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ADHD drug use for youth obesity raises ethical questions

Story Highlights

• Doctor uses ADHD drug Adderall, an amphetamine, to treat childhood obesity
• He says about 90 percent of his patients on Adderall have lost weight.
• Critics say the off-label use, while legal, is questionable and too risky
By Elizabeth Cohen
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(CNN) -- When Alex Veith was 11 years old, he was in a bad spot.

He was 30 pounds overweight, and blood tests showed he was headed toward Type 2 diabetes. His parents say Alex was already physically active and eating a healthy diet. They didn't know what to do.

Their pediatrician didn't know either, so she referred Lisa and Hank Veith to Dr. Fuad Ziai, a pediatric endocrinologist in nearby Oak Lawn, Illinois. In the summer before Alex entered sixth grade, Ziai prescribed Adderall, an amphetamine used to treat attention deficit and hyperactivity disorder, or ADHD. Alex didn't have ADHD, but one of the drug's common side effects is weight loss. And that's what happened to Alex.

"You should have seen everyone when I went back to school the next year. They didn't believe it was me," says Alex. "It was a great feeling to be a thin kid."

Ziai's approach to treating obesity -- he says he has prescribed Adderall for weight loss to about 800 children and teens -- raises an important ethical question: Has the obesity epidemic among children become so severe that it's OK to prescribe a drug not approved for weight loss when the drug can have serious, sometimes life-threatening side effects? (Interactive: What is Adderall? )

The Veiths say they'd give their son Adderall again. Now 17, Alex is a normal weight after being on the drug for more than four years -- from age 11 until about 18 months ago.

Lisa Veith says she was distressed about her son's weight. She didn't want him to develop diabetes, and she didn't want him to be teased. "I didn't want him to face what could come as kids turn into teenagers. I know how brutal kids can be," she says. "I just didn't want my child to go through that."

Alex says the Adderall cut his appetite in half. Drugs for ADHD are in the amphetamine family and are well-known appetite suppressants. "I didn't get the urge to eat as often," Alex says. "It seemed like I was always full."

Ziai says about 90 percent of his patients on Adderall have lost weight. He credits Adderall (along with a prescription for Glucophage, a diabetes medication) with helping Alex and many others avert diabetes.

The Food and Drug Administration has not approved ADHD drugs like Adderall for weight loss, but it's legal, and common, for doctors to prescribe medications "off label."

Several pediatricians contacted by CNN say they suspect other pediatricians are prescribing ADHD medications off label for weight loss. "No one admits it," says Dr. John Lantos, professor of pediatrics at the University of Chicago. "It's morally and medically questionable, so I don't think anyone's proud of doing this."

The Food and Drug Administration warns that some patients on ADHD drugs with pre-existing heart problems have suffered sudden death. The agency also warns that some on Adderall develop psychiatric problems, such as hearing voices and becoming manic. Pediatricians like Lantos say it's wrong to prescribe Adderall for weight loss when risks are known and the benefits are questionable. The drug has never been studied for weight loss, so they suggest that Ziai's success stories may be anecdotal. "Doctors who prescribe this could end up killing kids by giving them a medication that doesn't work for the reason they're prescribing," Lantos says.

Ziai says he screens his patients for heart problems, and none of his patients on Adderall has had cardiovascular side effects. He says about 2 percent of his patients on Adderall have had psychiatric side effects -- mood swings, irritability, crying for no reason -- but most patients are fine after he lowers the dose and then later raises it again.

Ziai says Adderall is the only option for many of his overweight kids. "Prior to the administration of the medication, there was no solution available medically for these children," he says. "In my experience, this is a very rewarding and very effective approach."

He adds that he knows other doctors are critical. "I respect their opinions, but I'm sure I'd be very happy to have them review the cases that we've had," he says.

Lisa Veith counts her son as one of Ziai's success stories. "He told us it was given for ADHD," she says. "We felt comfortable with what he was doing. We didn't give it a second guess."

Elizabeth Cohen, MPH, is a correspondent with CNN Medical News.


Now 17, Alex Veith is a normal weight after taking Adderall for more than four years -- from age 11 until about 18 months ago.


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