AAP Guidelines — the Backlash Grows, Part 2

This post is a continuation of yesterday’s, whose general topic is the increasing unrest over the latest guidelines published by the American Academy of Pediatrics. In particular, we are now discussing the various sorts of damage that healthcare professionals can unwittingly or carelessly bring about.

Iatrogenic harm can be produced not just by bacteria or a scalpel, but by words, and even without words. Yes, the spoken and unspoken communications of a physician, nurse, or other staff members can also cause significant damage. One website for medical professionals says,

Less well recognized are the potentially harmful influences of the knowledge, values, beliefs, and attitudes of well-intentioned health care providers and patients themselves, upon patient outcomes.

Another source quotes these thoughts from Arthur J. Barsky, M.D.:

Some of the information that physicians convey to their patients can inadvertently amplify patients’ symptoms and become a source of heightened somatic distress… One mediator of this variability between symptoms and disease is the patient’s thoughts, beliefs, and ideas… Although cognitions may not cause symptoms, they can amplify, perpetuate, and exacerbate them, making symptoms more salient, noxious, intrusive, and bothersome.

In the worst cases, this is the stuff of malpractice lawsuits. The Journal of Ethics explains a fine distinction:

Iatrogenesis refers to harm experienced by patients resulting from medical care, whereas negligence is more narrowly conceived as deviation from standard care. While all harm resulting from negligence is iatrogenic, not all iatrogenic injury is negligent.

Now, speaking of symptoms and disease, one problem pointed out by Dr. Pretlow and many others is the tendency of some clinicians to skip too speedily over the history and variety of symptoms. They head straight for the preconceived and possibly erroneous “answers,” which in perhaps too many cases tend to be either drugs or surgery. A sort of mass amnesia takes over and causes many healthcare professionals to forget that something came first, before symptoms.

In common parlance, we call that thing a cause. As Dr. Pretlow says,

Even with the new recommendations, only the symptoms are still being treated, not the underlying cause.

When a ship begins to sink, the water that sloshes around the sailors’ ankles is the indicator that something is wrong — the symptom. Naturally, some of the crew grab buckets and start bailing, and of course, others get to work on fixing the sails. But isn’t it a good idea to first locate the holes through which the water pours in, and plug them? When the underlying cause of the patient’s obesity remains unaddressed, how much good can be accomplished by a weight-loss drug regimen, or even bariatric surgery?

Sadly, failure to ponder the symptoms, along with the proclivity to leap to a demanding and costly solution, could in some cases be fairly characterized as iatrogenic harm. And nobody wants that.

Your responses and feedback are welcome!

Source: “Iatrogenesis,” HIGN.org, undated
Source: “The Iatrogenic Potential of the Physician’s Words,” JAMANetwork.com, 12/26/17
Source: “When Is Iatrogenic Harm Negligent?,” AMA-assn.org, August 2022
Image by driver Photographer/CC BY-SA 2.0

AAP Guidelines — the Backlash Grows, Part 1

Rather than settling down, it appears that resistance against the guidelines recently issued by the American Academy of Pediatrics grows more vehement as time passes.

Of course, some individuals and groups had plenty to say before January even ended. The Academy for Eating Disorders (AED) warmed up by calling the document a “major shift in perspective,” although diligent readers of past AAP publications believe it was easy to see this coming. Their statement ended by asking the AAP to revise this last edition of the clinical practice guidelines for obesity, and to include input from “key stakeholders” such as eating disorder professionals and actual patients who have lived through these problems and processes.

The AED has three main objections, and one of them is that the Guideline does not have much to say about screening or treatment referral for people afflicted by eating disorders. There is “no clear course of action for healthcare providers to take if an eating disorder is suspected or identified.” This is especially important because it is exactly the type of problem that needs to spotted and derailed early on.

Sensitivity

Another concern is that it does no good to recommend that clinicians approach the topic of weight in a sensitive manner, when they are offered no training on how to do that. Furthermore, there is a lack of long-term data on pharmacological and surgical interventions among the pediatric population. Rather than concentrating on individual-level changes like drugs and surgery, the group would much prefer to see more emphasis on structural reconstruction, like changes in food policy, the reduction of food insecurity in the population, and the reduction of stigmatizing attitudes in people’s minds.

Also criticized the lack of information on how “eating disorders can and do emerge after weight-loss surgery.” Another objection is, to put it delicately, “we wonder about the independence of the AAP recommendations given the financial reliance on pharmaceutical companies that is often required to investigate medication efficacy.”

