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Is Childhood Obesity Epidemic a Myth?

THE childhood obesity epidemic sweeping the country is a myth, controversial research has claimed.

child obesity

A study by the Democracy Institute, which was published yesterday, argues that there is a dearth of evidence to support claims the UK faces an epidemic of obese and overweight children.

And the researchers said there was little evidence to suggest obesity is caused by children eating too much or the wrong sorts of foods.

Academics Dr Patrick Basham and Dr John Luik also said there was no evidence of a link between obesity and food advertising.

The comments contradict official government and Assembly government policies designed to improve children’s health and reduce the number of obese and overweight children.

And they counter comments from Welsh dieticians who told the Western Mail they are treating obese two-year-olds fed a diet of their favourite foods.

Dr Luik, a senior fellow at the Democracy Institute, said: “There are substantial and well-evidenced doubts as to whether childhood obesity is a significant problem, whether in terms of numbers, risk to health either in childhood or adulthood, or in terms of reduced life expectancy.

“It’s tremendous irony that the Government’s claims about childhood obesity are not supported by the facts produced by the very same government.”

The pair’s research – Fat Kids? The Obesity Epidemic Myth – also pours doubts on links between obesity and diabetes, claiming that type 2 diabetes, which is generally accepted asadisease which affects overweight people, is genetic in origin.

Dr Basham, director of the Democracy Institute, said: “There simply is not a body of clinical evidence that shows that overweight and obese children have notably poorer health outcomes than other children.”

Official figures reveal that Wales has one of the highest rates of childhood obesity in the world with 22% of 13-year-old boys and 16% of girls classed as either overweight or obese.

And there is evidence children are already suffering the long-term health consequences. At least 30 children in Wales have already been diagnosed with type 2 diabetes, a condition normally associated with the overweight over-40s.

Dr Tony Jewell, Wales’ chief medical officer, said: “There is a general consensus from health professionals and academics across the world, that having a healthy lifestyle and diet have a positive impact on people’s health and well-being. Clearly, it is best to encourage people from a young age to develop good lifestyle habits that they can take into adulthood.

“Eating a healthy, balanced diet is only one factor in staying fit and healthy. It is also important to ensure children have more opportunities to undertake regular physical activity. That is why we have invested in, among other things, free swimming during school holidays. It is about making it easier for people to make healthy choices.”

Andy Misell, policy and public affairs manager for Diabetes UK Cymru, said: “This report highlights some important issues, but some of the conclusions are wide of the mark.

“It is very important that we discuss what sort of interventions are really likely to bring about long-term lifestyle changes and improved health, but simply denying the existence of the problem is not an option.

“Where work has been done in Wales to measure children’s body mass index, the clear indication is that levels of overweight and obesity are rising sharply.

“The researchers have also confused thing by focusing on the detrimental effects of dieting.

“Most people in the field of diabetes are agreed that short-term weight loss diets are less effective than real changes in eating and exercise patterns that people are able to sustain in the long term.

“Eating a healthy mix of foods, and balancing food intake with the amount of physical activity we do is the key to diabetes prevention and diabetes management.”

US Obesity Could Cost $147-Billion a Year

us obesity cost

America’s expanding waistlines have nearly doubled medical spending on obesity-related conditions which could reach $147 billion a year, a study said Monday.As Congress debated President Barack Obama’s major push to overhaul US healthcare, researchers warned that the prevalence of obesity — which now affects over 25 percent of Americans, up from 18.3 percent in 1998 — and associated medical problems, are behind ballooning overall medical spending.US obesity rates grew 37 percent between 1998 and 2006, pushing obesity-related spending up another $40 billion a year, according to the study published by Health Affairs.Obesity currently accounts for 9.1 percent of all medical spending, up from 6.5 percent in 1998.”The medical costs attributable to obesity are almost entirely a result of costs generated from treating the diseases that obesity promotes,” said lead author Eric Finkelstein, who heads RTI International’s Public Health Economic Program.”Obesity will continue to impose a significant burden on the health-care system as long as obesity prevalence remains high.”Per capita medical spending for obese individuals was $1,429 more each year than for those of normal weight — a whopping 42 percent more. Finkelstein and researchers from the US Centers for Disease Control and Prevention (CDC) and the Agency for Health-care Research and Quality based their analysis on data from 1998 and 2006 medical and health spending surveys, and defined obesity as body mass index above 30.The bulk of obesity spending, the researchers said, is not devoted to treatments such as bariatric surgery, but rather to treating obesity-linked diseases. Excess weight, they noted, is the best predictor of developing diabetes, which costs $191 billion each year.”If not for obesity, these costs would be much lower, as would costs for other conditions caused by excess weight,” the authors said. “The connection between rising rates of obesity and rising medical spending is undeniable.”

Poor Diets, No Exercise – Obesity: 90 per Cent of the Population Could Be Overweight by 2050.

The levels of obesity are increasing throughout the world particularly in North America and Europe. England has some of the worst figures in Europe and also some of the worst trends in acceleration of obesity. In the majority of European countries numbers have increased between 10 and 40 per cent over the last 10 years, but in England this has more than doubled.

Obesity in UK

Two-thirds of British adults are now either overweight or obese and, based on current trends, this figure could rise to nine out of 10 by 2050.

Obesity occurs when a person puts on weight to a point where it can seriously endanger their health. Some people are genetically more likely to put on weight but the basic cause is consuming more calories from food and drink than are used in everyday activity.

