Through the MOBILITY study, researchers are exploring compelling new ideas and findings regarding weight gain among children and teens with mood disorders.
Challenges from COVID-19 among Children & Teens with Bipolar
Separation from school, activities, and friends during the COVID-19 era have been major challenges for teens and children throughout the world. But the pandemic has imposed unique obstacles for those with bipolar disorder. For a subset of young people who take second-generation antipsychotic medications, quarantines and physical distancing have posed yet another hurdle.
Second-generation antipsychotics, or SGAs, can carry the side effect of unwanted weight gain. This weight gain, in turn, can lead to unhealthy metabolic changes, including a rise in insulin and blood glucose levels and the onset of type 2 diabetes.
During COVID-19, the possibility of weight gain for young people taking SGAs has been compounded by several factors. The disruption of normal routines can lead to unpredictable mealtimes, disrupted sleep patterns, and excessive snacking caused by stress or boredom. Activities that might help thwart weight gain, such as exercising during gym class or walking the halls at school with friends, may not be available. Regular bedtimes and mealtimes may be difficult to maintain.
New Research into Weight Gain
Researchers with the national MOBILITY trial, funded by the Patient-Centered Outcomes Research Institute (PCORI) and highlighted as “promising research” by the Depression and Bipolar Support Alliance (DBSA), are studying whether a healthy lifestyle and/or the drug metformin can help prevent unwanted weight gain in children and teens who require treatment with SGAs. They have enrolled more than 1,400 young people in the study and are continuing to enroll and follow up with participants remotely, via telehealth, at 36 sites throughout Ohio, New York, and other areas of the United States.
The MOBILITY team recently presented a poster at the American Academy of Child and Adolescent Psychiatry’s annual meeting in October 2020, showing that there was no decline in retention when transitioning to remote visits that are linked to clinical care visits. Month 6 retention declined when comparing the pre-COVID-19 enrollment period in 2019 to the same period in 2020, whereas month 24 retention was close to significantly increasing.
All MOBILITY participants receive guidance about maintaining a healthy lifestyle through nutrition and exercise, and one-half of the participants also receive the drug metformin. Metformin, commonly prescribed to people with type 2 diabetes, has been available in the United States for 25 years and is on the World Health Organization’s list of essential medicines.
Pandemic-Related Disruptions for Children & Teens with Bipolar
MOBILITY researchers are concerned about the added burdens that the pandemic imposes on their patients: “We know that disrupted schedules, sleep patterns, and social interactions have interfered with everyone’s nutritional habits,” says Melissa DelBello, MD, MS, principal investigator of MOBILITY and professor and chair of the Department of Psychiatry and Behavioral Neuroscience at the University of Cincinnati.
Alluding to “the freshman fifteen” (which refers to the weight gain common among first-year college students), the media has written extensively about “the COVID 15”—the number of pounds the typical American has gained during the pandemic.
At the same time, physicians are seeing some children and adolescents develop eating disorders with weight loss resulting from disrupted circadian rhythms and the stress caused by isolation from friends and normal activities.
Nevertheless, Dr. DelBello and her colleagues say that children and teens who take SGAs can continue to strive for healthy behaviors, even when confined to home. Here are a few of their recommendations.
Tips for Improving Your Physical Health at Home
A good mat and an internet connection are all you really need to stay fit. Search for yoga and exercise videos on YouTube—such as “P.E. with Joe” and “Cosmic Kids Yoga”—or look around online to find exercise sites and apps that match your own fitness level and flexibility, such as GoNoodle, Shaun T’s Fit Kids Club, and Alo Yoga. Schedule a time each day to exercise, stretch, or practice mindfulness with your new virtual fitness friends.
Need some extra motivation? Find an “exercise buddy,” a friend who will do the exercises with you, so that you can hold yourself accountable.
Andrew Smith, LSW, MPH, is the community engagement manager for the Depression and Bipolar Support Alliance (DBSA), where he provides opportunities for individuals with the lived experience of a mood disorder to engage in advocacy and/or share their story. Smith is passionate about addressing mental health from a perspective of public health and promoting mental wellness in all people, with the goal of reducing the risk of “othering” people who live with mental health conditions.
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