The AED quotes the Hippocratic Oath, especially the part about “First, do no harm.” And mention of the oath leads into another ancient concept, iatrogenesis, derived from the Greek words for healer and causation. The AED feels that all the explicit focus on weight loss, in the ideas and practices being advocated, carries the potential for iatrogenic effects on some patients.

In the medical universe, that is a very scary word, partly because it has shades of meaning. In the most benign sense, it refers to problems that are not considered to be in the natural course of an injury or illness; harm that results from diagnostic procedures or medical treatment but without any intention. Charging a doctor with causing an infection would be a whole different level of an accusation than charging a hospital ward with causing one.

(To be continued…)

Your responses and feedback are welcome!

Source: “The Academy for Eating Disorders Releases a Statement,” Newswise.com, 01/26/23
Image by Johan Lange/CC BY 2.0

What They Say About Bariatric Surgery for Kids — Part 2

A lot of news stories elicit massive commentary when first published, but only some of them sustain interest for very long. In the past weeks, Childhood Obesity News has explored many angles of the American Academy of Pediatrics opus, “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity.”

We looked at a piece called “Children with obesity should get proactive treatment, including medication, surgery: new guidelines.” The word choice in that headline is indicative of how the reactions fall into categories. Some ask for treatments that are not just proactive, but aggressive. Others go further and insist on treatments that work. This might lead to a discussion based on the question, “Define work?”

If a weight-loss method involves expensive and potentially harmful endless dependency on pharmaceuticals, can it fairly be said to work? Can an intervention be honestly defined as effective, if it involves the removal of a major organ? Does it really work if it requires a lifetime of walking a nutritional tightrope? Can a person take in enough essential vitamins to compensate for the missing body parts, and at the same time not eat enough food to stretch the remaining stomach and invalidate the surgery?

Putting the cart before the horse

That good old saying is about doing things backward. Let’s be real. Tennis elbow could be eliminated by amputating the entire arm. Certain behaviors can be stopped by slicing out part of a person’s brain. Weight can be lost by taking a drug that may considerably increase the underpants laundry bill.

But just because a thing can be done, does not mean it should be done. And, important as these questions are, there is something even more basic going on. As Dr. Pretlow expresses it,

Even with the new recommendations, only the symptoms are still being treated, not the underlying cause.

Exactly. This fairly obvious fact has been noticed by laypersons and healthcare professionals alike, both immediately and in the ongoing second wave of responses. If more attention were paid to the underlying causes, we would not have to worry about the potential for various ugly complications like the ones listed by Christine Byrne in her article for Self.com, including…

[…] gastroesophageal reflux disease, chronic nausea and vomiting, the inability to eat certain foods, weight gain or failure to lose weight, low blood sugar, malnutrition, ulcers, bowel obstruction, and hernias.

And when certain statistics are aired, concern rises:

The guidelines also state that between 13 and 25% of those who get bariatric surgery will need a follow-up procedure within five years.

Your responses and feedback are welcome!

Source: “Children with obesity should get proactive treatment, including medication, surgery: new guidelines,” 6abc.com, 01/10/23
Source: “The New Obesity Guidelines for Kids Are Appalling,” Self.com, 02/02/23
Image by Stephen Edmonds/CC BY-SA 2.0

What They Say About Bariatric Surgery for Kids — Part 1

Recently, we followed early reactions to January’s American Academy of Pediatrics guidelines, then offered a retrospective look at what had been said here about the topic, previous to those new guidelines, with a comprehensive catalog of various aspects and angles (the pages known as Bariatric Surgery Roundups, #1 through #6). This has obviously been a hot topic for a long time.

Here is a look at some additional pieces that have appeared in the press in the recent past. The older gastric band method, in vogue until around 2008, was less invasive and less permanent than some other styles of weight-loss surgery, but had high complication and failure rates. As patient Amy Scheiner described,

A reversible, inflatable device was placed around the top portion of my stomach, creating a smaller “pouch” and limiting the amount of food I could consume.

By way of contrast, the current favored option, the gastric sleeve or sleeve gastrectomy, is done laparoscopically, with generally five small incisions. About 80% of the stomach is removed. The hospital stay is short (a day or two), and the overall recovery time is not long.

On the other hand, the lasting metabolic changes might not all be positive. The big problem is, it’s not like having a broken arm casted until it mends, and then the child goes on their merry way, good as new. The surgical option requires genuine long-term (as in, life-long) commitment and inflexible adherence to strict nutritional requirements. As Gina Kolata noted in The New York Times,

You have it the rest of your life. You cannot reverse it. You can’t say, I want my old intestines back. It’s gone.