Rising levels of obesity are due to changes in eating habits and less active lifestyles. The reasons for both of these are complex. They include family patterns of eating and cooking and levels of physical activity which are all determined by level of knowledge, attitude and behaviour.

Cultural and psychological issues also play a major role as do poverty, access to affordable local facilities for healthy food and exercise and, of course, busy lifestyles. This has been made worse by the ease with which we can get cheap, high-calorie fastfoods and the physically-demanding lifestyles that we were once used to have now been replaced by more sedentary jobs and leisure activities.

There are several groups who are at increased risk of obesity – those from poorer backgrounds, people with physical or learning disabilities and people who recently stop smoking. Women, especially women from some ethnic groups such as Black Caribbean and Pakistani women, are more at risk of becoming obese than the rest of the population.

In Birmingham there is a large South Asian population who are at additional risk of developing conditions such as diabetes and heart disease because the weight gained in this group tends to be around the tummy region.

Other high-risk groups include children where one or both parents are obese. The problem facing children and young adults is a big one but it has the potential to be much worse in the future. At the moment at least 16 per cent of children aged two to ten in the Midlands are classed as obese and we have, at about 40 per cent, the highest proportion of women aged 16-24 years who are either overweight or obese. If current trends continue then 20 per cent of all boys and 33 per cent of all girls will be obese by 2020.

Poor diet and a lack of physical activity are mainly to blame. Children tend to watch more TV, play video games and spend time on line rather than pursuing more physical activities as was the case 30 years ago. One real concern is that poor dietary habits and physical inactivity in childhood are often carried through to adulthood and those who are overweight or obese children tend to become overweight and obese adults.

Currently the definition of obesity is based on what is known as the Body Mass Index (BMI). This is calculated by dividing the weight in kilograms by the height in metres squared. A BMI of more than 30 is classed as obese. However this is a rather crude method in that it does not take into consideration the percentage body fat and muscle, gender, ethnic origin or the distribution of body fat. For example, an athlete may have a body mass index of 30 and therefore technically would be classed as obese. Clearly this is incorrect and it is the amount and distribution of fat which is more important.

Fat distribution, particularly around the abdomen, would make an individual more prone to developing not only diabetes but also high blood pressure and problems with their cholesterol.

Obesity in the UK is now accepted as a major cause of social, psychological and medical problems. Obese people are twice as likely to die of heart disease. Obesity will reduce an individual’s life by an average nine years and is responsible for at least 30,000 premature deaths.

More concerning is the rise in Type 2 diabetes which has even been diagnosed in children. This was a condition mainly confined to older and elderly people but it is becoming more common at a younger age. Obese women, for example, are 27 times more likely to develop diabetes than normal weight woman.

The increased number of people with diabetes is associated with an increase in heart attacks and strokes.

The cost of treating obesity is huge and set to rise further with massive implications for the NHS. Treating obesity and its related problems nationally costs the NHS at least pounds 500 million per year and the wider cost to the economy could be an additional pounds 2-3 billion per year. It has been estimated that each year 18 million days of absence through sickness are related to obesity.

Obesity has been highlighted as a national priority for major health policies with several government initiatives addressing this issue.

Recently Health Secretary Alan Johnson and School Secretary Ed Balls published a longterm strategy aimed at tackling obesity. A pounds 372 million plan aimed at schools, the NHS, employers, town planners and individuals has been suggested and this includes pounds 30 million for the creation of “healthy towns to promote physical activity”.

Although the causes of obesity tend to be simple, the solutions are far more complex.

Clearly the major drive to tackle the problem of obesity has to be around improving dietary intake and also increasing levels of physical activity. Simple measures an individual can take, such as avoiding snacking and walking on a daily basis, can help reduce obesity levels.

Indeed many individuals need to make only modest changes in their lifestyle in order to get their weight down and keep it down.

Unfortunately, a common desire is to lose weight quickly so that the impact of the changes can be seen quickly. However, rapid weight loss is often associated with drastic measures and bad diets which are extremely difficult to maintain in the long term. Therefore when these individuals go back to their normal lifestyle the weight is rapidly regained and often with a little more. This is very disheartening and often results in people giving up on trying to lose weight.

In order to shed the pounds and maintain weight loss, healthy eating rather than fad diets, and a moderate increase in physical activity, such as an hour’s brisk walk on a daily basis, would help most people. An average weight loss of up to 1lb per week is good and this can be achieved by making modest changes to both diet and physical activity levels and can be maintained in the long term.

It needs to be remembered that weight gain usually occurs over many years and therefore to try to achieve weight loss over a short period of time and maintain this weight loss is generally unrealistic and, when the weight is regained, extremely disheartening.

Small changes in eating habits can have a major impact on your weight over time. For example, eating an extra 100 calories a day more than you require, which is equivalent to a slice of bread, on a daily basis in a year will result in weight gain of about 10 lbs. If you multiply this by five years then, over a fiveyear period just with one extra slice of bread per day, you could potentially gain 50 lbs in weight.

An increase in physical activity of walking briskly for about one hour a day is equivalent in a year to burning off about one stone in weight. Currently we walk about a mile a day less than we did 20 to 30 years ago.

For those with higher levels of obesity and who have developed problems such as diabetes and heart disease, there are tablets which can help. One such tablet can reduce the amount of fat that is absorbed from the food that you eat.

However, it reduces the absorption of fat by only about 30 per cent and therefore to achieve good results with this you need to be on a low-fat diet.

