When Bright Minds Get Bored....

When bright minds get bored, they start to do silly things with their time and talent. Really, they do. Why would I say this? Have a read for yourself: Diabetes Drug Helps Dieting Teens Lose Weight. Does anything about that title strike you as odd? Maybe the whole ‘diabetes medication being used on non-diabetic patients’ part?

I happened to come across this article while surfing the web and couldn’t help but think to myself, “Why would you even consider doing that?” Now, before I go on, be forewarned that I have strong opinions. Anyone who knows me will tell you this is true. I also openly admit that I have not read every single piece of literature out there on this matter, nor have I checked all the references in this study. However, I do feel that as a dietetic student, I can bring a new perspective to this situation and raise some questions about this particular study.

Published this month in the Archives of Paediatrics & Adolescent Medicine, the bright minds at Glaser Pediatric Research Network provided a glimpse into a potentially new realm of treatment for obesity. In fact, their study’s background statement reported: “Metformin has been proffered (proposed for acceptance) as a therapy for adolescent obesity, although long-term controlled studies have not been reported”. This is where they stepped in. For a total of 48 weeks, 39 individuals were placed on metformin XR (extended release) and were tracked using various measures, as compared to placebo groups. At the end of the study, it was concluded that “Metformin XR caused a small but statistically significant decrease in BMI when added to a lifestyle invention program.”

For those of you who are not familiar with this drug, Metformin is a pharmaceutical compound used to treat type II diabetes. It helps to decrease the amount of blood sugar your body absorbs from food, and also decreases the amount of sugar your liver makes on its own. The theory then is that the less excess sugar in the blood, the less excess energy there is to be converted to fat. Plus, obese individuals are already at risk for diabetes, so why not get a head start on regulating their blood sugars? Simple, right? Wrong. Metformin has a whole host of side effects, only some of which were BRIEFLY LISTED in the study (pg. 6). But to reassure their readers, researchers reinforced that Metformin was “well tolerated” by this population. What does that even mean? Who defines well-tolerated?

A little digging on the internet revealed that Metformin can not only cause hyper and hypoglycaemia if it is not regulated properly, but can also be held responsible for other fun side effects like: diarrhea, unpleasant metallic taste in mouth, flushing of skin, nail changes and muscle pain (http://www.nlm.nih.gov/medlineplus/druginfo/meds/a696005.html#special-dietary). And for bonus points, a disclaimer at the bottom notes: “Some female laboratory animals given high doses of Metformin developed non-cancerous polyps in the uterus…it is not known if Metformin increases the risk of polyps in humans.” Well isn’t this convenient? Testing a medication that could have implications for fertility on obese teenagers in the midst of puberty (13-18 yrs)? Fantastic! Did the researchers also consider the frequency with which teenagers skip meals, or take twice the dose of Metformin when they’ve had a little too many calories for the day? Is that not also a danger?

As a dietetic student, I can only help to wonder, what happened to promoting lifestyle changes, behaviour modification, and health over diets. The scientists at the Glaser Pediatric Research Network seem not to support such ideas as illustrated in this statement: “Short term prospective trials using various lifestyle modification programs have shown that effectiveness is often related to the intensity of the program…..and has limited longevity”. I have scanned through each page of this report, curious to know more about this magical regimen. Although the study was relatively thorough and was a legitimate randomized, double-blind, controlled trial, I still came across a couple of ‘gems’, statements that would get yours gears turning.

Quote 1: “Metformin, in combination with lifestyle modification had a small but statistically significant effect to reduce BMI in obese adolescents; this effect WANED within 12-24 weeks of DISCONTINUING Metformin treatment.”

So in short, using Metformin is just as ‘ineffective’ as they had accused behaviour modification of being? Could this be because this is a short-term Band-Aid solution that never addresses the root causes of obesity?

Quote 2: “While healthy eating was a major component of the lifestyle modification program [initiated as part of the study], no specific calorie goal was assigned to the subjects.”

No calorie restriction on a weight loss program? This would explain why those following the ‘lifestyle modification’ treatment didn’t fare so well. It’s a well known equation in the dietetic community that: Eating pattern – 500 calories/day = loss of 1lb per week.

Quote 3: “To mitigate the possible impact of diet modification on vitamin and calcium intake, as well as possible EFFECTS OF METFORMIN on vitamin B metabolism… subjects were instructed to take a multivitamin and calcium carbonate…”

Is this what we’re really trying to teach the public? That all these years, we have lied to them and there really is a magic pill for weight loss (Metformin)? And that true health can be managed by balancing pills and not meals?

There is something very backwards about this thinking that goes against everything I’ve learned and have come to value. Why would they promote pills so readily for patients without a diabetic or pre-diabetic diagnosis? I suspect it might have something to do with Bristol-Myers Squibb, the makers of Metformin XR, who were the sole group listed in the financial disclosure portion of the study. A tiny little conflict of interest, n’est pas?

Studies like these, I believe, really undermine the dietetic profession. They subliminally suggest our techniques (e.g. diet modification) and knowledge about the power of food is nowhere near close to that of the power a drug. Much like rock beats scissors, drugs beat food. I’m still left with the question of why we would use metformin so readily on young, pubescent teens even though dietitians have been trained to regulate glucose through timing of eating, the glycemic index, and combining carbohydrate and protein.

*Sigh* I wasn’t lying to you. When bright minds get bored, they REALLY do take part in silly things, like putting children on metformin for obesity. Maybe if they really want a challenge, they can help Adam Giambrone solve the service issues with the TTC. But that, my friends, is a story for another day. :)