Specialist Monika Ostroff is the executive director of the Multi-Service Eating Disorders Association. She has worked with many patients who developed eating disorders after bariatric surgery, some of whom were operated on as teenagers. Ostroff says that the surgery completely changes the way in which a person can nourish their physical body, from food amounts and types to their method of chewing. If patients are not adequately prepared for these radical changes, disaster can ensue.

The “forever” aspect is a very big deal to some people. Dr. Katy Miller (a hospital medical director in charge of adolescent medicine) was quoted:

[I]t is a very serious surgery that carries profound impacts for the rest of a patient’s life.

Your responses and feedback are welcome!

Source: “I Had Weight-Loss Surgery at 17, and It Worked — but It Didn’t Address My Real Problem,” Slate.com, 02/01/23
Source: “An Aggressive New Approach to Childhood Obesity,” NYTimes.com, 01/26/23
Source: “New childhood obesity guidance raises worries over the risk of eating disorders,” NPR.org, 02/15/23
Source: “New Guidelines Underscore How Complicated Childhood Obesity Is for Patients and Providers,” NYTimes.com, 01/20/23
Image by faungg’s photos/CC BY-ND 2.0

Guidelines Backlash, the Biggies — Surgery, Part 3

Today’s post serves a dual purpose, being also the Sixth Bariatric Surgery Roundup. Obviously, it’s not as if weight-loss surgery for kids had never been discussed prior to the publication of new guidelines from the American Academy of Pediatrics at the beginning of this year.

“Conscience and Consent”
In an era when court cases about sexual reassignment surgery are being argued, bariatric surgery might seem rather tame. Still, both kinds change the body irreversibly and bring lifelong consequences.

“Does It Have to Be Surgery?”
Despite what may seem like a too-hearty endorsement of bariatric surgery, the AAP has always held that it would be preferable for childhood obesity to be corrected in some other way. The organization would like to emphasize this point: Surgery or no surgery, the obese patient who is serious about change will, either way, have to adhere to a limited diet forever.

“Bariatric Surgery and Race”
Even though minority children and teens are statistically more likely to be overweight or obese, the majority of weight-loss surgeries are performed on white patients. It seems that figuring out the reasons for this disparity might be rather important.

“Evaluation for Metabolic and Bariatric Surgery”
This post explains the green light, yellow light, and red light system of evaluating a surgical candidate.

“Bariatric Surgery’s Progress”
A major drawback is the lack of long-term followup studies. In the short term, the failure rate seems to hover around 20%. Children and teens do not even have fully-formed personalities in the first place, and they tend to emerge from major surgery with the same emotional problems that led to obesity in the first place.

“Bariatric Surgery in a Less than Ideal World”
A discussion of the studies that have been completed about the medical and psychosocial effects on people who had undergone bariatric surgery as children and teens. The definition of “complications” includes the need for subsequent surgeries of the same kind. Sometimes, the problem is traceable to insufficient nutrition, particularly a shortage of calcium, iron, and various vitamins. Additionally, at the two-year mark after the completion of such surgeries, it was found that almost one in five of the young patients showed signs of clinical depression. Obviously, both nutritionists and psychologists are very important members of the clinical team.

“Can Best Be Improved On?”
In the great majority of cases, Type 2 diabetes ceases to be a problem after bariatric surgery. The opportunity to end all that misery should thrill the fiscal conservative, because if uncorrected, all those co-morbidities will cost even more than the operations.

“The Aspirations of Bariatric Surgery”
Another post includes more about the multidisciplinary team concept, and includes words from Dr. Pretlow:

I’m not an advocate of bariatric surgery, particularly in the pediatric population, except for life-threatening cases. I feel strongly that overeating/obesity is an addictive process and should be treated with addiction medicine methods. Our research results support this position.

“Contemplating Bariatric Surgery”
This one is basically a review of a horrifying and hilarious article whose author suggests that “death on the operating table can start to sound like the best-case scenario.”

Your responses and feedback are welcome!

Image by Yeison Varón Velásquez

Guidelines Backlash, the Biggies — Surgery, Part 2

For all practical purposes, today’s post is also known as the Fifth Bariatric Surgery Roundup. In other words, Childhood Obesity News has looked into this subject diligently, because it is so impactful. Those who are in favor of recommending bariatric surgery at a younger age say that the longer obesity is allowed to flourish in a child, the more difficult it will be to reverse that trend and get back to a healthy weight — and that is a valid point.

