So much has already been said about psychiatric meds, obesity, and fast food when it comes to the affect on our physical health. But, the link between these three categories in terms of the day to day realities of children, adolescents and adults who are taking certain psychiatric medications needs to be continually addressed. A post at PsychCentral titled “10 Ways to Manage Your Weight on Psych Meds” focuses on a subject that is in search of effective interventions and that has gone under reported for those working with people who are on these types of drugs. Everyday with a child or adolescent who has a psychiatric disorder(s) and is on medications is one filled with multiple, intense, challenges, none more so than the battle over food, specifically fast food and junk food.

The fact that psychiatric medications like Zyprexa and some antidepressants can lead to weight gain was not discussed with staff or parents when I started working in residential treatment facilities or in the home with families. As far back as ten years ago I was noticing dramatic weight gain in children on certain antipsychotics and antidepressants, but was not making the connection at the time or for a number years afterwards because the evidence was not out or training programs to address this factor were not in place. A article from HealthyPlace titled “New Research Shows How Antipsychotic Drugs Cause Weight Gain” states:

Scientists say they have pinpointed a mechanism in the brain that helps explain why certain antipsychotic drugs can trigger increased appetite and potentially dangerous weight gain in patients.

The side effect has cast a cloud on newer and more powerful drugs, such as Eli Lilly & Co.’s Zyprexa, used to treat schizophrenia and other mental illnesses. Significant weight gain increases the risk of life-threatening complications, including heart disease and diabetes.

Histamine may help spur the weight gain seen in patients taking certain kinds of antipsychotic drugs, researchers say.

In some cases, patients taking these drugs to treat mental illness gain so much weight that they develop serious complications such as heart disease and diabetes.

“We’ve now connected a whole class of antipsychotics to natural brain chemicals that trigger appetite. Our identification of the molecular players that link such drugs to increased food intake means there’s now hope for finding a newer generation of drugs without the weight-gain side effects,” Dr. Solomon H. Snyder, professor of neuroscience at the Johns Hopkins School of Medicine in Baltimore , said in a prepared statement.

The latest study, appearing in the Proceedings of the National Academy of Sciences, links a class of antipsychotics to brain chemicals that regulate appetite. The mechanism was discovered in mice. A similar link still needs to be established in people.

“If we understand why the drugs make you fat, we can design drugs that don’t do that,” said Snyder.

In an article from a few years ago in the NYT titled “Proof Is Scant on Psychiatric Drug Mix for Young,” the author Gardiner Harris writes:

Stimulants like Ritalin are by far the most commonly prescribed psychiatric medicines in children. But doctors routinely pair stimulants with antidepressants, antipsychotics and anticonvulsants, even though some of these medications can cause serious side effects, have few proven pediatric psychiatric benefits and lack clear evidence about how they interact or influence mental and physical development.

Last year, the Food and Drug Administration required drug makers to warn on their labels that antidepressants can cause suicidal thoughts and behavior in some children. Anticonvulsant drugs carry warnings about liver and pancreas damage and fatal skin rashes. The side effects of antipsychotic medicines can include rapid weight gain, diabetes, irreversible tics and, in elderly patients with dementia, sudden death. When drugs are combined, these risks compound.

We thought the weight gain for many of these children and adolescents was based more on impulse due to their emotional/behavioral/developmental challenges. This led to blaming them staff, and parents, instead of understanding there were other contributing factors that may be causing them to crave fast food and sugar. Soda, in particular, was a much coveted commodity. They craved soda, saving their change to get someone to take them to the store to buy a cheap liter. Other trips consisted of them getting us to take them to McDonalds for a fast food fix. I have also talked about the use and risks of polypharmacy with children in a previous post.

Many meltdowns and even violent behaviors ensued with a great deal of hoarding junk food taking place if we did not give in and meet their demands. Room searches would find food tape behind toilets, in closets, stuffed in clothing. Diabetes was also a concern and in a number of cases young men and women ended up becoming diabetic do to their poor diets and massive weight gain while on these medications. Discussions would include determining whether the negative and harmful behaviors they were exhibiting outmatched the risks to their health due to weight gain. In many instances their high degree of at-risk behaviors required that in order to keep them safe we had to keep them on these medications. This left us in a paradoxical position of having to come up with alternative strategies for keeping their weight down. Unfortunately, so many times the power of their appetite for fast food and junk food was greater then our ability to find healthier choices.

So many interventions in terms of offering healthy food choices were tried and food was locked down and strictly monitored. I knew we were up against something quite different than a child simply wanting fast food when I had to keep a adolescent boy from trying to cram an entire Big Mac into his mouth almost choking before a staff could get it out of his hands. On these medications they were always hungry and tired, unwilling to exercise. Their was literally no motivation to get them to eat better foods or be more active.

Fast food is already an addictive stimulant as noted in the film Supersize Me and through the work of people like David M. Kessler M.D.. In all of the challenges I have faced with children and adolescents, regardless of the degrees of emotional behavioral challenges they face, combating the power of fast food and junk food in their lives is one of the greatest. Multiply this challenge by putting psychiatric drugs with these adverse affects into them and you feel like you are fighting a losing battle and the overall war. To this day I see the challenges children, adolescents, parents and staff are facing when it comes to this complex mix of psychiatric medications, food and exercise. But, better understanding how these medications affect diet and physical activity will help us come up with behavioral modification programs and instill the empathy required to help these children and adolescents live healthier lives.