There are other tablets available which can help you if you feel hungry all the time. These drugs work by suppressing hunger.

However, all these medications are effective only if used as part of general lifestyle changes, which include healthy eating and an increase in physical activity levels. Taken on their own they are unlikely to have any significant impact on weight.

For those who are classed as morbidly obese, that is those who weigh twice as much as their recommended body weight for their height, there is the more drastic measure of surgery. Before this is considered the benefits of surgery will be weighed against the risks.

This is not a procedure which is entered into lightly and, once again, surgery generally is only successful in those who have made some lifestyle changes before their operation.

There are two types of surgery available. The first is a gastric band operation which places a plastic band around the stomach, causing patients to feel full sooner and limiting the amount that can be eaten.

A second operation is more permanent and involves essentially re-plumbing the stomach to prevent it from digesting food that has been eaten.

This is a permanent procedure and once again is considered for those where the risk of obesity outweighs the risks of the operation.

Obesity is a major problem already. If we do nothing now then the future for us and our children looks bleak.

Three People Die in Scotland Every Week Because of Obesity

RECORD numbers of Scots are eating themselves to death as the country’s obesity epidemic spirals out of control. Shocking figures obtained by the Scottish Daily Mail show three people a week die as a result of being dangerously overweight.

The number has rocketed by 70 per cent since devolution, according to disturbing statistics compiled by the General Register Office.

Last night experts called for radical action to curb the level of obesity deaths, which lead by around 14 per cent between 2004 and 2005.

Dr Colin Waine, of the National Obesity Forum, said: We are not sitting on an obesity time-bombthe time-bomb has gone off and the consequences are going to be devastating. The rising tide of Scots falling prey to obesity shows that lifestyle and diet are getting worse despite successive multi-million pound healthy eating campaigns.

The latest disclosures also prompted calls for obese children to be taken into care if their parents fail to encourage them to eat more healthily.

Obesity was either listed as the underlying cause of death or mentioned on the death certificate in 158 cases in 2005, the latest figures available just over three per week compared with 139 in 2004a rise of nearly 14 per cent and up nearly 74 per cent from 91 deaths in 1999.

Eighty-five of the 2005 cases were male, showing the problem is greater among men, according to the General Register Office for Scotland.

The figures, described as concerning by ministers, bring the obesity death toll north of the Border to around 900 between 1999 and 2005.

The surge in the number of times obesity is mentioned as a significant contributing factor to a death shows doctors increasingly believe the condition is responsible for a growing number of deaths.

Obesity is believed to cost NHS Scotland [pounds sterling]500million a year and by 2020 it is estimated 25 per cent of the NHS budget across the UK will be spent on treating diabetes and obesity-related conditions if present trends continue.

The condition poses a major risk for chronic diseases including type 2diabetes, cardiovascular disease, hypertension, stroke and some cancers.

North of the Border, 65 per cent of men and 60 per cent of women are overweight and more than a fifth are obese while of Scottish children born in 2001, more than 20 per cent were overweight by the time they reached the age of three-and-a-half.

The National Obesity Forum described the increase in obesity deaths as deeply worrying and called for obese children to be taken into care in extreme cases.

Last year, the Mail told the story of Scottish teenager Emma McAuley who had to have life-saving surgery after her weight rose to 34 stone at the age of only16.

Dr Waine said: Solutions could include legislation to force manufacturers to limit salt content and so on rather than the current voluntary arrangements.

But in the most extreme cases, we have to consider whether obese children ought to be taken into care if their parents ignore health advice for the sake of the youngsters survival. He added: Obesity is a significant risk factor for developing a whole range of conditions, not just heart disease and diabetes.

It does not seem that ministers have curbed the problem despite the investment and that is desperately worrying. Professor Annie Anderson, of Dundee University’s Center for Public Health Nutrition Research, said: Obesity is notjust a genetic problem or a cultural problem or a clinical problem or a psychological problem it is all of these things and that needs to be recognized as we try to deal with a global issue which is posing a major health risk. Research by the University of Edinburgh earlier this year showed the number of people diagnosed with type 2 diabetes the preventable form of the disease will soar by 60 per cent within ten years. The disease is thought to reduce a patients life expectancy by at least eight years and can also lead to blindness, heart attacks, strokes, kidney failure and even amputation.

Diabetes and the problems associated with it already costs Scotlands health service nearly [pounds sterling]1billion a year.

North of the Border, ministers efforts to tackle the obesity epidemic have so far ended in failure despite massive investment.

It emerged in May that Scotlands fat star had been axed after an [pounds sterling]80millioncampaign to tackle the obesity crisis failed to make an impact, seen by some critics as a tacit admission of defeat.

Gillian Kynoch had been appointed as the Scottish Executives food and health-coordinator to promote healthy eating.

Health Secretary Nicola Sturgeon said: It is concerning that the number of deaths associated with obesity has risen.

We recognise that obesity is an increasing problem and poses a very serious threat to health. This is why we are making tackling the problem, particularlyearly in life, a high priority.

Move over Viagra

Ever since sildenafil (Viagra, Pfizer) hit the market in 1998 as the first oral medication for erectile dysfunction (ED), people have been wondering, “What’s next?”

New data presented at a recent meeting of the European Association of Urology demonstrated strong results for two potential new treatments. Bayer AG presented promising data for its investigational phosphodiesterase (PDES) inhibitor, vardenafil, now in phase III studies. In an analysis of 580 patients, vardenafil improved erections in up to 80% of men, as well as increasing the ability to complete sexual intercourse with ejaculation.

