Obesity and Drug Use

In general, the majority of obese adults tend not to be substance abusers. In fact, the diagnosis of a mental health disorder such as depression or anxiety tends to be higher for the obese population, whereas a lifetime risk of a substance use disorder tends to be relatively low. Alcohol abuse is relatively low in the adult obese population, as is marijuana, cocaine, and heroine abuse. It appears that for obese individuals, the drug of choice is food. The statistics point to an increase in substance use over the past decade in the obese adolescent population. Exact percentages of substance use, substance abuse, and dependency regarding obese adults, adolescents, or younger children are relatively scarce.

In general, 8.2 percent of the U.S. population aged 12 and older are illicit drug users. Of this number, 2.7 percent abuse prescription drugs. There are three categories of prescription drugs most commonly abused. The first category is opioids. Opioids are most commonly prescribed for pain and include oxycontin, vicodin, and demerol. The second category of abused prescription drugs includes central nervous system depressants. These drugs are primarily prescribed for sleep disorders and anxiety and include valium, xanax, nembutal, and mebaral. The last category of prescription drugs that tends to be highly abused by obese adults is stimulants. Stimulants are most commonly prescribed for obesity, attention deficit hyperactivity disorder (ADHD), and narcolepsy and include adderall, ritalin, dexadrine, and meridia. Stimulants including adderall and ritalin are being used by some pediatricians in the treatment of childhood obesity. The Food and Drug Administration, however, has not approved this “off-label” use of stimutants for the treatment of childhood obesity.

Similarly, off-label use of other medications, such as antidepressant medications that have weight loss side effects, may be prescribed to obese children and adults. The prescription use of stimulant drugs to treat adult obesity is more common. Physicians are required, though, to monitor adult patients taking obesity-related medications on a monthly basis. Legislation is currently looking into ways to monitor the abuse of prescription medications. Prescription drug abuse is becoming a large societal problem as abusers search for means to obtain their drug, from [Page 535]stealing prescriptions to having multiple physicians prescribe them.

There are many causes of obesity, including a genetic predisposition, metabolism, a medical condition, a lifestyle issue, or any combination of the above. Another cause is thought to be brain chemistry and its link to addictive and compulsive behavior. Serotonin levels in the brain affect mood. Serotonin also causes the body to crave carbohydrates. Carbohydrates, in conjunction with the smell or taste of food, can stimulate dopamine which is the reward system in the brain. Dopamine is a naturally occurring substance that regulates feelings of pleasure. Reduced activity of dopamine in the brain may contribute to addictive behavior and obesity.

Compensating for low levels of serotonin, individuals consume more foods high in carbohydrates to temporarily feel better. This process slows down dopamine and the individual needs more of the same substance to feel pleasure. As a result, the individual begins to gain weight. Viewed from an addiction perspective, obesity has similar characteristics to other addictive disorders including drug addiction and compulsive gambling. These similarities include cravings for, obsessive searching for, and overconsumption of the substance (food). Research has demonstrated that obese adolescents admitted to a rehabilitation facility for drug dependence gained an average of 11 pounds after 60 days in treatment.

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