Obesity is a chronic state of being overweight. It’s a life threatening condition and current research has shown that obesity is the leading cause for the increased health threats that persons of the developed world face. Obesity increases a person’s threat for contracting diabetes, strokes, heart problems, certain kinds of cancer etc. What’s worse is the over two thirds of the industrialized world’s population is suffering from obesity and that’s putting them in greater health dangers. In recent years, policymakers and medical experts have expressed alarm about the growing problem of childhood obesity in the United States.
While most agree that the issue deserves attention, consensus dissolves around how to respond to the problem. This literature review examines one approach to treating childhood obesity: medication. The paper compares the effectiveness for adolescents of the only two drugs approved by the Food and Drug Administration (FDA) for the long term treatment of obesity, sibutramine and orlistat. This examination of pharmacological treatments for obesity points out the limitations of medication and suggests the need for a comprehensive solution that combines medical , social, behavioral, and political approaches to the complex problem.
Why Is Child Obesity an Important Health Problem in America? A Review of the literature According to researcher, Tyre (2004), In March 2004, U. S. Surgeon General Richard Carmona called attention to a health problem in the United States that, until recently, has been overlooked: childhood obesity” 15% child obesity rate constitutes an “epidemic”. Since the early 1980s that rate has “doubled in children and tripled in adolescents. ” Now more than nine million children are classified as obese.
While the traditional response to medical epidemic is to hunt for a vaccine or a cure-all pill, childhood obesity has proven more elusive; the lack of success of recent initiatives suggests that medication might not be the answer for the escalating problem. Another reason children may be overweight is the fact that developing and more highly developed countries are eating more beef and the meat, especially in the United States, has growth hormones in it in trace amounts. The laws in the United States allow cattle to be slaughtered for meat within hours of having been fed growth hormones, while in Europe this is forbidden.
Studies have shown that growth hormones create overweight children, with early development and growth spurts during pre-teen years. This literature review considers whether the use of medication is a promising approach for solving the childhood obesity problem by responding to the following questions:
1. Is over eating an addiction that can lead up to obesity? 2. What are the impact confronting the Childhood Obesity Epidemic? 3. What are the implications of childhood obesity? 4. Is Medication Effective at Treating Childhood Obesity? 5. Is Medication safe for children? 6. Is Medication the Best Solution? Understanding the limitations of medical treatments for children highlights the complexity of the childhood obesity problem in the United States and underscores the need for physicians, advocacy groups, and policymakers to search for other solutions. Is over eating an addiction that can lead up to obesity? Many people tend to think that all obese people have to do to solve their problems is eat less and move more. Alcoholics, on the other hand, need treatment.
But are the two disorders really all that different? Is it possible that eating in today’s sweet and salty fast-food world is actually somewhat, well, addictive? Could people with a predilection to abusing alcohol and drugs just as easily abuse food? Researchers Berkowitz, Wadden, Tershakovec (2003) examined two large surveys of nationally representative samples of American adults questioned about alcoholism in their families. Each included about 40,000 adults; one survey was carried out in 1991 and 1992; the other was done a decade later, in 2001 and 2002. According to esearchers, Flegal,Carroll, Odgen,& Johnson (2002), the people surveyed were asked whether a relative had “been an alcoholic or problem drinker at any time in his/her life,” a question repeated for several types of relative — mother, father, brother, sister, half-sibling and children.
Participants also reported their own weight and height, so body mass index could be calculated (B. M. I. is a calculation of weight in kilograms divided by height in meters squared, and a result of 30 or more is considered obese). The first survey, from the early 1990s, found no link between a family history of alcoholism and obesity. There was an almost perfect overlap between the B. M. I. distribution of people without a family history of alcoholism and people with a family history of alcoholism. In 2001 and 2002, adults with a family history of alcoholism were 30 to 40 percent more likely to be obese than those with no alcoholism in the family. Women were at particularly high risk: they were almost 50 percent more likely to be obese if there was family alcoholism than if there wasn’t. (Men were 26 percent more likely to be obese. )Why the change over time?
He says our so-called obesigenic, or obesity-inducing, food environment has changed in the decade between the two surveys. The most likely culprit, he said, “is the nature of the food we eat, and its tendency to appeal to the sorts of reward systems, which are the parts of the brain implicated in addiction. ” Other explanations for the increased obesity among relatives of alcoholics are possible, however. For example, it may be that people from families with alcoholism are more susceptible to stress generally, or to suffer from underlying depression that leads them to drink or overeat.
No single gene is responsible for making someone obese or alcoholic. But people who eat or drink excessively may share critical characteristics like lack of impulse control and the inability to stop once they get started, a sort of “missing stop signal,” he said. Stress is also implicated in both behaviors. “The notion of alcoholism being a disease can be oversimplified”. At some point, it’s a behavior and a choice. It’s just that some people are more vulnerable to the effect of that choice than others (Robinson &Killen, 2004).
Confronting the Childhood Obesity Epidemic According to researchers, Ogden, Carroll, & Curtin (2009) in U. S. children and youth is an epidemic characterized by an unexpected and excess number of cases on a steady increase in recent decades. The epidemic is relatively new but widespread, and one that is disproportionately affecting those with the fewest resources to prevent it. Although it does not have the exotic nature or immediate mortality of severe acute respiratory syndrome, anthrax, or Ebola virus, it is harming a much broader cross section of our young people and may significantly undermine their health and well-being throughout their lives.