In a separate study, vardenafil was found to be highly selective at targeting the PDE5 enzyme. PDE5 selectivity is of potential clinical importance because phosphodiesterases are widely distributed throughout the body, with PDE3, for example, playing an important role in cardiac contractility.

Lilly/ICOS unveiled compelling results for its next-generation PDE5 inhibitor, IC351 (Cialis). In a placebo-controlled phase III study in men with difficult-to-treat diabetes-related ED, up to 64% of men reported improved erections, compared with 25% for placebo.

In preclinical investigations, Cialis demonstrated an even higher affinity for the PDE enzyme than sildenafil did. Researchers saw no significant changes in clinical laboratory values, ECGs, or blood pressure in the phase III trial.

Black Men and the New Sex Pills

BROTHERS might not want to admit it right away, but Sisters and the doctors who know about these things will tell you in a minute that, despite the dominant myths about Black male sexuality, Black men–like all men–can experience sexual problems brought on by life’s typical stresses, relationship tensions, medical conditions or just plain old aging.

Now, thanks in part to a media blitz on the new sex pills, experts are saying they have seen a growing admission among Black men that they can have a sexual problem, and a growing use of a pill to resolve that problem. The result is a high level of satisfaction among those Brothers who have used the pills and enjoyed sex, and a marked improvement in the health of their relationships.

“No question about it,” notes Atlanta-based urologist Dr. James Bennett, who has seen an increase in Black men who are taking sex pills. “Usually, when African-American men come in, it’s at the insistence of their spouse,” says Dr. Bennett, who also hosts “Radio House Call” in Atlanta. “Even the radio show callers tell me how the drug has changed their lifestyle.”

Once thought of as private, sexual performance problems these days are being discussed everywhere, blaring in headlines, in news accounts and ads for new sex pills Viagra and Levitra with their sports celebrity pitchmen, to be followed soon by Cialis, which has been approved for U.S. sales. And a fourth drug, Uprima, is on the pharmaceutical horizon awaiting approval.

Although there are differences among the pills currently on the U.S. market–which cost about $10 apiece–they basically take the same approach, blocking certain enzymes to allow an erection. They merely allow nature to take its course with sexual stimulation.

Clinical trials conducted on behalf of the pharmaceutical companies have shown the pills work for Black men. Viagra showed an 81 percent satisfaction rate among Blacks, and Levitra showed Blacks, Hispanics and Whites at 80 percent. The pills that are out or are coming out try to distinguish themselves in going after the huge segment of the potential market that has been left out. The main differences with these pills are in their relative effective periods–usually about 4 to 5 hours, although newcomer Cialis boasts effectiveness up to 36 hours, giving rise to its French nickname, “Le Weekender.” There also are relative differences in the amount of time it might take for the pills to kick in–from 30 to 60 minutes–and differences with side effects that can include headaches, backaches or facial flushing.

Surprisingly, apart from efficacy studies that show satisfaction levels, there have been no research studies on the impact of the new sex pills on Black sexuality or on Black health. It is still early, but experts in this area say there is need for just that kind of research.

It has been estimated that up to 30 million men in this country have at least some episode of impotency at some point, with a number of men facing chronic occurrences after they pass age 60. Reportedly as many as 50 percent of men over age 40 can be affected to some extent, and even much younger men can have episodes–sometimes health-related.

While there are no hard figures, there is reason to believe Black men–especially Black men over age 40–may face increased risk. Apart from the emotional causes, like problems in a relationship or everyday stress, there are certain medical conditions that are commonly associated with male sexual performance. Diabetes, coronary disease, hypertension and certain cancers all can give rise to sexual performance problems, and these are medical problems that affect Blacks to a higher extent than the general population.

That is why it is critical for Black men to address any sexual problem right away. It just might be an early warning sign of more serious medical problems, according to Dr. Bennett, who also served as lead investigator for American clinical trials on the efficacy of Levitra. “That’s the message we need to send out to our community. Regardless of your age, whether you’re in your late teens or twenties or thirties, if you have any signs of erection problems,” he advises, “that is a sign that you could have some underlying cardiovascular problems. And you need to get checked out. It’s nothing to get embarrassed about, but it may save your life down the road from a stroke or a heart attack or even going into renal failure.”

A doctor will also advise on potential side effects, how certain products might affect Black men with special health concerns, and whether a man’s particular physical condition poses a risk. Your medical history and prescriptions are critical in making this determination, because there is the very real possibility that certain medical conditions and medications for those conditions—like hypertension medication–can be adversely affected by use of sex pills. No one who is on nitrates–prescribed for certain heart conditions–should use these medications. Similarly, a recent heart attack or heart irregularity would likely bar any use of these drugs for a certain period of time. Diabetes and prostate cancer might be factors in determining not to use certain medication.

Still other men might have simpler causes of sexual problems that can be addressed without drugs. “So I think it is a matter of making sure you have the right assessment to determine whether you need medication,” suggests Dr. David Satcher, director of the National Center for Primary Care at the Morehouse School of Medicine. “There are many men who will not need medication in order to deal with their erectile dysfunction,” says Satcher, the former U.S. Surgeon General, who notes that physical activity or counseling just might be enough.

Everyone agrees that women partners should be involved in any effective counseling, improving the overall satisfaction in the relationship. “It says that my partner cares enough about me to go in to the doctor to talk about something so that our lives can be better,” notes Dr. Gail Wyatt, sex therapist and professor of psychiatry and behavioral science at UCLA. “No matter what the outcome is, we’re going to get better because we’re in this together,” she says.

