The Hunger Games

**VivaLasViejas**, ASN, RN

`urp` groannnnnnn......

How in the name of all that is reasonable is it possible to eat this much and not blow up??! I just polished off a two-enchilada dinner, complete with salsa and chips plus a slice of flan to top it all off, and even though I feel like a beached whale I know darned well I'm going to be hungry again before bedtime.

Why? Because I'm taking a medication whose major side effects are increased appetite and weight gain. Actually, "increased" doesn't even begin to cover it: I'm eating practically everything that's not red hot, nailed down, or running for the hills. What I've consumed in the past three weeks could feed an entire Third World country for a day. Thankfully I've got only a few more doses of the stuff, so the voraciousness should soon be a thing of the past; but the way I've been Hoovering food lately, I'm shocked that I haven't gained back half of the sixty pounds I dropped over the past year. Yikes!

While in reality I've only put five of those pounds back on since I started the drug, I see a fuller face and a bloated abdomen in the mirror. I feel thick and lazy and unmotivated, like I did before I lost the weight. My appetite is so out of control, in fact, that I half-jokingly promised my family and friends that I'd never get sick for the rest of my life if it means never again having to take meds that make me wolf down everything but my shoes! (They just laughed and reminded me that I wasn't exactly in charge when this latest bout took matters to a whole new level.)

As both a nurse and patient, I would like to find out some day what makes certain medications so likely to induce overeating and weight gain, and what (if anything) can be done to change that. The irony of it all is really too much: I take one drug that stopped my lifelong habit of compulsive eating dead in its tracks (hence the weight loss), but with this one I could star in my own reality show called Extreme Eating. The fact that it is also very good at curing what ailed me makes it worth using in a crisis, but I feel sorry for people who have to take large doses or stay on it for very long.

Obviously, patient adherence to medications that increase appetite and body weight is an issue, especially over the long term, and the advice given to them is often unhelpful. It's all too easy for the prescriber or the nurse caring for the patient to say "You have to resist the temptation to overeat". It's enough of a challenge for the patient to stick with the meds knowing that no matter what she does, she is more than likely going to gain weight, without being told that she needs to "just say no".

A person who's never been on an appetite-inducing drug cannot possibly understand this ravenous hunger that literally overwhelms the patient's defenses and drives him to eat enormous quantities of food in a relatively short amount of time. There IS no "just say no"---the best that can be hoped for is to contain the number of calories consumed until such a time as he can stop taking the medication or his appetite levels off (as it sometimes does). Patient teaching needs to be directed toward keeping weight gain to a minimum by encouraging them to use foods that satisfy the "crunch" factor, such as apples and crisp vegetables, and to increase their physical activity gradually so that their appetite doesn't become even larger.

All of which is much easier said than done. Oooh, look, is that pumpkin cheesecake??

The Hunger Games

About VivaLasViejas, ASN, RN

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