Are Obese Patients Chronically Underdosed?
The Sydney Morning Herald reported on Dr Bruce Green's fears that current calculations of how much drugs to give patients, based on body weight, may leave some overweight and obese patients in danger of being under-dosed or over-dosed.
Some drugs are calculated per kilo of bodyweight - but for drugs which cause side-effects at relatively low doses, this could leave some people at risk.
Other drugs have a maximum limit regardless of the patient's weight - but this could mean heavy patients don't get enough of the drug.
The most striking thing about this report is the sheer number of patients to which it could apply. As the Sydney Morning Herald explained:
With almost half the population now overweight or obese, ''it's no longer a special population'', Dr Green said, but a major group for which drug dosing principles deserved proper scientific investigation.
It's becoming increasingly obvious that the obesity crisis is causing strain on health systems across the Western world. What should our governments be doing? And what can we do ourselves -- not just as individuals safeguarding our own health, but as members of families and communities?
It's a concern to think that ill patients might be incorrectly dosed and experience side-effects. Should we question what illnesses these drugs are treating? If a large majority of patients are receiving treatment for illnesses that are caused by obesity and poor lifestyle then should governments be looking at the root causes rather than trying to fix the problems after they have occurred? Are these patients just given drugs to treat diseases caused by obesity with no follow up plan? Maybe governments should be thinking about a 2 pronged approach where patients also receive follow up coaching from fitness and nutrition professionals to help them improve their lifestyles and eventually get them off the drugs or at least help them get down to a weight where a safe dosage can be administered.
ReplyFrom what I've always understood, the standard dosage on most medications is supposed to be for a 150-lb. person. At least, that's the case with most antibiotics anyway. They usually adjust the dosage to be smaller for kids/babies and for animals, but I guess a lot of doctors don't think about adjusting the dosage upwards for very heavy people. With antibiotics, it's very important to get a full dose, otherwise the bacteria can develop resistance. As far as other drugs go, I could see the need for those to be adjusted as well to minimize side effects and maximize the treatment effect.
ReplyYes, I find it odd that my safe dosage of over-the-counter painkillers is (apparently!) exactly the same as my fiance's. He's slightly over twice my weight (I'm a small build, 5 ft 2 -- he's 6 ft 4 and on the big side).
I can understand why they need to set a safe dose, but surely there should be some allowance for body weight even on over-the-counter meds, seeing as someone of 100 or of 300 lbs could potentially be taking the same medication.
ReplyYeah, I noticed the same thing. My husband weighs about twice what I do and when he takes cold medicine, he takes the same dose that I do. My dog is on a daily aspirin regimen because of her arthritis and I do adjust the dosage for her weight...she weighs about 60 lbs, so I usually give her the kids' size dosage, which seems to work for her.
I wonder if obese kids are also underdosed, especially when it comes to antibiotics for things like ear infections and strep throat. Doctors are supposed to adjust the dosages on those, but if they don't, that could be a really bad thing.
ReplyI have a morbidly obese teenager and it is very difficult to see he gets the right dosages due to age and weight. A lot of isurance, meddicai or edicare are willing to pay after you have a problem but not for prevention. And it goes for all sorts of problems like smoking, cancer, obesity, etc. Sad situaion for us all.
ReplyIt amazes me that drug companies continue to disallow for volunteers to participate in their studies if their BMI is above a given number. The bell curve of participants in a study never include the morbidly and super morbidly obese patient. Having been a large person all of my life, it occurred to me (several years ago) that being medicated was, in fact, a true crap shoot and that there was a good chance of being under/over medicated -- not, necessarily the fault of the prescribing doctor. Drug companies need to "get it" and get it quick regarding including those who are beyond "normal" weight limits in their studies. I'm really surprised this hasn't been an issue in health care sooner than this...what's even more surprising is that there haven't been reported deaths of the obese based on the number of units given for a dosage. Or, if there have been deaths that could have been caused by an overdose, how it may have been swept under the carpet and deemed the death was due to weight issues, not the over dose. Just a thought.
ReplyWith more and more people becoming obese, it doesn't make sense that they would be excluded from studies.
ReplyYes - since the drugs are going to be used on overweight/obese individuals, it would seem sensible to include them in studies where possible!
ReplyThese book hucksters are always coming up with something new to get people to buy their useless books. Remember the useless books written by Kevin Trudeau? (The Natural Cures they don't want you to know about). I purchased 3 of them. One for me, and for my sisters. When I began to read it, I realized that he didn't give any definite answers to anything. All he did was refer the reader to a book written by someone else. I realized then that this was just a scam that about 20 guys were benefitting from. I'm sure if I had been dumb enough to purchase one of the other books, it would only have referred me to another.
Does anyone know how to spell the word scam? S.C.A.M If you ever see a book written about a miracle cure and they never tell you what the miracle cure is; it's a S.C.A.M.
ReplyActually what frightens me most is how chronically overdosed on medication we are as a society. How quickly we turn to pills as the be-all and end-all.
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