Despite the growing acceptance of medical treatment among Black men, dealing with it so openly still is hard. “Men do hide from this and they will ask for the pills through their wives or they will ask someone else about the medication,” notes Dr. James Wyatt, an obstetrician/gynecologist and sex therapist. “They don’t like to present themselves at a physician’s office saying, ‘I am not a stud, I can’t perform,’” says Dr. Wyatt who, with his wife Dr. Gall Wyatt, co-authored the book No More Clueless Sex: Ten Secrets to a Sex Life that Works for Both of You. “It’s embarrassing and it’s self-deflating for them to do that.”

Looking ahead, experts say, Black men will have to face the reality of life, rejecting the myth of Black male sexuality. In the end, for couples who have a healthy attitude about their sexuality and their relationship and where the man can use a sex pill, the relationship benefits. “It certainly can increase desire because if you’re able to perform, you’re going to want to try again,” Dr. Gall Wyatt says. “If you’re not, then you’re going to want to avoid sex, and avoid intimacy.”

SOME BLACK WOMEN ASK: WHERE’S OUR MIRACLE PILL?

An informal, unscientific survey in the Black community suggests that many Sisters applaud high-profile sex pills such as Viagra and Levitra and say that these drugs are saving marriages and, in some cases, lives. “We know that if the sex is not good in a relationship, it can affect that relationship in various ways,” says Charlotte, N.C., psychologist Elaine Stevens, founder and president of the relationship consulting company, Matters of the Heart, Inc. “The positive thing that has happened in Black relationships is that a lot of couples, where the partner was once impotent, are now able to have an enjoyable sexual relationship, so their marriage is back.”

Los Angeles-area sex therapist Rosie Milligan, author of Satisfying the Black Man Sexually, Made Simple, agrees, adding that these sex drugs also save lives. “Black men [suffer] higher fates of high blond pressure and diabetes, and the prescribed medications for these ailments may impair their ability to perform,” Milligan says. “Before [the new sex pills] came along, many men would rather risk their lives by not taking their blood pressure medicine.”

But if it takes two to tango, many Sisters have one burning question:

Where’s our miracle drug to combat sexual dysfunction?

“Viagra enables men to have more confidence in themselves and to perform, and that’s a blessing,” says Nr.w Ynrk-area psychologist Vera S. Paster, author of Staying Married.” A Guide for African American Couples. “But the real problem is that there should be a ‘Viagra’ for women.”

To date, there still isn’t an FDA-approved impotence medication for women on the market. Same doctors, however, are experimenting with low doses of Viagra and Levitra to treat female patients; and others, like Shaft Goldman, a Chicago-area gynecologist, told a reporter that she considers testosterone therapy for women who say they suffer from low libidos.

Alicia Simon, assistant professor of sociology at Clark-Atlanta University, says women’s sexual issues are gradually becoming the focus of research.

“The [impotency drug] revolution is a good thing, because once they do address the male reproductive issues, then our issues will gel addressed as well, so eventually we will all benefit.”

Perhaps the greatest benefit is the promise of re-igniting the passion in Black relationships, says Detroit-area psychologist and attorney Paris M. Firmer Williams, author of Marital Secrets: Dating, Lies, Communication and Sex. Dr. Finner-Williams believes that couples who become intimate at least once every 72 hours are more likely to succeed.

“Sex is very important in keeping spirituality between the couple,” she says. “Despite all of the issues and concerns that are surrounding us, if we are able to make love and appreciate each other’s spirits, we can once again reassure ourselves that there is a compromise. We can make it. We can resolve whatever our issues are. And we are not going to let those issues separate us.”

DIRECT-TO-CONSUMER DRUG ADVERTISING

More people are using prescription drugs at a younger age, for more conditions, and for longer periods of time. An aging population and more complicated medical conditions fuel an increase in drug expenditures. Between 1995 and 1998, drug expenditures in the United States more than doubled. In 2001, Americans paid $208 billion for prescription drugs, double the amount that was spent in 1996. Some 20 percent of employers’ health care dollars are spent on drugs. Medicare beneficiaries spent an average of $813 in out-of-pocket expenditures on prescription drugs in 2000 and $1,051 in 2002. An estimated 45 percent of those 85 years or older have no prescription drug coverage. The increasing cost of drug usage is painfully evident to consumers, many of whom are forced to choose between medicine and food because many patients without prescription drug coverage cannot afford to spend several hundred dollars each month on needed drugs. The inability of many senior citizens to pay for needed drugs has entered the political arena as a campaign issue. Both political parties have drafted bills to provide such coverage. Congress has also considered a proposal that would make it easier for Americans to import prescription drugs from Canada, where drug prices are lower than in the United States. The pharmaceutical industry continues to spend massive amounts of money in an attempt to derail or limit such legislation.

To further stimulate demand for expensive drugs, pharmaceutical companies spend astronomical amounts on “direct-to-consumer” advertising. Spending on such advertising rose to $2.8 billion in 2001, up 35 percent from $1.8 billion in 1999. Drug advertisements are a powerful voice in the American health care scene. The nightly network news appears to be largely funded by advertising for drugs for the treatment of acid reflux (Nexium and Prevacid), osteoarthritis (Celebrex and Vioxx), allergies (Clarinex), osteoporosis (Fosamax), high cholesterol (Zocor and Lipitor), anemia accompanying chemotherapy (Procrit), bladder control (Detril), and high blood pressure and stroke (Altace). The number of prescriptions for the 50 top drugs most heavily advertised to patients grew at a rate six times that of other drugs.