Obesity can affect a child’s health immediately through physical or psychological conditions such as type 2 diabetes, hypertension, steatohepatitis, depression, and stigma. Obesity can also affect a child’s health in the longer term with additional illnesses that include arthritis, cancer, and cardiovascular disease. Infectious disease epidemics require and usually receive immediate high-level attention, with resources invested to control the problem and prevent its recurrence. Childhood obesity must be treated with comparable urgency.
As with other emerging health problems, our degree of knowledge and arsenal of effective interventions are quite limited. But we do not have the luxury of waiting to accumulate large bodies of evidence. Therefore, it behooves us to chart our course of action wisely based on what evidence we have drawing from our dealings with analogous problems and the outcomes of natural experiments and learn as we proceed. Complicating the process will be the multiple causes and correlates of childhood obesity and the need for many concurrent actions and interventions.
What Are the Implications of Childhood Obesity? Obesity can be a devastating problem from both individual and societal perspective. Obesity puts children at risk for a number of medical complications, including type 2 diabetes, hypertension, sleep apnea, and orthopedic problems. Researchers have noted that obesity is often associated with psychological issues such as depression, anxiety, and binge eating (Lee, Blair, & Jackson, 1999). Obesity also poses serious problems for a society struggling to cope with rising health care cost.
The cost of treating obesity currently totals $117 billion per year a price, according to the surgeon general, “second only to the cost of treating tobacco use “(Willett & Mason, 2002). And as the number of children who suffer from obesity grows, long-term costs will only increase. Is Medication Effective at Treating Childhood Obesity? The widening scope of the obesity problem has prompted medical professionals to rethink old conceptions of the disorder and its causes. As researchers Yanovski and Yanovski (2002) have explained obesity was once considered “either a moral failing or evidence of underlying psychopathology” (p. 92).
But this view has shifted: Many medical professionals now consider obesity a biomedical rather than a moral condition, influenced by both genetic and environmental factors. Yanovski and Yanovski (2002) have further noted that the development of weight-loss medications in the early 1990s showed that “obesity should be treated in the same manner as any other chronic disease through the long-term use of medication” (p. 600). Researchers, Ebbeling, Pawlak, and Ludwig, (2002) researched for the right long-term medication has been complicated.
Many of the drugs authorized by the food and Drug Administration (FDA) in the early 1990s proved to be a disappointment. Two of the medications fenfluramine and dexfenfluramine were withdrawn from the market because of severe side effects (Yanovski & Yanovski 2002 p. 592), and several others were classified by the Drug Enforcement Administration as having the “potential for abuse”. Currently only two medications have been approved by the FDA for long-term treatment of obesity: sibutramine (marketed as Meridia) and orlistat (marketed as Xenical).
Sibutramine suppresses appetite by blocking the reuptake of the neurotransmitters serotonin and norepinephrine in the brain. Though the drug won FDA approval in 1998, experiments to test its effectiveness for younger patients came considerably later. In 2003, researchers Berkowitz, Wadden, Tershakovec, and Conquist released the first double-blind placebo study testing the effect of sibutramine on adolescents, aged 13-17, over a 12-month period. Is Medication Safe for Children?
According to researchers, Willett & Mason (2002) while modest weight loss has been documented for both medications, each carries risks of certain side effects. Sibutramine has been observed to increase blood pressure and pulse rate. In 2002, a consumer group claimed that the medication was related to the deaths of 19 people and filed petition with the Department of Health and Human Services to ban the medication. The sibutramine study) noted elevated blood pressure as a side effect, and dosages had to be reduced or the medication discontinued in 19 of the 43 subjects in the first six months.
The main side effects associated with orlistat were abdominal discomfort, oily spotting, fecal incontinence, and nausea. More serious for long-term health is the concern that orlistat, being a fat-blocker, would affect absorption of fat-soluble vitamins, such as vitamin D. However, the study found that this side effect can be minimized or eliminated if patients take vitamin supplements two hours before or after administration of orlistat (p. 91). With close monitoring of patients taking the medication, many of the risks can be reduced. Conclusion, Is Medication the Best Solution?
The treatments of childhood obesity raise the question of where medication is the best solution for the problem. The treatments have clear costs for individual patients, including unpleasant side effects, little information about long-term use, and uncertainty that they will yield significant weight loss. In purely financial terms, the drugs cost more than $3 a day on average (Critser, 2003). In each of the clinical trials, use of medication was accompanied by an expensive regime of behavioral therapies, including counseling, nutritional education, fitness advising, and monitoring.
As journalist Greg Critser (2003) noted in his book Fat Land, use of weight-loss drugs is unlikely to have an effect without proper “support system” one that includes doctors, facilities, time, and money. For some, this level of care is prohibitively expensive. Addressing each of the above questions requires more than a doctor armed with a prescription pad; it requires a broad mobilization not just of doctors and concerned parents but of educators, food industry executives, advertisers, and media representatives.
The barrage of possible approaches to combating childhood obesity from scientific research to political lobbying indicates both the severity and the complexity of the problem. While none of the medications currently available is a miracle drug for curing the nation’s nine million obese children, research has illuminated some of the underlying factors that affect obesity and has shown the need for a comprehensive approach to the problem that includes behavioral, medical, social, and political change.
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