fatphobic like that?” Or, “Why do you think it’s okay to discuss ______’s body?”

Another important part of creating a body-size inclusive culture is to conduct a physical audit of your environment. Are there chairs and workstations to accommodate all sizes of bodies? Are your waiting areas or lobbies welcoming to all sizes of bodies? Do your vending machines sell regular and low-calorie drinks for the same price?

Just like “love is love”, “food is food.” Food is neutral, not good or bad. What you eat does not define you as good or bad or qualify as being good or bad. And it’s no one’s business what or how much someone else is eating, so request employees keep their commentary (which is probably related to their own insecurities) to themselves. It is important for leadership to recognize that it is likely that a percentage of their workforce has, or has had, and eating disorder, and comments about food and size can be very triggering for them. What might seem like a neutral comment (“I can’t believe how bad I was! I ate that whole piece of cake!”) reinforces to someone with an eating disorder that food and eating is bad or shameful.  Or talking about how you haven’t eaten all day as some badge of honor reinforces to others that they are somehow weak or wrong for eating regularly.

It is also important to remember that an eating disorder is a disability, therefore the Equality Act 2010 applies. Eating disorders are the most lethal of all mental illnesses. Managers and colleagues should be aware that individuals with eating disorders, as with any long-term health condition, may have changes their performance.

Reasonable adjustments for those suffering with an eating sidorder could include: flexibility in allowing time off for appointments, working hours or extended lunch or other breaks, consideration of factors such as a place to eat in private or avoiding lunch meetings or other work events involving eating socially.

Compliment people without bringing their weight or bodies into it. Find ways to bond, connect and have conversations with people in the workplace that do not involve food, bodies, or weight loss.

Encourage movement for fun, for change of scenery, for better productivity. Play music, normalize dance breaks.

Why not create a routine where everyone has the opportunity to  get up from their desk at least once every hour and takes a 2 minute walk. But avoid tracking steps or putting a lot of emphasis on competition.

The best way for people to be released from diet culture is to have a community of support. The workplace can become a safe space. If you are concerned an employee may have an eating disorder, there is help at the Lindner Center of Hope 513-536-HOPE.

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Binge eating disorder (BED) is the most prevalent eating disorder but remains largely undiagnosed and untreated.  BED is characterized by recurrent episodes of loss of control and consumption of unusually large amounts of food within a short period of time (<=2h).  Episodes are associated with significant emotional distress but are not followed by purging behaviors (vomiting, misuse of laxatives, etc.), which differentiates BED from Bulimia Nervosa.  In addition to psychological distress, BED is associated with medical complications including accelerated weight gain, metabolic abnormalities, functional impairment, and decreased quality of life.  Untreated BED leads to worse clinical outcomes in a variety of medical and psychiatric conditions and poor treatment response in hypertension, diabetes, dyslipidemia, and obesity, which are commonly seen in primary care.  Patients with BED stand to benefit from increased screening, diagnosis, and treatment, particularly patients with type 2 diabetes mellitus (T2DM).

Screening for BED is particularly important in patients with T2DM.  While the prevalence of BED in the general population is estimated around 3%, prevalence is significantly higher in T2DM, where the prevalence of BED is estimated around thirteen times higher than in the general population.  In fact, eating disorders are frequently encountered among patients with T2DM, with prevalence estimated around 20%.  Diagnosis and treatment are important because the presence of binge eating greatly complicates management and is associated with worsened outcomes such as impaired glycemic control, dyslipidemia, and accelerated weight gain.  BED is associated with decreased response to weight loss interventions (including dietary and bariatric surgical procedures), impaired glycemic control, dyslipidemia, and exacerbation of insulin resistance.  Moreover, common pharmacotherapies for diabetes (such as insulin, sulfonylureas, and dietary restraint) have been implicated in the exacerbation of binge eating.

As we have seen, BED is a barrier to achieving treatment goals in T2DM.  It is important to take binge eating into account when selecting treatment.  Reducing the frequency and severity of binge eating can facilitate the achievement of treatment goals in T2DM.  Primary care providers manage most patients with T2DM, but screening and management of BED is still overlooked.  It is necessary to treat patients to decrease the frequency and severity of binge eating to help patients achieve treatment goals for diabetes.  Optimal outcomes in treatment are not possible with untreated BED.  Primary care providers face the challenge of identifying and initiating treatment for this population with complex needs.

Even though BED is an important comorbidity in T2DM, significant barriers to diagnosis and treatment persist.  First, eating disorders are associated with significant stigma and patients may not readily disclose disordered eating behaviors due to shame.  In many cases, patients are aware that some of their eating behaviors are abnormal, but they do not know that they are suffering from a treatable eating disorder.  In addition, primary care providers may overlook binge eating as a possible factor when patients fail to achieve treatment goals despite intensification of treatment.  In addition, primary care providers face time and financial constraints which limit their ability to diagnose, refer and treat.  Finally, there are not enough trained clinicians who can offer specialized medication management, dietary counselling, and psychotherapy for BED.  Medication options are still limited to an FDA approved agent (lisdexamphetamine), plus a couple of drugs used off-label.  However, providers still have options to start addressing the needs of patients with T2DM and BED, including:

Further research is needed to understand the needs of patients with comorbid T2DM and BED as well as to develop treatments to lessen the occurrence of binge eating episodes clinical care guidelines.

