Intervensi Perilaku dan Aktivitas Fisik pada Pasien Gangguan Bipolar dengan Obesitas dan Emotional Eating: Laporan Kasus

Meidian Sari; Abdullah Sahab; Lilis Khairani; Ahmad Ghiffari; Raden Ayu Tanzila

doi:10.55606/klinik.v5i3.7057

Authors

Meidian Sari Universitas Muhammadiyah Palembang
Abdullah Sahab Universitas Muhammadiyah Palembang
Lilis Khairani Universitas Muhammadiyah Palembang
Ahmad Ghiffari Universitas Muhammadiyah Palembang
Raden Ayu Tanzila Universitas Muhammadiyah Palembang

DOI:

https://doi.org/10.55606/klinik.v5i3.7057

Keywords:

Bipolar Disorder, Cognitive Behavioral Therapy, Emotional Eating, Metabolic Comorbidity, Obesity

Abstract

Obesity is a growing global health problem. Obesity is more common among patients with bipolar disorder than in the general population and has been associated with greater clinical burden, including depressive symptoms, impaired functioning, poorer quality of life, and metabolic complications. Case Presentation: A 38-year-old woman with a five-year history of bipolar III disorder presented with a 15 kg weight gain over two years. She had a history of manic episodes followed by depressive episodes. During depressive phases, she reported fatigue, low motivation, emotional eating, increased appetite, and preference for high-carbohydrate foods. She had been treated with valproate 750 mg/day and olanzapine 10 mg/day. Management included pharmacotherapy review, switching olanzapine to lurasidone due to lower metabolic risk, nutritional counselling, structured physical activity, cognitive behavioral strategies for emotional eating, sleep routine education, and family support. Conclusion: Behavioral intervention combined with regular physical activity may be a relevant adjunctive approach for patients with bipolar disorder, obesity, and emotional eating. This case highlights the need to assess eating behavior, sleep routine, physical activity, metabolic risk, and adaptive coping strategies in patients with bipolar disorder and obesity.

References

Bauer, I. E., Gálvez, J. F., Hamilton, J. E., Balanzá-Martínez, V., Zunta-Soares, G. B., Soares, J. C., & Meyer, T. D. (2016). Lifestyle interventions targeting dietary habits and exercise in bipolar disorder: A systematic review. Journal of Psychiatric Research, 74, 1–7. https://doi.org/10.1016/j.jpsychires.2015.12.006

Blüher, M. (2019). Obesity: Global epidemiology and pathogenesis. Nature Reviews Endocrinology, 15(5), 288–298.

Braden, A., Ahlich, E., & Koball, A. M. (2025). Emotional eating and obesity: An update and new insights. Current Obesity Reports, 14(1), 70. https://doi.org/10.1007/s13679-025-00661-9

Correll, C. U., Solmi, M., Veronese, N., Bortolato, B., Rosson, S., Santonastaso, P., Thapa‐Chhetri, N., Fornaro, M., Gallicchio, D., Collantoni, E., Pigato, G., Favaro, A., Monaco, F., Kohler, C., Vancampfort, D., Ward, P. B., Gaughran, F., Carvalho, A. F., & Stubbs, B. (2017). Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: A large‐scale meta‐analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry, 16(2), 163–180. https://doi.org/10.1002/wps.20420

Goldstein, B. I., Liu, S.-M., Zivkovic, N., Schaffer, A., Chien, L.-C., & Blanco, C. (2011). The burden of obesity among adults with bipolar disorder in the United States. Bipolar Disorders, 13(4), 387–395. https://doi.org/10.1111/j.1399-5618.2011.00932.x

Li, J., Hu, R., Luo, H., Guo, Y., Zhang, Z., Luo, Q., & Xia, P. (2024). Associations between dietary habits and bipolar disorder: A diet-wide Mendelian randomization study. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1388316

Li, K., Li, T., Yang, T., Lin, Y., Liao, Y., & Gan, Z. (2024). Prevalence of insulin resistance and its associated factors in drug-naïve patients with bipolar disorder among Han Chinese population. BMC Psychiatry, 24(1), 388. https://doi.org/10.1186/s12888-024-05838-5

Li, X., Liu, F., Ding, F., Ma, X., & Zhu, Y. (2025). Exercise interventions for depressive, manic, and anxiety symptoms in bipolar disorder: A systematic review and meta-analysis. Frontiers in Psychiatry, 16. https://doi.org/10.3389/fpsyt.2025.1648008

Liu, Y. K., Ling, S., Lui, L. M. W., Ceban, F., Vinberg, M., Kessing, L. V., Ho, R. C., Rhee, T. G., Gill, H., Cao, B., Mansur, R. B., Lee, Y., Rosenblat, J., Teopiz, K. M., & McIntyre, R. S. (2022). Prevalence of type 2 diabetes mellitus, impaired fasting glucose, general obesity, and abdominal obesity in patients with bipolar disorder: A systematic review and meta-analysis. Journal of Affective Disorders, 300, 449–461. https://doi.org/10.1016/j.jad.2021.12.110

Mansur, R. B., Brietzke, E., & McIntyre, R. S. (2015). Is there a “metabolic-mood syndrome”? A review of the relationship between obesity and mood disorders. Neuroscience & Biobehavioral Reviews, 52, 89–104. https://doi.org/10.1016/j.neubiorev.2014.12.017

