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When Kids Grow Fat From Medication, Who Protects Them From Being Bullied?

Weight gain from drugs taken to help mental illness is the blind spot in the battle against drug side effects. The problem is ignored, rationalized as a small price to pay for the therapeutic benefits of the treatment.
11/03/2014 03:43pm ET | Updated January 3, 2015
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The good news is that the increase in obesity in kids seems to be leveling off. Perhaps this is due, in part, to healthier school lunches and/or an attempt to get kids to exercise more. It's a good thing, because fat kids are likely to be a verbal and physical punching bag at school, in their neighborhoods, and often at the family dinner table.

That obese adults are targets of verbal abuse, often from strangers as well as from officious relatives and nasty co-workers, is well known. Their ability to defend themselves is limited. Unlike hate speech, there is no legal penalty for laughing at the body of someone else, and it is hard to prove that obesity is involved in job discrimination. But adults sometimes have the option of escaping from situations in which they are victims. They don't have to see offensive relatives or spend time with puny-brained fellow employees who feel good by making others feel bad.

Children don't have escape routes from bullying, even when parents and school officials get involved. What happens on the walk home from school, or on the playground away from the eyes of a monitor, in the school bathrooms, or on Facebook, is often not preventable no matter how many meetings of school officials and declaration of no-bullying policies.

Obese children are the most likely to be bullied.

The National Education Association (School Psych Rev 2013; 42:280-297) reported weight-based bullying to be the most prevalent of all causes of bullying, and not just among younger children but among obese teens as well. Sadly, criticism and worse about their weight seems to come from parents and teachers as well (Pediatrics 2013; 131 abstract).

Now imagine a kid, formerly thin, who gains 50-75 pounds from medication he is taking to control uncontrollable rages or impulsive behavior or anxiety or depression. A pediatrician at one of Boston's leading pediatric departments told me that such kids who are put on anti-psychotic medications to control severe behavioral problems might be able to be mainstreamed in school. But now the 7-year-old who weighs as much as a 13-year-old is the victim of bullying. He is still fragile emotionally, and perhaps not well socialized into his peer group because of his mental problems or autism or Asperger's syndrome. He no longer can run fast, bend down to pick up a ball, do gymnastics, or climb a rope. He is alone in the proverbial school yard or bathroom. Who is protecting him from the inevitable teasing? These children are supposed to be helped and supported en route to being integrated into conventional schoolrooms, but bullying presents a barricade that many may not be able to overcome.

Putting such kids on a diet seems like an obvious solution, except that these kids can't prevent themselves from overeating. Their medication is making them constantly hungry and unsatisfied with food portion levels that kept them full before going on their meds. And like adults who gain weight from the same medications, few, if any weight-loss interventions really grapple with the cause of the weight gain or come up with interventions that counteract the effect of the drugs on food intake.

Medications and other interventions like physical therapy have been developed to handle the side effects of chemotherapy and other medical treatments. Anti-nausea drugs, medications to control vertigo or mouth sores, and physical therapy to help overcome muscle and nerve weakness and pain are among only some of the ways drug side effects are being combated. But weight gain from drugs taken to help mental illness is the blind spot in the battle against drug side effects. The problem is ignored, rationalized as a small price to pay for the therapeutic benefits of the treatment. Or, the obese patient is handed off to a conventional weight-loss program with no experience in dealing with this specific cause of weight gain. If most of these programs have little or no permanent success treating obese individuals who gained weight the traditional way, how then can we expect any success among those whose meds are making them eat too much and too tired to exercise?

Prevention may be the only workable answer. When children are started on these medications, parents must be alerted to the increased appetite that will follow and advised to restrict or eliminate highly caloric foods in their homes, school lunches, and restaurants like fast-food chains. The child must also be encouraged to exercise constantly to prevent weight gain from becoming so excessive that it becomes difficult to do so.

And parents, teachers, school staff and relatives have to protect their child from becoming a target because of his or her weight gain. The child is already a victim of the side effects of the medications; more victimization is unthinkable.