title: Obesity, but not metabolic syndrome, negatively affects outcome in bipolar disorder.
abstract: OBJECTIVE
  Examine the effects of obesity and metabolic syndrome on outcome in bipolar disorder.
  
  
  METHODS
  The Comparative Effectiveness of a Second Generation Antipsychotic Mood Stabilizer and a Classic Mood Stabilizer for Bipolar Disorder (Bipolar CHOICE) study randomized 482 participants with bipolar disorder in a 6-month trial comparing lithium- and quetiapine-based treatment. Baseline variables were compared between groups with and without obesity, with and without abdominal obesity, and with and without metabolic syndrome respectively. The effects of baseline obesity, abdominal obesity, and metabolic syndrome on outcomes were examined using mixed effects linear regression models.
  
  
  RESULTS
  At baseline, 44.4% of participants had obesity, 48.0% had abdominal obesity, and 27.3% had metabolic syndrome; neither obesity, nor abdominal obesity, nor metabolic syndrome were associated with increased global severity, mood symptoms, or suicidality, or with poorer functioning or life satisfaction. Treatment groups did not differ on prevalence of obesity, abdominal obesity, or metabolic syndrome. By contrast, among the entire cohort, obesity was associated with less global improvement and less improvement in total mood and depressive symptoms, suicidality, functioning, and life satisfaction after 6 months of treatment. Abdominal obesity was associated with similar findings. Metabolic syndrome had no effect on outcome.
  
  
  CONCLUSIONS
  Obesity and abdominal obesity, but not metabolic syndrome, were associated with less improvement after 6 months of lithium- or quetiapine-based treatment.
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.|Lindner Center of HOPE, Mason, OH, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: McElroy
authors.affiliation: Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Kemp
authors.affiliation: Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: E S
authors.initials: ES
authors.lastname: Friedman
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: N A
authors.initials: NA
authors.lastname: Reilly-Harrington
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: L G
authors.initials: LG
authors.lastname: Sylvia
authors.affiliation: Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Calabrese
authors.affiliation: Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Rabideau
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Ketter
authors.affiliation: Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Thase
authors.affiliation: Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: V
authors.initials: V
authors.lastname: Singh
authors.affiliation: Department of Psychiatry, University of New Mexico Health Science Center, Albuquerque, NM, USA.
authors.forename: M
authors.initials: M
authors.lastname: Tohen
authors.affiliation: Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Bowden
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: E E
authors.initials: EE
authors.lastname: Bernstein
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA.
authors.forename: B D
authors.initials: BD
authors.lastname: Brody
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: T
authors.initials: T
authors.lastname: Deckersbach
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Kocsis
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: G
authors.initials: G
authors.lastname: Kinrys
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
authors.forename: W V
authors.initials: WV
authors.lastname: Bobo
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
authors.forename: M
authors.initials: M
authors.lastname: Kamali
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: McInnis
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Leon
authors.affiliation: Department of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Faraone
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Nierenberg
authors.affiliation: Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Shelton
keywords: bipolar disorder; metabolic syndrome; obesity; outcome