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WMC Exclusive: The Mystery Suspect in the U.S. “Obesity Epidemic” by Paula Caplan
March 27, 2008
Here’s one surefire way to make anyone feel helpless, hopeless, even crazy: Teach them that others will value them mostly for being thin and being nurturing, and put them in situations where they are too agitated or sad to be cheerful caretakers for family and friends. When they ask for help, give them a pill that may calm them down or pep them up but will have a good chance of increasing their weight. This has been the fate of millions of women, who then are more likely than men to blame themselves for their part what is being called the U.S. obesity epidemic.
The media are full of stories about the causes of this epidemic, which is described as including two-thirds of American adults classified as overweight—more than 130 million. Nearly half of these are labeled “obese,” usually described as, for women, having a greater than 30 percent body fat composition. The most touted causes are fast food, large meal portions, and sedentary lifestyles.
While these factors can play roles in weight gain, a largely unnoticed suspect in this epidemic is the skyrocketing use of psychotropic drugs. The increase in the average U.S. resident’s weight has paralleled the warp-speed rise in use of anti-depressants, anti-anxiety drugs, and the drugs marketed as anti-psychotics—despite recent, high-profile exposés that adverse effects of these products have been concealed by their makers.
Psychologist David Cohen estimates that 50 million U.S. residents (1 in 6) take psychotropic medication. Many take more than one kind simultaneously, as, increasingly, drugs are added in the hope that a patient’s symptoms will abate or the negative effects of earlier drugs will disappear. One of the most common but least talked-about negative effects of a wide variety of psychotropic drugs—including many of those marketed to treat depression, anxiety, and psychosis—is weight gain, often tremendous weight gain. A near silence exists in the media and on the part of government health officials on the relationship between psychiatric drugs and the obesity epidemic—due at least in part to reliance on drug company advertising dollars and to the effectiveness in Washington of the all-powerful drug lobby.
The far from well-understood mechanisms of weight gain from psychiatric drugs appear to be complex. Researchers have proposed that some drugs affect metabolism and others may cause food cravings by impairing the central nervous system’s energy intake control. What is even less understood is the way that multiple psychotropic drugs interact with each other within a patient.
In a New York Times exposé in December, 2006, Alex Berenson reported that Eli Lilly had told its sales force to play down the fact that 30 percent of patients gain at least 22 pounds after a year or more on their drug Zyprexa, which is FDA-approved for treatment of schizophrenia and bipolar disorder but also often prescribed many other conditions, from dementia to posttraumatic stress disorder. Some studies show weight gains of 15 to 20 pounds on many drugs sold to treat depression, and one study showed a tripled incidence of obesity in patients on lithium compared to the general population.
Because they lack information, many patients, especially women, are totally in the dark when they find they are ravenous, that their body no longer handles food and weight as it once did. Their doctors lack information about drugs they prescribe or tend to minimize such negative effects. They seem to fear that patients, especially female patients, will refuse to try the drugs or imagine they are experiencing negative effects.
As a clinician, I have heard from countless patients that upon telling their doctors about weight gain after starting psychiatric drugs, they hear back a simple mathematical formula: The more you eat, and the less you exercise, the more weight you gain. Even the little that is known about how the drugs may radically alter weight-gain and hunger mechanisms is too frequently omitted from the picture. Women, who tend more than men to be socialized to blame themselves for every problem, are particularly susceptible to feeling deeply ashamed about weight gain. It can be devastating for a patient who is suffering from anxiety or depression in the first place.
Precisely because of the silences about this topic, there is no way of calculating how much drugs marketed as antidepressants, antipsychotics, and tranquilizers are adding to people’s weight. The total number of antidepressant purchases alone skyrocketed from 88 million in 1997 to 161 million in 2004, and the number of people who reported making such purchases increased from 15 million to nearly 25 million.
As alarming as it is for adults—whose central nervous systems are mature—to suffer weight gain and associated health problems through inadequately tested psychiatric drugs, the problem is worse for children and adolescents. There are exceedingly few long-term studies that could tell us the possible effects of these drugs on those whose central nervous systems have a long way to go to reach maturity. The lack of information is especially worrying in light of the huge increases in prescriptions for these age groups of not only antidepressants and stimulants but even of drugs prescribed as mood stabilizers and anti-psychotics.
The ballooning, unchecked power of pharmaceutical companies over the past two decades in the United States—born partly of the legalization of direct-to-consumer drug advertising, a phenomenon that many people from Canada and other countries find shocking—is, of course, a major contributor to this set of problems. So is woefully inadequate government oversight. U.S. residents—too many of them struggling to deal with the effects of overwork, poverty, violence, and alienation—may easily be persuaded that drugs will provide quick, effective fixes, the only remedy their time and incomes will afford.
Research has shown that a woman walking into a therapist’s or family practitioner’s office is more likely than a man with exactly the same emotional problems or concerns to be diagnosed as mentally ill. With that diagnosis, people often learn to attribute all their problems, including eating more, to mental illness. This makes it especially troubling that in an article last May in the American Journal of Psychiatry, two doctors proposed that obesity be classified as a mental illness. One likely consequence of that would be another massive increase in the prescribing of psychotropic drugs, resulting, no doubt, in another upsurge in obesity statistics.
As a beginning step, anyone who considers taking a psychiatric drug should be able to make that decision one that is fully informed. This means that government, the media, and certainly physicians must be energetic in educating themselves and the public and insisting that pharmaceutical companies disclose the extent of weight gain their drugs cause.
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