Boston.com THIS STORY HAS BEEN FORMATTED FOR EASY PRINTING
PERSPECTIVE

Fattened by pills

One of the biggest causes of obesity is seldom discussed.

As Americans struggle to keep New Year’s weight-loss resolutions, experts’ alarms about obesity ring in our heads. We obsess about portion control, flock to the gym, and can’t get enough of The Biggest Loser. As schools, congressional subcommittees, and even first lady Michelle Obama -- who’s made the issue a top priority -- take on the problem, the focus turns to the usual suspects: fast food, oversize servings, and sedentary lifestyle. For some battling weight problems, those factors are indeed critical. But overlooked in all this is one of the primary causes of America’s obesity epidemic: The elephant in the living room is the skyrocketing use of psychiatric drugs. Many of these, which are used to treat emotional problems including depression and anxiety, cause weight gain -- often of the rapid and massive sort -- as one of their “side effects,” that brilliant marketing term for what are simply negative effects of a drug.

It is striking that the weight of many Americans has ballooned just as the prescribing of psychiatric drugs has surged. The Obesity Society categorizes nearly two-thirds of adult Americans as overweight, the average weight of an adult having increased since 1960 by 25 pounds, and between 1996 and 2006 alone, prescriptions of psychiatric drugs for US adults increased 73 percent. The courageous Alaskan attorney James Gottstein in 2006 exposed drug company Eli Lilly’s concealment of its knowledge about the effects of its drug Zyprexa (approved to treat schizophrenia and bipolar disorder but also prescribed for other conditions) on weight gain, and subsequent reports have revealed such effects of a whole range of psychiatric drugs. But nearly all researchers and journalists who focus on obesity fail to mention the drug link.

It’s hard not to wonder why this happens. Could drug companies be that much more powerful than fast-food chains, or does it take the former much longer to come up with drugs lacking unwanted effects than for McDonald’s to produce healthier foods in smaller portions? Is it perhaps clinicians’ fear of not knowing what to do other than prescribe these drugs? If so, then it’s time to broaden their training so they know more about the wide array of other courses of action that can help many who suffer from emotional problems, such as exercise, meditation, changes in vitamin/mineral intake, participating in the arts, volunteer work, and developing or maintaining close friendships. Whatever the reasons, the result is that not enough people know that many of these emotionally troubled patients now will have added burdens.

What’s worse is that the connection between psychiatric drugs and obesity involves children, too. Over the past two decades the number of obese adolescents has tripled, while the 10 years after 1996 saw prescriptions of psychiatric drugs for US children rise 50 percent. And a new federal study shows that poor children are more likely than other kids to be put on drugs marketed as antipsychotics, one of the greatest culprits for causing major weight gain as well as lifelong metabolic problems. Add the humiliation to which kids subject overweight peers, and the potential psychological damage is frightening.

Another disturbing link could be on the way. The fifth edition of the major psychiatric diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), is expected to be released in 2013. One proposal under consideration: listing obesity as a mental illness. That would be a mistake, since obesity can be caused by metabolic and other physical problems that are often undiagnosed. And because obesity can also result from psychiatric drugs, calling it a mental illness would create a vicious cycle: Someone is troubled, put them on drugs, they become obese, therefore diagnose them as mentally ill, give them more drugs.

Overall, much must be done. The first lady should talk about the obesity/drugs link. The Food and Drug Administration must ride herd -- hard -- on drug companies that conceal that connection. Every physician should alert patients to this potential effect and explore other non-drug ways to treat emotional problems. Publishers and editors should insist that this link be addressed in stories about obesity. The American Psychiatric Association should refuse to categorize it as a mental illness in its DSM-V. And every citizen should stop the knee-jerk blaming of people with weight problems for allegedly lacking self-control.

Paula J. Caplan, a clinical and research psychologist at Harvard University, is the author of They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal. Send comments to magazine@globe.com.  

Copyright The New York Times Company