Do Obese People Need More Drugs?Thursday, March 4, 2010
Of course, obesity is associated with a wide range of health problems like high blood pressure, diabetes, arthritis, or reflux disease, all of which may all require pharmacological treatment. But this is not what this post is about.
Rather, this post is actually about the question whether or not larger patients need higher doses of medications to have an optimal treatment effect.
This topic was recently discussed by Matthew Falagas and Drosos Karageorgopoulos in a Lancet article that specifically addresses the issue of dose adjustments for antimicrobial agents in larger patients.
As the authors point out, body size is routinely considered in the optimization of drug therapy in oncology, anaesthetics and pediatrics. However, there remains a paucity of data on the optimal dosing of pharmacological agents for most of the drugs we use in clinical practice.
Thus, although regulatory agencies regularly demand special pharmacokinetic studies in children, elderly prople and patients with renal or hepatic impairment, no such studies are demanded for obese or even severely obese patients.
Requiring such studies would at least make theoretical sense as, conceivably, obesity can affect drug absorption, distribution, metabolism and clearance. Furthermore, it is obvious that body composition can particularly affect the disposition of lipophilic compounds. Obese patients are also likely to have comorbiditiesthat can affect these parameters (e.g. fatty liver disease) and are much more likely to be on multiple medications that can make drug-drug interactions problematic.
In short, as pointed out by Falgas and Karageorgopoulos the one-size-fits-all strategy for antimicrobial agents (and other drugs?) may well be outdated and require much more consideration than has been given to this issue in the past.
Thursday, March 4, 2010
Childeren, Elderly, pregnant women are all considered special population when it comes to studies to measure the efficacy and safety of a medication.
Also patients with Kidney and liver disease have given special attention and consideration when it comes to dosage and prescription for a medication.
Therefore, the concept of one size fits all as appears is not a routine practice for many drugs.
Obesity though is a different story and I think this is a time that our medical community needs to acknowledge the difference in the therapeutic needs of this group and make moves toward more resaerch in this area.
Friday, March 5, 2010
An irony of America’s obesity epidemic is that at a time when Americans arguably know more about food and nutrition than at any time in their history, they are gaining more weight. Despite all the diet books, the wide availability of reduced-calorie and reduced-fat foods and the broad publicity about the obesity prob¬lem, the obesity epidemic has not slowed. Indeed, it is growing much faster than it was thirty years ago.
As Albert Einstein once observed, the significant problems we face cannot be solved at the same level of thinking we were at when we created them. That we’d have to shift to a new level, a deeper level of thinking, to solve them.
A new book Thinking in Circles about Obesity: Applying Systems Thinking to Weight Management, argues for, and presents, a different perspective for thinking about and addressing the obesity problem: a Systems Thinking perspective.
It is a different way of thinking.
By helping people better understand the structures and dynamics underling human weight and energy regulation, it is hoped that Thinking in Circles about Obesity would have a profound influence on how ordinary people think about and manage their health and well being.
Wednesday, March 10, 2010
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