Let them eat.... drugs?

A new study finds that 1 in 5 American preschoolers are obese, and another in the same journal reveals that prescriptions are way up for children with high blood pressure, high cholesterol and diabetes.  Who has kidnapped common sense?

 

The theme of the recently published issue of Archives of Pediatrics and Adolescent Medicine is "Obesity, Diabetes and Comorbidities."  There are a plethora of important articles in the journal, but it's a sad sign of the times that an entire issue is devoted to the topic.  The two articles getting the most media attention can be summed up as follows: a rising number of preschoolers are obese (about 1 in 5) and a rising number of children are being prescribed medications for conditions associated with obesity (high blood pressure, high cholesterol and diabetes).  Conveniently placed alongside the WebMD coverage of the rising rate of drug usage is an adverstisement for Lipitor.  And while I don't have the Archives print journal in hand yet, it would not surprise me if it contained at least one ad for a medication to treat an obesity-related condition.

Once again, the juxtaposition of these two articles demonstrates the failure of our quick-fix, disease-care medical system to address any of the complex, chronic conditions increasingly affecting our children.  Obesity, like autism or cancer or any other condition with complex environmental-genomic roots, is crying out for an integrative, preventive solution.  Is it easy to solve?  Of course not.  Making lifestyle changes - including a focus on nutrition, fitness and stress, along with other environmental factors - is hard work.  Although necessary in severe circumstances to help children deal with the consequences of obesity and metabolic syndrome, medications are clearly not the best solution.  Yet this is what we have come to expect in our current, broken health care system.  Priorities must be shifted to incentivize wellness care and prevention.  We must find ways to support healthy choices, including access to integrative primary care for the populations that need it most.  As I've written before, health care disparities disproportionately affect children, especially with respect to conditions with environmental components.  It is time we recover common sense and support broad, community-oriented solutions to the obesity epidemic, as wisely proposed by Dr. Leslie Lytle in what is perhaps the most crucial read in the entire journal.  Dr. Lytle's editorial, "School-Based Interventions: Where Do We Go Next?," takes current research efforts to task for not looking at meaningful outcome measures and for not looking at a wide array of environmental factors that likely interact to contribute to obesity and poor overall health.  Yet she cautions, "These criticisms should not be viewed as a rationale for abandoning interventional efforts that focus on school approaches to help curb the obesity epidemic in children."  Instead, she offers this advice - which I think is a perfect place to conclude:

"Interventionists should resist the urge to change just 1 element of the school environment (such as removing vending machines or eliminating soft drinks from schools) and assume that it will be potent enough to affect weight-related outcomes. If we believe that environments are obesogenic, I would suggest that the gestalt of the environment might be more important than any singular aspect of the environment. For example, while the presence of sugar-sweetened beverages offered in vending machines is important, many other influences in schools also contribute to their obesogenic risk, including snack foods and beverages served on the à la carte lines, school policies and practices around foods used as fundraisers and incentives, and school-level reinforcement for being active, not only in physical education class but also throughout the school day. A reductionistic approach may not serve us well and may result in negative findings that belie the importance of the environment.^"

Comments

[jmalak]

I finished medical school almost 30 years ago. Did it prepare me to manage an 80 pound two-year old? Was the common sense needed to care for teens that max out the office scale (which tops out at 440 pounds) sufficiently inculcated?

No. The many, many hours spent memorizing enzyme pathways, the attachment of tendons in the foot, and starting IV's on very low birth weight infants didn't help at all.

One wonders what value the training that current medical school students are now receiving will have in 30 years.

[Dr. Larry Rosen]

Education is key. I don't think we are preparing pediatricians to look at integrative solutions to complex, chronic problems and even more importantly, giving them tools to help promote wellness and prevention.

[Taylor Walsh]

Where is the AAP on the question of establishing healthier school environments in the broader context Dr. Lytle recommends? Does AAP have any interface with K-12 institutions? It seems to me that creating healthier conditions will have to involve collaborations among several disciplines that are not presently connected. Including new ones like those created to advance green architecture.

There has been discussion on part of the integrative health community about establishing - in the context of US health reform programs - a demonstration project that would focus on a chronic condition in a large population where integrative interventions would be able to illustrate clear benefit. A project directed at obese children was one highly touted such effort. I am not sure where it stands.