Another, and even more valid point, is that non-surgical methods should be tried earlier and more earnestly. The American Academy of Pediatrics is doing the best it knows how with new recommendations for more weight-loss drugs and earlier surgery. Meanwhile, Dr. Pretlow is working toward a world where both pharmaceuticals and bariatric surgery become exceedingly rare.

“Bariatric Surgery and Very Young Children”
Obesity was officially defined as a disease only about 10 years ago. To leap so quickly from that, to blithely recommending life-altering surgery for kids, seems rather precipitous. Let’s quote Dr. Pretlow on this one:

If non-surgical methods were effective, then bariatric surgery would be unwarranted. Therefore, we need to figure out exactly why non-surgical methods are ineffective, and create non-surgical methods that ARE effective, like addiction-based and displacement-based methods.

“Bariatric Surgery for Children”
Back in 2019 when this post was published, many professionals believed that “marketing weight loss surgery to children is wrong because it is invasive and dangerous, and can irreversibly transform the metabolic system.” And many still agree. For instance, Dr. David L. Katz opined,

Epidemic childhood obesity is a cultural crisis. Turning to the literal cutting edge of biomedical advance to address it is not a solution, but an abdication.

“Bariatric Surgery for Children — A Desperate Case”
This post relates a disturbing story of a sleeve gastrectomy performed on a child less than a year old, and what made it particularly horrific is that it did not work, possibly because her parents continued to supply “chips, biscuits, chocolates, and ice cream.” The youngster’s stomach expanded, leading to a second sleeve gastrectomy when she was seven.

“Weight-Loss Surgery and Non-Adults”
Some of the difficulty with assessing the usefulness of these procedures for children lies in the disparity between different methods of defining success — for instance, measuring loss in terms of excess body weight, versus loss relative to baseline weight. Despite the uproar over the AAP’s recent endorsement of surgery for kids, it has already been employed in extreme cases for very young children for years, even in the USA.

“Who Is Ready for Bariatric Surgery?”
In this post, we noted how enthusiastically Saudi Arabia has embraced surgical solutions for obesity, and how the government willingly pays for it under the citizens’ standard insurance policy.

“Why Operating on Children and Teens Is Okay”
This post reviewed some of the history of the trend toward acceptance of bariatric surgery for children and young people. Even before the recent headline-grabbing new AAP guidelines, that organization had stated that there is “no evidence to support the application of age-based eligibility limits.”

Your responses and feedback are welcome!

Image by Nutritional Doublethink/CC BY-SA 2.0

Guidelines Backlash, the Biggies — Surgery, Part 1

As we have seen, plenty of experts have a lot to say about the concept that kids as young as 12 (and in extreme cases, even younger) should be prescribed weight-loss drugs. It turns out to be a pretty controversial topic. But that debate almost fades into the background when compared to the real shocker. For patients as young as 13, bariatric surgery also is now on the table.

Before approaching this subject in light of the new American Academy of Pediatrics guidelines, let’s look back on some previous Childhood Obesity News discussions. So far, there have been three related “roundups.” The first was titled “Many Aspects of Bariatric Surgery for Teens.” The second was “Another Teen Surgery Compendium,” and the most recent was “The Third Bariatric Surgery Roundup.” A multitude of angles have already been covered but there is, astonishingly, still much more to consider. So today’s post wears two hats. It is also, officially, the Fourth Bariatric Surgery Roundup. Here goes:

“Bariatric Surgery, Qualifications, and Conscience”
“MBS” stands for metabolic and bariatric surgery, and for an adult, five major decision criteria must be taken into consideration. When the candidate is a minor child, issues become much more complicated.

“Bariatric Surgery and Consent”
Even a highly motivated mature adult, who is willing to practice total compliance, can find some aspects of post-operative care barely manageable. What happens when the patient is not even old enough to drive or vote?

“Bariatric Surgery and the Mind”
Adherence to post-op dietary and medication regimens is vital to success. What happens when the patient is cognitively impaired, psychiatrically unstable, or developmentally disabled? What happens when that already troubled patient is a minor child?

“More on Bariatric Surgery and the Mind”
When the patient is young and the procedure involves far-reaching lifestyle changes, forever can be a long, long time. What happens if a complication like substance abuse later enters the picture?

