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No ‘super-sizing’: Help kids on psychotropics avoid weight gain

Vol. 4, No. 1 / January 2005

W.Victor R. Vieweg, MD; A. Bela Sood, MD; Anand Pandurangi, MD; Joel J. Silverman, MD

No ‘super-sizing’: Help kids on psychotropics avoid weight gain

Pediatric overweight and obesity can cause serious health problems later on. Use of psychotropics associated with potential weight gain compounds this risk.

Convincing youths to exercise and eat healthier foods can help them maintain a normal weight for their age and gender (see “Choose precise BMI charts to track youths’ weight gain,” (Current Psychiatry, October 2004,).

Cutting calories
Discuss the fat and calorie content of popular high-fat foods with the parents, who can then encourage their child to make more-informed dietary choices. Explain, for example, that it takes all day to burn the calories in two doughnuts, one fast-food bacon cheeseburger, or one extra-large serving of fast-food french fries.

A table listing portions of high-fat foods equaling 500 Kcal—the amount of energy a typical youth burns in 1 day through brisk walking—accompanies this article at www.currentpsychiatry.com.

Increasing exercise
Physical activity declines substantially during adolescence.1 In youths with chronic mental illness, reduced activity may contribute more than increased caloric intake to overweight/obesity.

Tell youths that they can lose 1 lb of body fat per week with normal walking and can lose more weight by simply taking a 30-minute walk each day. Alternately, each of the following activities burns as many Kcal as a 30-minute walk:

jumping rope 11 minutes

jogging 13 minutes

swimming 19 minutes

moderate cycling 24 minutes

mowing lawn 30 minutes.

Then encourage youths to wear a pedometer to measure physical activity and to motivate them to exercise. A pedometer the size of two quarters when closed can be easily worn and function unobtrusively. Models costing less than $30 are available at discount stores and on the Internet.

The pedometer is attached to the belt near the buckle and records a step every time the hip drops. Pedometers measure activity by steps per day; they cannot gauge activity on a bicycle.

Assuming that a youth burns 40 Kcal per 1,000 steps, a child will burn 480 to 640 Kcal and an adolescent will burn 440 to 480 Kcal per day through brisk walking. Burning 500 Kcal/day translates to 3,500 Kcal—the equivalent of 1 lb of body fat—across 1 week.

Encouraging exercise. It is harder to promote exercise to a chronically mentally ill youth than to a youth who is not mentally ill. Work with the patient’s family, case manager, school system, teacher, nurse, and/or family doctor or pediatrician to plan an exercise regimen.

References
Kimm SYS, Glynn NW, Kriska AM, et al. Decline in physical activity in black girls and white girls during adolescence. N Engl J Med 2002;347:709–15.
The authors are faculty members in the department of psychiatry, Medical College of Virginia, Virginia Commonwealth University, Richmond.

Current Psychiatry ©2005 Dowden Health Media

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