McElroy, S. L., Kemp, D. E., Friedman, E. S., Reilly‐Harrington, N. A., Sylvia, L. G., Calabrese, J. R., Rabideau, D. J., Ketter, T. A., Thase, M. E., Singh, V., Tohen, M., Bowden, C. L., Bernstein, E. E., Brody, B. D., Deckersbach, T., Kocsis, J. H., Kinrys, G., Bobo, W. V., Kamali, M., … Shelton, R. C. (2016). Obesity, but not metabolic syndrome, negatively affects outcome in bipolar disorder. Acta Psychiatrica Scandinavica, 133(2), 144–153. https://doi.org/10.1111/acps.12460

Nissen, T., & Wynn, R. (2014). The clinical case report: A review of its merits and limitations. BMC Research Notes, 7(1), 264. https://doi.org/10.1186/1756-0500-7-264

Pedersen, S. D., Manjoo, P., Dash, S., Jain, A., Pearce, N., & Poddar, M. (2025). Pharmacotherapy for obesity management in adults: 2025 clinical practice guideline update. Canadian Medical Association Journal, 197(27), E797–E809. https://doi.org/10.1503/cmaj.250502

Penninx, B. W. J. H., & Lange, S. M. M. (2018). Metabolic syndrome in psychiatric patients: Overview, mechanisms, and implications. Dialogues in Clinical Neuroscience, 20(1), 63–73. https://doi.org/10.31887/DCNS.2018.20.1/bpenninx

Phelps, N. H., Singleton, R. K., Zhou, B., Heap, R. A., Mishra, A., Bennett, J. E., Paciorek, C. J., Lhoste, V. P., Carrillo-Larco, R. M., Stevens, G. A., Rodriguez-Martinez, A., Bixby, H., Bentham, J., Di Cesare, M., Danaei, G., Rayner, A. W., Barradas-Pires, A., Cowan, M. J., Savin, S., … Ezzati, M. (2024). Worldwide trends in underweight and obesity from 1990 to 2022: A pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. The Lancet, 403(10431), 1027–1050. https://doi.org/10.1016/S0140-6736(23)02750-2

Prillo, J., Soh, J. F., Park, H., Beaulieu, S., Linnaranta, O., & Rej, S. (2021). Obesity and metabolic comorbidity in bipolar disorder: Do patients on lithium comprise a subgroup? A naturalistic study. BMC Psychiatry, 21(1), 558. https://doi.org/10.1186/s12888-021-03572-w

Rosenblat, J., & McIntyre, R. (2017). Bipolar disorder and immune dysfunction: Epidemiological findings, proposed pathophysiology and clinical implications. Brain Sciences, 7(11), 144. https://doi.org/10.3390/brainsci7110144

Siskind, D., Gallagher, E., Winckel, K., Hollingworth, S., Kisely, S., Firth, J., Correll, C. U., & Marteene, W. (2021). Does switching antipsychotics ameliorate weight gain in patients with severe mental illness? A systematic review and meta-analysis. Schizophrenia Bulletin, 47(4), 948–958. https://doi.org/10.1093/schbul/sbaa191

Smith, J., Ang, X. Q., Giles, E. L., & Traviss-Turner, G. (2023). Emotional eating interventions for adults living with overweight or obesity: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 20(3), 2722. https://doi.org/10.3390/ijerph20032722

Speyer, H., Westergaard, C., Albert, N., Karlsen, M., Stürup, A. E., Nordentoft, M., & Krogh, J. (2021). Reversibility of antipsychotic-induced weight gain: A systematic review and meta-analysis. Frontiers in Endocrinology, 12. https://doi.org/10.3389/fendo.2021.577919

Suha, G. R., & Rosyada, A. (2022). Faktor-faktor yang berhubungan dengan kejadian obesitas pada remaja umur 13–15 tahun di Indonesia (analisis lanjut data Riskesdas 2018). Ilmu Gizi Indonesia, 6(1), 43. https://doi.org/10.35842/ilgi.v6i1.339

Thomson, D., Turner, A., Lauder, S., Gigler, M. E., Berk, L., Singh, A. B., Pasco, J. A., Berk, M., & Sylvia, L. (2015). A brief review of exercise, bipolar disorder, and mechanistic pathways. Frontiers in Psychology, 6. https://doi.org/10.3389/fpsyg.2015.00147

Wang, H., Wang, J., Zhao, L., & Zhu, Y. (2026). Network meta-analysis and dose–response analysis of exercise on sleep quality and BMI in obese populations. Frontiers in Public Health, 14. https://doi.org/10.3389/fpubh.2026.1766438

World Health Organization. (2025, December 8). Obesity and overweight.

Rosaline Darwis. (2024). Hubungan faktor risiko obesitas dengan kejadian hipertensi di wilayah Pelabuhan Harbour Bay Tahun 2024. Protein: Jurnal Ilmu Keperawatan dan Kebidanan, 3(1), 01–16. https://doi.org/10.61132/protein.v3i1.916

Estri Novia Febrianti, & Miftakhul Jannah. (2025). Pengaruh stres terhadap emotional eating pada atlet arung jeram Jawa Timur. Observasi: Jurnal Publikasi Ilmu Psikologi, 3(1), 323–332. https://doi.org/10.61132/observasi.v3i1.982