How to Manage Weight Gain

How to Manage Weight Gain From Bipolar Medications

If you’re struggling with weight gain as a side effect of your bipolar disorder medications, these expert tips can help.

1. Discuss Whether You Could Switch Medications

If you’re noticing symptoms like weight gain, increased hunger, or daytime sleepiness, tell your psychiatrist. These details help your doctor investigate what’s happening, including whether it’s tied to your medication.

Sometimes, it may be a matter of changing medications or dosages. “The encouraging news is that because there’s such a range, we often have room to pick or switch to an option with a lower weight-gain [likelihood], if that’s a priority for you. This is exactly the kind of trade-off worth discussing openly with your psychiatrist,” Terry says.

A lower-risk option still needs to be effective for your bipolar symptoms, and you shouldn’t change doses or stop a medication yourself, he says.

Your doctor may ask about your diet and lifestyle, too, Peay says. “Sometimes there are other things that can be happening at the same time that could also be causing weight gain,” she says. She considers how much weight you’ve gained, how quickly it happened, and whether changes in your stress levels, sleep, eating habits, or lifestyle could be contributing.

2. Check Blood Sugar and Cholesterol Alongside Weight

The scale doesn’t catch every change to your metabolic health. Before starting you on an antipsychotic medication, your doctor may check your weight, blood pressure, blood sugar, and cholesterol to establish a baseline. After that, they may repeat checks periodically during the first few months of treatment and yearly thereafter. In some cases, however, your doctor may increase the frequency of repeat checks from yearly to every few months.

“This lets us catch changes early rather than being surprised a year later,” Terry says.

Peay suggests asking which tests you need, when they need to be done, and who will review the results with you. These checks matter because excess weight can increase the risk of type 2 diabetes, high blood pressure, stroke, and heart disease.

3. Plan Regular Meals That Help You Feel Satisfied

Skipping meals then snacking heavily later can make eating patterns harder to manage, Terry says. Instead, he recommends regular, balanced meals with a focus on protein and fiber, including vegetables, fruit, whole grains, and lean proteins. He also suggests cutting back on sugary drinks and heavily processed packaged foods.

“Small, sustainable changes beat dramatic diets that don’t last,” he says. He typically tells his patients to build volume into their meals, such as making large salads or big bowls of vegetable-heavy soups, both of which can be filling yet low in calories.

If medication-related hunger makes things difficult, ask for a referral to a registered dietitian. “It’s not a sign of failure, it’s bringing in an expert who can build a realistic plan around your life, tastes, and budget,” Terry says. That support can help you choose meals and snacks you enjoy without needing to overhaul your entire routine.

4. Pay Attention to How You Eat

Eating quickly or grazing while watching television can make it harder to notice how much you’re eating, Terry says. Sit down for meals and give yourself time to notice how you feel. “Slowing down, eating at a table, and paying attention to actual hunger and fullness cues can make a real difference,” he says.

Peay says people with bipolar disorder need to be sensitive to their medical history and any co-occurring conditions they may have, especially if something like disordered eating or obsessive-compulsive disorder (OCD) is involved. “That’s a piece we want to be aware of,” she says. “We want this to be about mindfulness, as opposed to becoming a space of restriction and hyperfocus.”

Some people may find that talk therapy, such as cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT) can help them address their mental health concerns, alongside related issues such as binge eating or restricted eating.

Talk to your psychiatrist if you’re curious about therapy, Peay says. It’s often recommended alongside medication, and it can be tailored to your needs.

5. Make Movement Achievable

Exercise may provide multiple benefits for people with bipolar disorder, aiding with weight management while boosting mental health.

And physical activity doesn’t have to look like getting dressed to go to the gym or committing to a months-long boot-camp class.

Terry suggests taking a daily walk, trying an at-home workout, taking the stairs, or doing other movement you enjoy. “It doesn’t have to mean a gym membership,” he says. “Consistency matters far more than intensity.”

6. Ask Whether Weight Loss Treatment Could Help

For some people, eating changes and exercise aren’t enough, and switching bipolar disorder medications isn’t a possibility. In this case, ask your doctor whether additional treatment aimed at weight management is an option.

One option to consider is metformin, a type 2 diabetes medication that’s also prescribed off-label to prevent or manage antipsychotic-related weight gain.

There’s evidence that it may help with weight gain related to bipolar disorder medications, but you’d have to discuss with your doctor to see if you’re a candidate, Terry says.

Researchers have suggested that clinicians should discuss metformin early on with people who are candidates, including when they start some antipsychotics. That includes those who have already experienced antipsychotic-induced weight gain, especially if modifying lifestyle factors like diet and physical activity levels isn’t possible or hasn’t been effective.

“It tends to work best when started early, alongside the antipsychotic, rather than after a lot of weight has already accumulated,” Terry says.

Ask about the potential benefits, side effects, and whether it’s a good fit for you in light of your health history. “You shouldn’t have to choose between mental stability and physical health … the goal is to protect both,” he says.