“Still More on the Mind and Bariatric Surgery”
One expert says, “Co-morbid psychosocial and emotional problems of obesity generally act as causal or maintaining factors of obesity and thus significantly affect the treatment outcome.” Weight-loss surgery alone does not straighten out any mental or emotional kinks the patient may have possessed in their pre-surgical life.

“Body, Mind, and Bariatric Surgery”
Just a couple of years before the controversial decision to endorse surgery for young obese patients, the American Academy of Pediatrics issued a couple of significant reports on the subject.

“The Evolution of Thought about Pediatric Bariatric Surgery”
Bariatric surgery is not only about reducing appetite. It is an investment in the future. Some experts feel that the only real justification for inflicting this kind of surgery on a child is that it will prevent a severity of obesity that ushers in one or more complications, known as co-morbidities.

Your responses and feedback are welcome!

Image by Nutritional Doublethink/CC BY-SA 2.0

Guidelines, Quibbles and Quirks — Part 4

This continues the description of some uncommon but dangerous eating disorders, brought to public attention by the National Eating Disorders Association during National Eating Disorders Awareness Week. Today’s post describes two more of the lesser-known eating disorders which are not yet officially deemed to be such.

Diabulimia

Diabulimia is something that afflicts only Type 1 diabetes patients, especially adolescents, who fear that the insulin that keeps them alive also makes them overweight. They will limit or skip their required insulin injections, which leads to nothing good.

Pregorexia

Pregorexia is also limited to certain patients, in this case, the pregnant ones. The expectant mother wants to control the amount of weight she gains during pregnancy. This behavior can turn into an eating disorder like anorexia or bulimia. The possible consequences affect not only herself but the unborn child. The infant may suffer restricted growth, fetal development irregularities, or low birth weight, as well as outright miscarriage, or the risks incurred by prolonged labor. For the mother, the possibilities also include bone loss, abnormal fatigue, dizziness, electrolyte abnormalities, and dehydration.

Along with calorie counting and food intake restriction, the prospective mother might insist obsessively on a demanding exercise routine. Several other warning signs should be watched for:

— Self-induced vomiting
— Laxative use
— Feeling shame or guilt about weight gain
— Weighing yourself several times a day or doing other things to measure the size of your body
— Fear or intense distress about gaining weight
— Avoid going to doctor’s appointments
— Feel disconnected from the baby growing inside them
— Avoid social situations with friends or family

Why have these unusual disorders been brought up here? Because one of the major objections to the new American Academy of Pediatrics guidelines for childhood obesity treatment is that the beliefs and intentions expressed therein are in danger of inspiring a new wave of eating disorders, especially among the young.

National Public Radio’s “All Things Considered” interviewed eating disorder specialist Nooshin Kiankhooy, who points out that there have been no long-term studies of how a child may be impacted by either weight-loss drugs or bariatric surgery.

There is also the psychological angle. When many adults barely grasp how these treatments could affect them, how are children supposed to understand what they are letting themselves in for? Kiankhooy says,

The fact that we are placing such an emphasis on the size of a child’s body, to me, is a huge concern — and how that not only is going to impact a child’s body from a physical standpoint but how it’s really going to impact them from a mental standpoint in — this is what your body is, and we must now change it…

Also for NPR, journalist Kaitlyn Radde wrote,

[W]hen adult patients stop taking the class of weight loss drugs recommended in the guidelines, they often gain the weight back, which means kids might be on the medication for the rest of their lives. But supporters say the updated guidance will help destigmatize obesity precisely because it treats it as a disease — like cancer or COVID — that requires medical intervention and isn’t the patient’s fault.

Your responses and feedback are welcome!

Source: “NEDA National Eating Disorder Awareness Week 2023,” EatingDisorderHope.com, undated
Source: “This eating disorder expert is worried by new guidelines to treat childhood obesity,” WVIA.org, 02/17/23
Source: “New childhood obesity guidance raises worries over the risk of eating disorders,” NPR.org, 02/15/23
Image by Enzymlogic/CC BY-SA 2.0

Guidelines, Quibbles and Quirks — Part 3

Today, February 27, is the first day of National Eating Disorder Awareness Week, sponsored by the National Eating Disorders Association (NEDA). One of the problems with the new American Academy of Pediatrics guidelines for treating childhood obesity is a fear that making a big deal out of weight only leads to a rising incidence of eating disorders.