Of some concern is the fact that two-thirds of the new drugs approved from 1989 to 2000 were modified versions of existing drugs that the FDA has determined do not provide significant benefits over those already on the market. Some companies seem more interested in “gaming” the system to extend their exclusive marketing rights on existing drugs by strategies such as slightly altering the formula just as the drug’s patent is expiring. Intense marketing by the pharmaceutical companies has promoted the sale of reformulated drugs such as Nexium (a modification of Prilosec), Clarinex (a modification of Claritin), and Sarafem (a modification of Prozac). In some cases, brand-name drug manufacturers have entered into collusive agreements that provide payments to generic drug manufacturers to keep generic equivalents off the market. As the pharmaceutical companies transform themselves into marketing companies, more expensive drugs with no clear advantage to patients are promoted over existing cheaper alternatives.

It is not surprising that the pharmaceutical industry, whose profit margins surpass those of almost every other economic sector in terms of return on revenue, assets, and shareholders’ equity, is opposed to any form of price controls. The high price of drugs in the United States is subsidizing sales abroad because most other countries have imposed price or profit controls on the sale of drugs. Many residents in border states such as Maine, Vermont, and California routinely travel to Canada and Mexico to purchase drugs. To protect themselves, consumers should question whether they

SHOULD CHILDREN BE GIVEN PROZAC

It Can Stunt Growth, Damage Young Brains and Even Trigger Suicide. Yet Now This Most Controversial Antidepressant Is about to Be Prescribed to Youngsters of Just Eight . . .

prozac and children

JAMES was ten when he was first put on the antidepressant Prozac. His mother was an invalid, and after his father left home, the pressure of caring for his mother had become overwhelming.

Sometimes James would sit and stare into the middle-distance, not responding to anything; other times he’d lock himself in his room. He cried a lot.

Increasingly, he refused to go out because he was being bullied at school.

‘He started showing signs of depression,’ says Jude Sellen, a children and adolescent mental health consultant at the charity Young Minds, who was involved with his case.

‘His situation was very difficult and he badly needed psychological help.’

But there was an 18-month wait for therapy, so what he got instead was long-term treatment with an antidepressant.

Two years later he is still on Prozac – even though it causes him stomach problems, including diarrhoea and painful cramps, and makes him feel ‘funny’.

He also suffers from painful headaches.

He wants to stop taking the medication, but when he does, he becomes violent – a potential-side-effect of withdrawal from drugs such as Prozac – and his mother insists that he goes back on the pills.

James is now being seen by a psychologist and his medication is being reduced. But as Sellen points out, his case shows ‘how important it is to monitor patients on the drug carefully – and only use it short-term’.

The tragedy is that stories such as James’s could become increasingly common. Last week, in a controversial move, the European Medicines Agency announced that depressed children as young as eight could be given Prozac.

This is one of a class of drugs known as selective serotonin reuptake inhibitor, or SSRIs – and in America, children as young as three are already being prescribed them.

These drugs have already been linked with a raised risk of suicide and patients becoming dependent on them. But some experts are now concerned about giving these drugs to younger children because almost nothing is known about how these drugs might affect their growing brains.

‘This is ignorance in the broadest sense of the term,’ said Dr Glen R.

Elliott, a child psychiatrist at the University of California at San Francisco. ‘We don’t know if this is a good idea or not.’ The drugs might also stunt growth.

One trial, reported two years ago, found that children given Prozac between the ages of eight and 17 were, on average, 1cm shorter and 1.1kg lighter than those on a placebo.

In fact, we don’t really know exactly how SSRIs work to treat depression in adults or children – we believe they increase the amount of the ‘ feelgood’ chemical serotonin in the brain, but evidence for this theory is surprisingly thin on the ground.

The latest research suggests that they work by encouraging the growth of new brain cells. But whether this is good for a young brain that is already growing fast is also unknown.

What is known is that childhood depression is a growing problem in the UK.

About 1 per cent of children aged five to 11 and 3 per cent of adolescents aged 11 to 18 are thought to suffer from depression in any one year – with 80,000 five to 16-yearolds suffering from serious depression.

Some experts believe that the increase is partly to do with children’s high expectations – they expect life to be rosier than it is.

Others suggest that children are being exposed to increasingly stressful and emotional experiences, such as sex.

Whatever the cause, the difficulty for parents is knowing if their child is depressed or just feeling a bit down.

And giving medication to children who are not seriously depressed is a cause for concern.

The new guidelines from the European Medicines Agency recommend that the first line of treatment for moderate to severe depression should be psychological therapy.

Only after four to six sessions can fluoxetine – the name of the chemical in Prozac – be prescribed, and even then it should be combined with therapy.

HOWEVER, there is a drastic shortage of therapists as the case of James shows. He has been on Prozac for two years without having any counselling.

Provision of psychological services across Britain is notoriously patchy.

A recent report estimated that 10,000 more therapists were needed to provide effective treatment for depression in all age groups. As a result, the problem of medication without counselling is increasing.

David Cottrell, Professor of Child and Adolescent Psychiatry at the University of Leeds, says: ‘Far more prescriptions are written for children than there ought to be, and many GPs are not so good at monitoring the effects.’ But there is a more deep-rooted problem.

