ADHD Drugs for Obese Kids

Got noisy neighbors? Do they keep you awake at night with their incisive banjo playing? Here’s an idea, try taking a drug that lists hearing loss as a potential side effect, that’ll fix your problem in a jiff. Sounds pretty ridiculous, right? Not to one doctor, who prescribed an ADHD drug to a teenage patient who couldn’t lose weight. Why? Because the ADHD drug Adderall comes with a risk of weight loss—the teenager didn't even have ADHD! Elizabeth Cohen of CNN reports:
Their pediatrician didn't know either, so she referred Lisa and Hank Veith to Dr. Fuad Ziai, a pediatric endocrinologist in nearby Oak Lawn, Illinois. In the summer before Alex entered sixth grade, Ziai prescribed Adderall, an amphetamine used to treat attention deficit and hyperactivity disorder, or ADHD. Alex didn't have ADHD, but one of the drug's common side effects is weight loss. And that's what happened to Alex.

"You should have seen everyone when I went back to school the next year. They didn't believe it was me," says Alex. "It was a great feeling to be a thin kid."

Ziai's approach to treating obesity -- he says he has prescribed Adderall for weight loss to about 800 children and teens -- raises an important ethical question: Has the obesity epidemic among children become so severe that it's OK to prescribe a drug not approved for weight loss when the drug can have serious, sometimes life-threatening side effects?

The Veiths say they'd give their son Adderall again. Now 17, Alex is a normal weight after being on the drug for more than four years -- from age 11 until about 18 months ago.
Now I’m no doctor, but treating patients with side effects seems crazy to me, especially when you consider all the issues surrounding the diagnosis of ADHD and the usage of ADHD drugs. Dr. Fuhrman discusses this in a previous post. From ADHD Over-Diagnosis and Treatment Options:
These medications with their reported adverse effects and potential dangers were simply unnecessary for so many children whom I have seen as patients. I have witnessed consistently positive results when these children followed my comprehensive program of nutritional excellence. The scientific studies lending support to a comprehensive nutritional approach to treating ADHD are ignored by physicians, and drugs are generally the only method offered.

Most new cases of ADHD are of the inattentive subtype. Inattentive ADHD are the children who have a short attention span, are easily distracted, and can appear to be a brain fog; they do not have hyperactivity. Research on the use of psychostimulants in these patients has shown high rate of nonresponders, and although medications showed a short-term decrease in symptoms, they did not improve grade point averages.2
Here’s a couple more posts on the topic:
1. Shatin D; Drinkard CR. Ambulatory use of psychotropics by employer-insured children and adolescents in a national managed care organization. Ambul Pediatr 2002;2(2):111-119.

2. McCormick LH. ADHD treatment and academic performance: A case series. J Family Practice 2003; 52(8):620-624. Cantwell DP, Baker L. Attention deficit disorder with and without hyperactivity; a review and comparison of matched groups. J Am Acad Child Adolesc Psychiatry 1992;31:432-438. Barkley RA, DuPaul GJ, McMurray MB. Attention deficit disorder with and without hyperactivity: clinical response to three dose levels of methylphendiate. Pediatrics 1991;87:519-531. Safer DJ. Major treatment consideration for attention hyperactivity disorder. Curr Probl Pediatr 1995;25:137-143.
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jlwarren - April 28, 2007 1:04 PM

Very nicely written, with many great points. You note that you are not a doctor, and are not familiar with prescribing a medication for its side effect profile. Since I am a doctor (family practice physician with a special focus in obesity management, and a personal interest in ADD/ADHD), I'd like to add a few comments. First of all, I'd like to quickly mention that using a medication "off-label" (using it for a medical benefit other than the originally approved use), is almost universal practice in some form in the medical community. I suspect that most, if not virtually all, physicians in active practice have used medication "off-label" in their practices. Medications that were originally used for blood pressure control, for example, are commonly used to help with migraine headaches, or chronic pain relief. Eventually after years of successful "off-label" use, some of these medications become formally approved for these purposes. Okay, that said, I must say that I was quite alarmed when I read that this Illinois physician was using Adderall for appetite control. Talk about killing an ant with a sledge hammer! The first line of treatment with a child/teen with overweight or obesity should ALWAYS be whole family education on healthy eating, lifestyle, and exercise. The entire family needs to be educated, and participate in the healthy lifestyle plan, whether they are overweight or not (skinny people have heart attacks too!) Ongoing support, with frequent followup is absolutely crucial for new habits to form and become routine. When and if it becomes clear that a child or teen, despite lifestyle interventions, would benefit from some type of medication, this child should be refered to someone who has formal Continuing Medical Education in obesity management, and is specialized in this field. Clearly the physician prescribing Adderall for appetite control has not had this training (or if he has, he has chosen to ignore the standard of care in obesity treatment for teens). Trained bariatric physicians do NOT use schedule II drugs like Adderall for appetite suppression - there are many effective, more mild options that are "schedule IV" (less addictive and less stimulating than schedule II). No one should be prescribing these either, unless they have special training in how to use these properly. And again, medication should never be prescribed without formal education in nutrition, exercise, and lifestyle management, and close, ongoing supervision and supportive behavioral therapy. IF, however, a child has ADHD AND an obesity problem, it would make perfect sense to use a medication such as Adderall that could "kill two birds with one stone". When a physician chooses the best medication for a given patient, we always should keep the side effect profile in mind. For example, two different medications for depression may have opposite side effects - one a stimulant, one a sedative. Of course we would look at the individual patient's needs and choose accordingly.

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