The Research Institute at the Lindner Center of HOPE is conducting a clinical trial of an experimental medication for Binge Eating disorder.  No prior diagnosis is required.  For additional information, contact us at 513-536-0700 or visit:  https://redcap.research.cchmc.org/surveys/?s=TP3C4TEA8J

Bibliography

Harris SR, Carrillo M, Fujioka K. Binge-Eating Disorder and Type 2 Diabetes: A Review. Endocr Pract. 2021 Feb;27(2):158-164. doi: 10.1016/j.eprac.2020.10.005. Epub 2020 Dec 13. PMID: 33554873.

Keshen A, Kaplan AS, Masson P, Ivanova I, Simon B, Ward R, Ali SI, Carter JC. Binge eating disorder: Updated overview for primary care practitioners. Can Fam Physician. 2022 Jun;68(6):416-421. English. doi: 10.46747/cfp.6806416. PMID: 35701190; PMCID: PMC9197289.

Winston AP. Eating Disorders and Diabetes. Curr Diab Rep. 2020 Jun 15;20(8):32. doi: 10.1007/s11892-020-01320-0. PMID: 32537669.

Nicole Mori, RN, MSN, APRN-BC, Lindner Center of HOPE Psychiatric Nurse Practitioner

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By: Annie Ward, MSN, PMHNP-BC
Psychiatric Nurse Practitioner, Lindner Center of HOPE

When we think of eating disorders, our society tends to think of individuals in emaciated bodies. Disordered eating is more common than not, and does not discriminate against body size, gender or race. The line between dieting and disordered eating is blurred in our society. There are narratives tightly woven into our culture which lead to disordered eating habits being encouraged, and unfortunately often praised. Sadly, they are only acknowledged as problematic when the physical manifestations become unignorable and when they can no longer be labeled under the guise of “healthy diets”.

One of the most common disordered eating patterns that I encounter in clients (whether they are seeking help for an eating disorder or not) is the binge-restrict cycle. This pattern can start with either binge eating or restricting. Essentially, when we restrict nutrition, our bodies increase our hunger cues as they search for sustenance, to alert you that your body needs food. This can often end up in a binge-eating episode which involves eating a large quantity of food while feeling out of control. Unfortunately, the feeling of lack of control often results in shame, which may then lead to subsequent restriction of nutrition. This may be due to feeling full after a binge or primarily due to shame, but unfortunately fuels the cycle of binge-eating and restricting.

It can be helpful to think about how this cycle was useful for our hunter and gatherer ancestors. They may have gone several days without food, and when they found it, the body wanted to obtain as much nutrition possible, because it didn’t know how long it would have to survive without food again. Their bodies pumped out hunger hormones to protect them and sustain them. Your body works the same way– it cannot identify why it is not getting food. I hope that you wouldn’t expect our ancestors to feel shameful for eating more when they found food- and hope this helps you understand why you should not feel shameful for eating more after a period of restrictive eating. Additionally, our bodies have natural weight settling points and when we restrict, to conserve the energy we have, we slow down our metabolism to conserve resources. This is one reason why diets are overwhelmingly unsuccessful.

In order to learn what your body needs and wants, one of the best things that you can do for yourself is structure regular nutrition throughout the day- regardless of what your eating looked like the day before. Our society certainly defaults to making us believe that we should eat less if we “overdid it” the day before, but this is simply not true. Your body needs and deserves consistent nutrition every day.

If you struggle with fatigue, poor concentration, mood swings, headaches or lightheadedness—these are a few of the ways that inadequate nutrition can present. They can present quickly after your body realizes it needs more fuel, and may not get better until your body can trust that you will consistently give it the nutrition it needs. I would encourage you to explore your relationship with nutrition and how it may be affecting you physically— and mentally.

What should we learn from this? 

  1. If you feel you ate too much of a meal or snack, you should forgive and forget. You deserve to eat all meals and snacks the next day. Returning to a consistent pattern of nutrition will help break the binge-restrict cycle.
  2. Our society promotes “health” but this often gets twisted into unhealthy recommendations which can lead to the binge-restrict cycle. This can then lead to guilt, shame, and eating disorders. Be wary of “healthy” diets.
  3. Consistent nutrition is self-care, and it is not helpful to use nutrition as a form or judgment of self-control

If you are struggling with this, reach out for help with an eating disorder specialist who is knowledgeable about Health at Every Size- you do not have to look a certain way to have an eating disorder or be “sick enough” to get help