Posts Tagged ‘weight gain’

Antidepressant Study Roils FDA, Media

June 20th, 2014

A new study on the use of antidepressants and suicides is roiling the Food and Drug Administration and the media. The study by Lu et al and published in the BMJ this week investigated whether widely publicized warnings in 2003-4 from the FDA about possible increased risk of suicide risks with antidepressant use in children and adolescents were associated with changes in antidepressant use, suicide attempts and completed suicides among young people. Researchers studied 1.1 million adolescents, 1.4 million young adults and 5 million adults.

Researchers found that the background studies behind the FDA warnings showed mixed outcomes. Nevertheless, after the FDA warnings, trends in antidepressant use and poisonings changed abruptly after the warnings. The FDA warnings received widespread and repeated media coverage becoming “frightening alarms to clinicians, parents, and young people.”

The decline was greatest among young adults, less among young adults and adults. Simultaneously, there were significant increases in psychotropic drug poisonings in adolescents and young adults but not among adults. Completed suicides did not change for any group. The study also found that there was no increase in alternative therapy usage

The researchers concluded that, “Safety warnings about antidepressants and widespread media coverage decreased antidepressant use, and there were simultaneous increases in suicide attempts among young people. It is essential to monitor and reduce possible unintended consequences of FDA warnings and media reporting.”

The media reaction to this study has been to shout that the warnings backfired and led to more suicide attempts. Meanwhile, the FDA is saying it sees no reason to change the warnings.

Why bring this study up in an obesity report? Several reasons.

First, obesity and depression co-occur in many people. There is so much overlap that most clinical trials of obesity interventions routinely exclude persons with depression from the study population. One reason is adherence. But another significant reason is that many antidepressants cause weight gain. In a recent study in JAMA Psychiatry found that people taking citalopram (Celexa) gained more than 2.5 pounds a year, on average. Those taking fluoxetine (Prozac) gained 1.5 pounds and those on sertraline (Zoloft) gained nearly 2 pounds in the course of a year. On the other hand, those taking bupropion (Wellbutrin) lost an average of nearly .5 pounds a year. (Bupropion is one component of the drug, Contrave, together with naltrexone, currently under consideration by the FDA for the treatment of obesity.) The discontinued drug, Meridia, was originally developed for the treatment of depression when its potential for weight loss was identified.

The main FDA warnings came out in 2003-2004.However in May, 2007, the FDA expanded the warnings to include young adults. The next month a FDA advisory panel recommended against approval of the drug rimonabant for the treatment of obesity, in part because of concerns of increase suicidial ideations. (See Stephanie Saul’s article in the New York Times.) Approval of rimonabant was reversed in 2008by the European Medicines Agency after the FDA’s negative decision.

Second, it seems evident now that the evidence base for the FDA warns was at best mixed. But the media so amplified the warnings that the crescendo did not admit of any doubt or consideration that maybe adolescents and young adults actually needed these medications and did not have any good alternatives. Unintended consequences are real but our current system, for all its reliance on scientific analysis, provides little room for doubt and discussion. The media like clean, crisp ‘talking points’ that fit their pre-defined “frames”, e.g. pharmaceutical companies are bad, natural remedies are good, etc. Changing the media’s approach is very difficult; there are just too many outlets. The FDA, on the other hand, is a single organization that can incorporate this experience into future activities.

 

AHRQ Looking at Comparative Effectiveness for Prevention Wt. Gain in Adults

September 5th, 2011

The Agency for Healthcare Research and Quality is undertaking a comparative effectiveness review of approaches to weight maintenance in adults. Information is available at Approaches to Weight Maintenance in Adults: A Comparative Effectiveness Review | AHRQ Effective Health Care Program The paper cites a recent Cochrane review of workplace diet and physical activity which found a rather minimal decrease in weight of 2.8 pounds or .5 BMI unit at 6-12 months.

