There are disquieting hints everywhere that if we really were honest about discovering the causes of childhood obesity, we might not be happy about the answers. We might wish we had never asked. For example, some people believe our entire culture is warped by massive overdiagnosis of pathological conditions. We have discussed the question of whether food addiction should be defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
In a way, this could be a good thing for obese children who are blamed for being lazy, stupid, or greedy. Their problem would be reframed as a disease, like alcoholism or drug addiction, for which they need treatment, and ultimately hold no more stigma than a broken arm. The definition of food addiction as a legitimate medical condition might even mean that some kids’ treatment would be covered, if their parents are insured. But it could also lead to even more problems. How?
In Wired magazine, Gary Greenberg recently looked at what he sees as an example of that very process, through which a change in the DSM definitions led to unforeseen consequences. Upon publication of the most recent edition (DSM-IV), America suddenly and startlingly became full of bipolar children.
Within a dozen years, bipolar diagnoses among children had increased 40-fold. Many of these kids were put on antipsychotic drugs, whose effects on the developing brain are poorly understood but which are known to cause obesity and diabetes.
In other words, solving one problem led directly to another problem: kids on drugs, drugs that further research has shown to make them fat and diabetic. Greenberg is not alone in thinking that legal pharmaceutical drugs can be potentially as harmful to children as illegal street drugs. He also takes a swipe at the officially fuzzy definition of “metabolic syndrome,” pointing out that such a disease is basically a statistical construct, defined by a committee of humans who have agreed to lay out the parameters of its symptoms.
To harness the power of medicine in service of kids with hallucinations, or compulsive overeaters, or 8-year-olds who throw frequent tantrums, is to command attention and resources for suffering that is undeniable. But it is also to increase psychiatry’s intrusion into everyday life, even as it gives us tidy names for our eternally messy problems.
There is a class of drugs called atypical antipsychotics, also known as second-generation antipsychotics, prescribed to tranquilize the patient. They are thought by some to be better than first-generation antipsychotics, because of causing fewer side effects, especially fewer movement disorders, also known as uncontrollable Parkinson-like symptoms, in the users. It all has to do with dopamine and serotonin, and insulin sensitivity and resistance, but, basically, nobody really knows how the drugs work. As Wikipedia eloquently phrases it,
The mechanism of action of these agents is unknown…
That alone is enough to make a person say, “Whoa, let’s not take anything for granted about these substances.” Sometimes the stuff we take to make us better makes us worse in other ways. In other words, unintended consequences are rampant in the world, especially the world of pharmacology. The debate over a possible relationship between antipsychotic drugs and obesity is just getting warmed up.
Last spring, David Gutierrez explored the topic for Natural News. He says the Food and Drug Administration (FDA) approved some atypical antipsychotics for kids between 13 and 17, to treat bipolar disorder, autism, and schizophrenia. And then, at that point, had started to investigate whether they are “more likely to produce abnormal weight gain and diabetes in children than in adults.”
A recent study published in the Journal of the American Medical Association found that children and adolescents taking atypical antipsychotics added between 8 and 15 percent to their body mass in only 11 weeks, which was sufficient for many of them to become overweight or obese.
There is little doubt that atypical antipsychotics cause weight gain and change the metabolism in ways that may lead to diabetes. This suggests that we need some better ways to help people in mental and emotional distress. Pharmaceuticals can be miraculous lifesavers, but they are not universally appropriate.
Sometimes a good after-school enrichment program can make all the difference. And yes, there are children who are incapable of appreciating an after-school program unless they’ve had their medication. But probably not as many as anyone thinks.
Your responses and feedback are welcome!
Source: “Inside the Battle to Define Mental Illness,” Wired, 12/27/10
Source: “FDA to probe risk of weight gain in kids using antipsychotic drugs,” Natural News, 04/28/10
Image by downing.amanda, used under its Creative Commons license.