The Education and Awareness section of NEDA’s website includes articles on Anorexia, Bulimia, Binge Eating, Weight & Body Image, Body Dysmorphia, Orthorexia, Compulsive Eating, Addictions, Diabulimia, Night Eating Syndrome, Pregorexia, Atypical Anorexia, and more. Childhood Obesity News has already covered several of these, so let’s take a look at a few of the less frequently discussed conditions. Of these four, none holds the title of official mental health diagnosis as defined by the institutions in charge of definitions. Yet they have been observed, and present themselves distinctively enough to earn their own categories.

Orthorexia

Whether it is regarded as a disease or a lifestyle, it affects a person by causing malnutrition, fatigue, emotional instability, social isolation, diminished quality of life, and stigmatization. In 2016, three defining characteristics of Orthorexia were named by Stevenn Bratman:

— An obsessive focus on “healthy” eating and avoidance of “unhealthy” foods,
— Mental preoccupation regarding dietary practices, and
— Very rigid dietary rules with violations causing exaggerated emotional distress (fear of disease, anxiety, shame, and negative physical sensations)

Night Eating Syndrome

In 2008, the First International Night Eating Symposium was held to figure out exactly what goes on with a phenomenon that, even though not officially named or claimed, was and is observed by many healthcare professionals. A person who takes in 25% or more of their daily calories after dinner or during the night may have Night Eating Syndrome. That is, if the disordered pattern “is not secondary to substance abuse or dependence, medical disorder, medication, or another psychiatric disorder” and has been going on for at least three months.

Other tentative diagnostic criteria are at least two episodes of nocturnal eating per week, along with awareness and recall of the event. Night Eating Syndrome is also considered to be present if three out of the following six items can be checked off:

— Lack of desire to eat in the morning and/or breakfast is omitted on four or more mornings per week.
— Presence of a strong urge to eat between dinner and sleep onset and/or during the night.
— Sleep onset and/or sleep maintenance insomnia is present four or more nights per week.
— Presence of a belief that one must eat in order to initiate or return to sleep.
— Mood is frequently depressed and/or mood worsens in the evening.
— The disorder is associated with significant distress or impairment in functioning.

(To be continued…)

Your responses and feedback are welcome!

Source: “NEDA National Eating Disorder Awareness Week 2023,” EatingDisorderHope.com, undated
Image by Karen/CC BY 2.0

Guidelines Backlash, the Biggies — Drugs, Part 4

In Part 1 of this series we mentioned orlistat, the generic name of one of the six kinds of drugs that the Food and Drug Administration has approved specifically for weight loss. As all pharmaceuticals of this type must warn, it is “Only effective as an adjunct to caloric restriction, increased physical activity, and behavioral modification.”

According to the manufacturer’s description,

Orlistat is a gastrointestinal lipase inhibitor that works by blocking the absorption of 25% of the fat in a meal and is used for weight loss in overweight adults, 18 years and older…

But that statement is misleading because it’s outdated. True, the substance’s safety and efficacy have not been established for children under 12 years old, and apparently it is not authorized for them. Which means, it is able to be prescribed for young persons over 12, to be taken by mouth every eight hours. And guess what? A half-strength version of the drug is available over the counter!

Another source says that for that age group,

A 6-12 month trial of orlistat… may be appropriate after specialist assessment, particularly in morbid obesity… or when co-morbidities exist, although evidence for long-term effectiveness in this age group is lacking.

A common side effect of its use is oily leakage that stains the undergarments, which results from another side effect, flatulence (gas) with discharge. The child might defecate more frequently, and the stools produced might be fatty, oily, painful, loose, liquid, clay-colored, or uncontrollable. A child who was previously picked on for being fat might have the chance to experience something new and different, the mortification of being picked on because they pooped their pants.

Then there is the possible onset of nausea, stomach pain, vomiting, weakness, itching, skin rash, dark urine, loss of appetite, jaundice, headache, and/or back pain. There might be problems with the teeth and gums, liver failure, or the whole spectrum of cold/flu symptoms, including chills and fever. The child might come down with a fancy ailment like oxalate nephropathy or leukocytoclastic vasculitis.

Orlistat has been known to interact mildly with at least 21 other drugs, and to interact moderately with at least 65 different drugs. To top it all off, the manufacturer cautions, “This information does not contain all possible interactions or adverse effects.” Orlistat is classified as a Gastrointestinal Agent and also, as Other. Maybe Other is code for “Let’s hope this is never authorized for younger kids.”

Your responses and feedback are welcome!

Source: “Orlistat,” RxList.com, 08/27/21″
Source: “Preventing Childhood Obesity: Evidence Policy and Practice,” Wiley.com, 2010
Image by Michael Saechang/CC BY-SA 2.0