Childhood Obesity

September 26th, 2009

Childhood obesity is one of the most important health problems facing the United States, if not the rest of the world. In an insightful article, David Ludwig describes Phase I of this crisis starting in the 1970s and ongoing where average weight increases among children from all demographic categories. However, this has little impact on medical care because an overweight or obese child may remain healthy for many years. Phase II which he describes we are now entering is marked by the emergence of serious health-related problems, such as type 2 diabetes, fatty liver, orthopedic problems and sleep apnea. Phase III, in the future, will see these problems evolve into life-threatening diseases, notably coronary heart diseases. He predicts that by mid-century, pediatric obesity will shorten life expectancy by 2 to 5 years..equal to all cancers combined. NEJM — Childhood Obesity — The Shape of Things to Come. His prediction, in my view, is unlikely to be disproved. New studies point to already significant increases in hospitalizations and costs associated with childhood obesity. Effects Of Childhood Obesity On Hospital Care And Costs, 1999-2005 — Trasande et al. 28 (4): w751 — Health AffairsThe seriousness of this problem should be compared to the seriousness and comprehensiveness of policy-makers thus far. MD

Prevalence

CDC Growth Charts N C H S – 2000 C D C Growth Charts: United States

State childhood obesity prevalence rates http://www.leadershipforhealthycommunities.org/images/stories/csg_ff_childhoodobesity1.pdf

Childhood obesity: trends and potential causes. [Future Child. 2006] – PubMed Result

Severe obesity in children increasing Prevalence and Trends of Severe Obesity Among US C…[Acad Pediatr. 2009] – PubMed Result

Prevalence and Trends of Severe Obesity Among US C…[Acad Pediatr. 2009] – PubMed Result

Weight status in the first 6 months of life and ob…[Pediatrics. 2009] – PubMed Result

General

See CDC Growth Charts Growth Charts – 2000 CDC Growth Charts – United States

See the Childhood Obesity Assessment Calculator from Shape Up! America Obesity Assessment

Childhood obesity and predictors of adult obesity Childhood predictors of adult obesity: a systemati…[Int J Obes Relat Metab Disord. 1999] – PubMed Result

Maternal Influence

Maternal Influence, Gestational Diabetes Metabolic syndrome in childhood: association with …[Pediatrics. 2005] – PubMed Result

Maternal perception of weight status and health ri…[Pediatrics. 2009] – PubMed Result

Family Circumstances

Do childhood social circumstances affect overweigh…[Scand J Public Health. 2009] – PubMed Result

Child Health and Wellbeing

The impact of overweight and obesity on health-rel…[BMC Public Health. 2008] – PubMed Result

Health-related quality of life among children and …[Int J Obes (Lond). 2006] – PubMed Result

Pediatric Obesity Screening, Assessment and Treatment

US Govt Recommendations for screening and treatment of childhood and adolescent obesity Screening and Interventions for Childhood Overweight: A Summary of Evidence for the US Preventive Services Task Force — Whitlock et al. 116 (1): e125 — Pediatrics

Screening and Treatment Recommendations Screening and interventions for childhood overweig…[Pediatrics. 2005] – PubMed Result

Identifying risk for obesity in early childhood. [Pediatrics. 2006] – PubMed Result

Reducing obesity and related chronic disease risk …[Obes Rev. 2006] – PubMed Result

Effectiveness of intervention programs Effectiveness of weight management programs in chi…[Evid Rep Technol Assess (Full Rep). 2008] – PubMed Result

Fat or Fit? Risks among 12-13 year olds. Relationship of fitness, fatness, and coronary-hea…[Pediatr Exerc Sci. 2007] – PubMed Result

Interventions for preventing obesity in children. [Cochrane Database Syst Rev. 2005] – PubMed Result

Child Care state Regulations and obesity Obesity prevention in child care: a review of U.S….[BMC Public Health. 2008] – PubMed Result

Small changes won’t help stop obesity in overweight children. Reductions of 300-500 calories per day needed ARS | Publication request: Halting the Epidemic of Childhood Obesity

Energy dense foods not affect female adolescents Energy-dense snack food intake in adolescence: lon…[Obes Res. 2004] – PubMed Result

Myths about childhood obesity Myths about childhood obesity. [Pediatr Ann. 1992] – PubMed Result

Societal Trends and Childhood Obesity: Part I: Preventing Chronic Disease: January 2005: 04_0038 Part II: Preventing Chronic Disease: April 2005: 04_0039

Children’s weight worsens at home, away from school Well – Summer Is a Nutrition Challenge for Parents and Children – NYTimes.com

Identifying high risk children Identifying risk for obesity in early childhood. [Pediatrics. 2006] – PubMed Result

Early determinants of risk Early determinants of overweight at 4.5 years in a…[Int J Obes (Lond). 2006] – PubMed Result

Youth Risk Behaviors Documented Youth Risk Behavior Surveillance — Selected Steps Communities, United States, 2007

Associated with obesity in children Prevalence of Obesity Among Children With Chronic …[Obesity (Silver Spring). 2009] – PubMed Result