domingo, 27 de julho de 2008

Evitar a obesidade infantil é prioridade de saúde pública

Há quem critique a proposta de controle da propaganda de alimentos dirigidos às crianças e jovens no Brasil. Nos Estados Unidos, a televisão é um mistura de anúncios de redes de restaurantes, de carros e de .....antiácidos para a digestão! Ainda não chegamos ao padrão americano, mas se políticas para evitar o aparecimento da obesidade não sejam estabelecidas desde já chegaremos no padrão descrito pelo The New York Times, na edição dominical.

Weight Drives the Young to Adult Pills, Data Says
By STEPHANIE SAULPublished: July 26, 2008
A growing number of American children are taking drugs for a wide range of chronic conditions related to childhood
obesity, according to prescription data from three large organizations.
The numbers, from pharmacy plans
Medco Health Solutions, Express Scripts and the marketing data collection company Verispan, indicate that hundreds of thousands of children are taking medication to treat Type 2 diabetes, high blood pressure, high cholesterol and acid reflux — all problems linked to obesity that were practically unheard-of in children two decades ago.
The data, disclosed publicly in recent months or provided at the request of The New York Times, shows that concerns that children will be taking adult medications — heightened recently by a controversial recommendation by a national pediatricians group — are already a reality.
This month, the
American Academy of Pediatrics said that more children, as young as 8, should be given cholesterol-lowering drugs. The recommendation was quickly attacked by some experts as a license to put children on grown-up drugs.
While the drugs do help treat the conditions, some doctors fear they are simply a shortcut fix for a problem better addressed by exercise and
diet. Even so, some pharmaceutical companies are developing new versions, including flavored ones, of adult medications for children.
While some of the percentage increases in the three analyses are significant, doctors empha-size that
prescriptions of these drugs to children still represent less than 1 percent of their sales.
Express Scripts and Medco developed estimates of how many children might be taking such drugs by extrapolating their data — involving a total of more than four million children — across the broader population.
The companies use different assumptions to reach their estimates, but the data suggests that at least several hundred thousand children are on various obesity-related medications.
The greatest increase occurred in drugs for Type 2 diabetes, with Medco’s data showing a 151 percent jump from 2001 to 2007.
Medco’s data, released in May, showed that use of drugs to treat acid reflux problems in children, often aggravated by obesity, increased 137 percent over seven years. Its analysis also showed an 18 percent increase in drugs to treat high blood pressure and a 12 percent increase in cholesterol-lowering medications during the seven-year period.
Express Scripts found a 15 percent increase over three years in drugs to treat cholesterol and other fats in the blood, a category that is primarily statins.
“We were amazed at how quickly the rates of drugs used have climbed,” said Dr. Donna R. Halloran, an assistant professor at St. Louis University who worked on the Express Scripts analysis, presented at a meeting of the American Public Health Association in November.
Verispan data recorded a 13 percent increase in high blood pressure prescriptions in the under 19 age group from 2005 to 2007. Its numbers show, however, a less than 1 percent increase during the period in cholesterol-lowering drugs in children.
Doctors and some financial analysts have said that less pronounced increases in cholesterol drugs compared with some other medications — seen in all three analyses — reflect a wariness by some doctors about using those drugs in children.
Some experts have expressed concern that the increases in many of these obesity-related drugs reflect a systemic failure, with doctors and parents turning to them because they find lifestyle changes too difficult to implement or enforce.
“I think a lot of people in
pediatrics, myself included, are struggling with what is the right management to do for these kids,” said Dr. Russell L. Rothman, an assistant professor at Vanderbilt University, who recently surveyed doctors and found wide variations in how children were being treated.
“You see elevated
blood pressure, or elevated sugars, or elevated cholesterol and you try exercise and diet and you don’t see any improvement,” Dr. Rothman said. “I worry that some providers and some families are looking for the quick fix, and are going to want to start medication immediately.” Some pediatricians say they have been treating children with statins for several years.

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