the $60.9 Billion Dollar Question, part 3

Photo by M Clock

I saw this sign yesterday.  I had to take a second look, and try to gain some context.

Being Easter Sunday, I should have known what the sign meant. 

I honestly thought it was part of a new night club promotion, or possibly a mail order bride service for the small town we were in.

If things were only so easy when I was on the prowl...

Taking a second look at something often helps you to really get a grasp on the situation, the relationships involved, the more likely understanding how something really is important, or isn't.

Honestly, so was the case with me as far as the issue of meds and associated weight gain.

I didn't doubt that there was some relationship between meds and obesity, but I didn't really take the time to investigate whether some of these reported untoward effects were more closely associated with the disease process itself, or the patients and his / her behavior who 'happened' to have said disease, or truly as a pharmacological effect encouraged / caused weight gain.

Pushing me toward defining that relationship is the fact that alot of the meds reportedly at fault are used in obesity-associated conditions such as DM2, HTN, and psychological conditions such as Bipolar and Depression.

Research does seem to support the fact that a variety of meds do cause either weight gain or interfere with reasonable efforts at weight loss.  The effects are related to a differential specificity and sensitivity of binding to receptors involved with appetite regulation.

The fairly common meds that are on the hit list to varying degrees include:

Paxil
Depakote
Prozac
Remeron
Zyprexa
Prednisone
Thorazine
Amitriptylline
Allegra
Chlorpropramide
insulin
Atenolol
Many of the OC's

So, what to do? 

The Bottom Line:  At first, just being aware of the relationship is a good place to start.  The old risk vs benefit test is the next step, and then considering trying other meds that may be as efficacious, but without the weight side effect, is the next in line.
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I will finish this post with our last area to mention, and that is stress. 

"Stressful eating" is a well known psychological maladjustment , and can certainly cause weight gain and difficulty losing weight.  As you may have heard in the past, "It's not the Monster in your life...It's how you react to the monster" that determines how significant a stressful a situational trigger is in your life.  And, to some degree, as psychologists will agree, we should have some degree of control over our reactions, or even the situations that lead to increasing stress in the first place. A good place for counseling to sort that out, and help patients get a handle on environmental management.

To be fair, there is a component of heightened Cortisol secretion to increase appetite, as well as the repetitive behavioral reinforcement for the initial sensation a patient gets from being satiated (usually with CHO and high calorie, "comfort foods"). 

There are some tricks of the trade that seem common sense enough, but I do think that this maladaption to stress is certainly more emotional than rational, and often difficult to unravel willfully.

Bottom Line:  Articles abound on-line regarding Emotional eating, and this Web-MD article has some great tips to try and break the cycle, and the resultant weight issues.

So there it is.  A few of the more noted aspects of a patient's environment that may be manipulated in a positive sense to make a difference in weight, and weight maintenance.  Complicated stuff, and I think we've just scratched the surface of these influences over these last 3 posts.


So, that comment about those 'Words to your Mother" I made in the last post.  Obviously, no way a patient could have control over their en utero environment, but I'll make a few comments on that, as well as the Breast vs Bottle discussion as it relates to obesity next.