In 2003, the Medicines and Health Products Regulatory Authority advised that most SSRIs were not suitable for children, and that only fluoxetine should be given to them.

However, research by the Mail has found that doctors are still prescribing the other SSRIs.

In other words, while we worry about children being given Prozac, many of them might be receiving other antidepressants that the health authorities have said are not suitable for children.

In a written response to a Parliamentary question by Liberal Democrat MP Paul Burstow, the Department of Health revealed that four SSRIs which the drug regulator has said should not be used are still being widely prescribed.

One of these is Venlafaxine (Effexor), which, not only is unlikely to produce any ‘clinically important improvement’ but, astonishingly, has a rate of ‘suicide-related events’ 14 times greater than a placebo, according to a major review published in The Lancet in 2004.

THIS study looked at all the evidence for the safety and effectiveness of the five SSRIs most commonly used to treat children. And its conclusion about one of them, Citalopram (Cipramil, Celexa), was equally worrying: ‘It is unlikely to produce a clinically important reduction in depressive symptoms’ and doubles the risk of suicide.

One of the authors of this study was Professor Cottrell, who at the time explained that the review was unusually reliable because it combined published with unpublished trials. The conclusion of The Lancet review was that only Prozac was suitable, while the others – including Paroxetine (Seroxat) and Sertraline (Zoloft) should be avoided.

The intention of the trial was to provide information to guide doctors.

But, clearly, GPs did not heed the alarm bells – for as the Parliamentary figures reveal, only around 30 per cent of antidepressant prescriptions written for children under 18 in 2004 were for Prozac.

Another 35 per cent were for one or other of the four ‘banned’ drugs (the cost to the NHS for Prozac was [pounds sterling]407,107, and for the other SSRIs, [pounds sterling]1.6 million). The remainder of the prescriptions were for other forms of antidepressants.

‘Doctors do seem to be flouting the guidelines,’ says Professor Cottrell.

‘Doctors are allowed to prescribe drugs that don’t have a licence for that use, and while there will be a small number of cases where these drugs could be relevant – such as anxiety or obsessive compulsive behaviour a large percentage of these prescriptions should not have been written.’ Dr Jim Kennedy, prescribing spokesman for the Royal College of General Practitioners, questions whether doctors are prescribing medication without therapy.

‘But these figures do raise the question: are there any hotspots where more are being prescribed than should be?’ he says.

‘I think we should be looking in detail at how doctors are prescribing, and if we find a problem, we should re-educate GPs in those areas.’ The Department of Health, while noting the guidelines state that antidepressants should ‘be used rarely in the five to 11 age group’, says that ‘it is for clinicians to decide which of these drugs, if any, to prescribe to their patients.

‘It is important to note that some drugs which may be classified as antidepressants are used for other disorders such as nocturnal enuresis [bedwetting], anxiety, obsessive compulsive disorder and phobic states.’ Most clinicians agree that when faced with the pain of a child who is severely depressed, the benefits associated with antidepressants outweigh the risks.

‘Most experts recognise that psychological support is very important and should be tried first, but there are cases where a drug can help,’ says Professor Cottrell.

However, he adds: ‘Prozac has been the only drug recommended for children here since 2003.’ Meanwhile, if children like James are ever to have a real chance in life, much more attention must be paid to providing the kind of psychological support that everyone agrees is needed, and there should be a serious attempt to stop prescribing drugs that are known to be ineffective and dangerous.

The natural alternatives

PARENTS concerned about the use of SSRIs such as Prozac, the natural question is whether there is an effective alternative for children with mild depression.

There is some evidence that the herb St John’s Wort, available over the counter, can be effective in adults. One study suggested it might help children.

However, it can interfere with other drugs, including medications for asthma, epilepsy and migraine, and should not be taken without first consulting a doctor.

In a book published last year, the French neuroscientist Dr David Servan Schreiber claimed the quickest way to deal with depression was via the body.

In Healing Without Freud Or Prozac, he outlined a number of physical approaches for dealing with depression. Some are relatively familiar, such as nutrition and exercise, others more exotic such as ‘circadian therapy’ and ‘EMDR’ (but all, he claims, with evidence supporting their use).

They all capitalise on the mind and brain’s own healing mechanism for recovering from depression, anxiety and stress, he says.

Some experts believe that the key to tackling depression lies in diet.

Even though mainstream psychiatry is highly sceptical of the benefits of the nutritional approach to this, or to any other mental disorder, there are a few professionals who believe it can be valuable and a couple of centres that specialise in it.

According to Dr David Wheatley, a consultant private psychiatrist and previously director of the Maudsley Stress Clinic, it is ‘an infinitely preferable first line treatment option for those who feel mildly to moderately depressed’.

The nutritionist Patrick Holford suggests that parents should move their child onto a low-sugar diet and boost their intake of Omega 3s (found in oily fish and fish oil supplements).

Other options include a chromium supplement.

DEPRESSION DIET; Junk Food Link to High Risk of Mental Illness

SHUN fruit and veg in favour of fast food and you won’t just get fat – you’re more likely to end up feeling blue, too.

junk food

Research has found that gorging mainly on fried food, processed meats, sweets, chocolate and fatty dairy products increases the odds of you getting depression.

But eating a diet rich in fresh vegetables, fruit and fish can protect against the mental illness.

The study is the first to look at overall diet and depression.

