ADHD drugs may fuel obesity in children

Drugs used to treat children with ADHD and aggression issues fuel rapid weight gain, new research suggests.

Though the rise has leveled off somewhat, recent years have seen a six-fold increase in antipsychotic prescriptions for children, with many of those written as off-label treatments for ADHD and disruptive behavior disorders. 

Simultaneously, more and more children are becoming overweight and obese. Today, one in three people under 18 are either overweight or obese. 

For those children who are both overweight and on alternative medications for their ADHD, the drugs may be partly to blame for their high body masses, according to a study from Florida Atlantic University and Washington University.  

Three antipsychotic drugs commonly prescribed to children with ADHD and aggression lead to dramatic weight gains and insulin sensitivity, a new study’s findings suggest

Not all children with ADHD are aggressive or disruptive, and not all children with so-called disruptive behavioral disorders also have ADHD, but there is a fair among of overlap. 

In these cases, typical ADHD medications – like Ritalin or Adderall – are often considered insufficient. 

Though these children do not have psychotic disorders, doctors may prescribe these kids antipsychotic drugs, often despite the fact  that the FDA has not approved them for this use. 

This has a become a far more common practice. 

In 2012, about one percent of all children who visited a psychiatrist left the doctor’s office with a prescription for an antipscychotic drug, and most of these were meant to treat disruptive behavioral disorders, a six-fold increase over rates from the 1990s.

Antipsychotics come with weight gain for many adults prescribed the potent drugs, but since they are given out off-label for these children, their side effects for smaller bodies have remained largely mysterious. 

‘Plenty of studies have shown blood changes

but very few studies in adults and none that we’re aware of in children that have looked at changes in body fat and insulin sensitivity during antipsychotic treatment,’ said Dr John Newcomer, lead study author and professor at Washington University School of Medicine. 

So he and his team recruited 144 children from whose doctors were considering starting them on an antipsychotic drug, but had not done so yet.

‘Many of the youths who entered the study to get treated have gotten in trouble at school, and that’s bad, we would like to get the youths back on the educational horse, so to speak, so we understand why the child psychiatrist community reaches for this tool,’ says Dr Newcomer. 

‘You can rapidly improve psychiatric symptoms.’  

They randomly assigned each of the six- to 18-year-olds one of three drugs: aripiprazole, olanzapine, or risperidone.

Over the course of 12 weeks, the scientists evaluated the children’s weights as well as their psychiatric and behavioral states. 

They all improved, but they also all gained weight and fat tissue, too. 

At the start of the study, about one third of the kids were overweight – on part with the national average – but within just those three months, 47 percent of the children were in that category. 

The subjects also became more insulin sensitive, a classic harbinger for type two diabetes, and something scientists already knew happened with the drugs in adults. 

All three drugs were about equally effective at treating the children’s psychiatric symptoms, and all three caused weight and fat gain, but olanzapine had the worst weight side effects.  

‘It’s well-known that if you produce these kinds of changes in a child or adolescent, now you have decades [of life over which] that increase in risk to plays itself out and impacts your risks downstream’ says Dr Newcomer.

‘All things being equal, these decisions about treating youth are in some ways a higher-stakes decision than treating adults.  

‘So this tool could be part of the solution [to treating disruptive disorders], but let’s pause and think carefully about the potential risks and benefits. We understand there are extraordinary situations, but we hope [this study] results in a recalibration of that risk-benefit ratio.’