Childhood Obesity and Meta-Analysis

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In a time of limited resources, to look at different independent studies with some kind of system or organizing principle in mind is a very economical use of information. The data is already paid for. It’s even possible that some error might be discovered in a long-completed survey, a misunderstanding that once led the scientific community into an erroneous belief, which can now be rectified.

To the more action-oriented activists, a meta-survey may sound like a bunch of angels dancing on the head of a pin. But its usefulness is obvious. Looking at old studies is a great way to learn how to design better ones. A mischievous historian could give several examples of when a little more meta-analysis could have changed human affairs for the better.

One arm of the National Institute of Mental Health is the Collaborative Psychiatric Epidemiology Surveys, also known as CPES. When a research team’s work consists of compiling the work of other research teams, to compare and combine and draw conclusions, that is meta-analysis. Or harmonization, as it says here at the CPES page, which also notes,

This project joins together three nationally representative surveys: the National Comorbidity Survey Replication (NCS-R), the National Survey of American Life (NSAL), and the National Latino and Asian American Study (NLAAS).

Frederik Joelving reported for Reuters on how this information from 20,000 American adults was used to explore the question of what some critics are calling over-prescription or hyper-medicalization. Joelving explains,

While studies have shown the drugs may help some people with depression, they come with a price tag — and not only the $100 or more that a month’s supply can cost. Some users experience sexual problems or gain weight, for instance.

According to these surveys, approximately one person in 10 told interviewers they had used prescription antidepressants within the past year. But a quarter of them never had an actual diagnosis of “anxiety disorder” or “major depression,” or any other condition that would merit the use of these pills. Joelving quotes Jina Pagura, a psychologist who is also one of the medical students who has worked on this project at the University of Manitoba:

Although an antidepressant might help with these issues, the problems may also go away on their own with time, or might be more amenable to counseling or psychotherapy.

In other words, not every problem needs a pharmaceutical intervention. If a chemotherapy patient desperately needs to eat more and plump up, medication that can help increase the appetite is a good thing. But, generally, a person taking medicine does not want to put on weight. Especially if the condition they are taking medication for happens to be depression. To get fat or fatter is the last thing they need! And it’s even more true if the patient is a child or teenager who already has problems, or they would not be a candidate for prescription meds in the first place.

Granted, the meta-survey used data gathered from adults. But the basic message is, if fewer antidepressants were prescribed, that would be good for everybody (except Big Pharma).

If America is serious about keeping children and teens away from street drugs, what could be more insane than teaching them to solve their problems with prescription drugs? While there may be a need for mood-altering pediatric pharmaceuticals, a few things should be established first. Does the child really have a pathological condition, or simply under-equipped, fed-up parents?

Another thing you want to know is, were other alternatives tried before writing a prescription? It’s a shame that some perfectly good therapies that work for a lot of people are not offered or available at the preventive stage, i.e. to children and teens. They only become available much later on, when the person is in addiction recovery.

The most important thing to know, one might think, is whether the antidepressant will bring along any side effects, such as obesity, or tremors, diarrhea, or suicidal thoughts. And then when more meds are added to correct the side effects, what further problems are they likely to cause? It seems like this should be obvious, but there are kids out there who would thrive a lot better on the natch than on whatever cocktail of medications has been prescribed to them.

Your responses and feedback are welcome!

Source: “About CPES,” icpsr.umich.edu
Source: “Many get antidepressants for no psychiatric reason,” Reuters, 02/04/11
Image by RambergMediaImages (Keith Ramsey), used under its Creative Commons license.

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