Previous research in this field has tended to focus on individual nutrients. A research team at University College London quizzed nearly 4,000 Whitehall civil servants, with an average age of 55 about their eating habits and whether they suffered from depression. They found that those who ate the most whole foods were less likely to report symptoms of depression.

And the opposite was true of those who ate the most junk food. Experts believe the high levels of antioxidants in fruit and veg, and of the B vitamin folate in broccoli, spinach and cabbage, may help to lower the risk of depression.

And fish contains polyunsaturated fatty acids – a major part of neuron membranes in the brain.

But it is not clear why junk food increases the risk of depression.

Dr Andrew McCulloch of Mental Health Foundation said: “Studies like this are crucial because they hold the key to us better understanding mental illness.”

18st.. I have to be obese

EIGHTEEN stone is the average weight at which people recognise obesity is a crisis, research shows.

It is the tipping point at which many seek surgery to turn their lives around.

Weight op experts The Hospital Group explained the obese “suffer in careers, family life and health”.

Fewer than one in five weighing above 18st earns more than pounds 20,000, a study of 2,056 obese adults questioned by YouGov found.

Four in 10 of those hitting 18st suffer back pain and one in five have diabetes.

BUN TO AVOID Fatty burger

Depression: A New Sexually Transmitted Disease

Nearly every discussion about sexual education focuses on preventing sexually transmitted diseases and pregnancy. However, recent research published in the American Journal of Preventive Medicine finds that, especially for girls, the discussion needs to include a third negative possibility: depression.

Most medical and mental health professionals would agree that there is a link between depression and sexual and drug using behavior in adolescents. However, it is commonly assumed that depressed teens use sex and drugs to “medicate” their depression. Thus, when faced with a depressed, sexually active teen, adults may overlook sexual or drug using behavior with the hope that the risky behavior will cease once the depression is gone.

Although the depression followed by sex and drugs link seems to make sense, a new study, which followed over 13,000 middle and high school students for two years in a row, found that depression did not predict risky sexual or drug using behavior.

Instead, the study found that depression often follows risky behavior. Lead author of the study, Dr. Denise Hallfors told me in an interview that her research team found evidence that heavy drug and alcohol use significantly increased the likelihood of depression among boys. For girls, the findings are stunning: Even low levels of alcohol, drug or sexual experimentation increased the probability of depression for girls.

Breaking down the results, Dr. Hallfors found that 25 percent of surveyed teens were complete abstainers, meaning they were virgins and used no substances, not even tobacco. Only 4 percent of these teens experienced depression.

Another group of teens could be considered dabblers in that they had experienced sexual intercourse and engaged in some kind of substance usage during the first 12 months of the study. For the boys, there was no increase in depression from this pattern of behavior (for boys, the significant risk was heavy drug use). However, for girls, the study revealed a more troubling pattern. Girls even experimenting with drugs were slightly more than two times as likely to be depressed (8-10 percent). Those experimenting with sex were three times more likely to be depressed than abstainers (12 percent versus 4 percent). For sexually promiscuous teen girls, the results are staggering: 44 percent of girls with multiple sexual partners during the study period experienced depression.

Did depression ever come first? Boys and girls were no more likely to begin or increase their sexual and drug use behavior when they were depressed than when they were not. In fact, depressed girls who were also abstinent were much less likely to engage in risky behaviors during the second year of the study. However, if they were already “dabbling” with substance use, depressed girls were more likely to go on to very risky sexual behaviors.

In other words, the sex and drug use are not only associated with depression but most often precede it. As a public policy matter, the drug use findings are not surprising and hardly controversial. For any teen, who advocates drug use of any kind?

On the other hand, for opponents of a strong abstinence message in schools, this study may be difficult to reconcile with their public policy activities. For instance, two groups opposed to abstinence education, Advocates for Youth and Sex Etc., are now sponsoring a contest for teens to promote condom usage. Teens can craft an e-postcard to send to their friends (and potential hook-up partners?) extolling the virtues of condom use. One such card has a picture of a heart and a condom with the caption: “Dream Team.” According to Dr. Hallfors’ research, for many teen girls, the caption should read: “Sad Nightmare.”

More research is needed to isolate the causes and cures for the link between experimentation and depression. However, there is no reason for policy makers to wait to encourage abstinence given these research findings. Citing the devastation and feelings of worthlessness that accompany depression, Dr. Hallfors warns, “Parents, educators and health practitioners now have even more reason to be concerned about teen risk behaviors and to take action about alcohol, drugs and sex.”

Instead of cheery postcards, teen girls need to know that their sexual behaviors may put them at risk for more than STDs and teen pregnancy. “Once a girl crosses that boundary, she puts herself at risk for a spiral of negative effects,” says Dr. Hallfors.

It seems to me that the evidence is consistent that teen sex is not a good idea, especially for girls. Why can’t everyone get behind that message?

Teens are nearly united in this sentiment. According to a poll conducted by the National Campaign to Prevent Teen Pregnancy, nine out of 10 adults and teens want society to send a clear message that abstinence is best for teens.

Whatever we think about the morality of sexual behavior, can’t we agree that teens should be given a clear and consistent message that it best to wait to engage in sex until they are ready to accept the financial, relationship and emotional consequences of making that choice? For nearly all teens, this would be adulthood.

My suggestion for a postcard? A picture of a gold nugget and a heart with the caption: “I’m worth the wait.”

Warren Throckmorton is associate professor of psychology and fellow for psychology and public policy in the Center for Vision and Values at Grove City College in Pennsylvania. He is past-president of the American Mental Health Counselors Association.