For years, ADHD experts have recognized the link between untreated ADHD and obesity. As for many weight-control experts and gastric-bypass surgeons, well, they must have missed the memo. Is it territorial jealousy? Willful ignorance? “ADHD Denial”?
Let’s be charitable and call it one more casualty of our highly specialized medical system. That is, most GI docs aren’t connected to most brain docs aren’t connected to most hormone docs, and down the line. (As for some sleep docs’ determination to ignore ADHD’s role in sleep challenges, that’s for another post.)
In February, a new study came from two Toronto-based clinicians and researchers seeking to bridge this cross-disciplinary knowledge. Physician Lance Levy and psychologist John Fleming set out to determine whether attention deficit hyperactivity disorder (ADHD) pharmacological treatment of severely obese subjects with newly diagnosed ADHD would result in sustained weight loss. (In short, yes it did.)
Digesting the Research
Here’s a bite of the abstract (by the way, refractory means “hard or impossible to manage” and comorbid means co-existing):
RESULTS: Comorbid conditions were found to be highly prevalent (sleep apnea 56.4%, binge eating disorder 65.4%, mood disorder 88.4%). After an average of 466 days (s.d.=260) of continuous ADHD pharmacotherapy, weight change in treated subjects was -12.36% of initial weight and in controls +2.78%, P<0.001. Weight loss in treated subjects was 15.05 kg (10.35%) and weight gain 3.26 kg (7.03%) in controls, P<0.001.
CONCLUSIONS: ADHD is a highly prevalent condition in the severely obese population. Treatment of ADHD is associated with significant long-term weight loss in individuals with a lengthy history of weight loss failure. This result is likely because of the positive effects of treatment on self-directedness, persistence and novelty-seeking behaviors. ADHD should be considered as a primary cause of weight loss failure in the obese. Individuals seeking medical or surgical weight loss should be evaluated for ADHD and treated appropriately before intervention. This may improve the outcome for medically managed patients and avoid
complications in surgical subjects because of poor compliance with diet and supplement requirements.
International Journal of Obesity advance online publication, 17 February 2009; doi:10.1038/ijo.2009.5
And here’s a 2005 study from the same team:
Symptoms of attention deficit hyperactivity disorder in severely obese women
Past and current symptoms of Attention Deficit Hyperactivity Disorder (ADHD) were assessed in a clinical sample of severely obese females.
METHOD: Core symptoms of ADHD were examined in 75 consecutive, severely obese (BMI > or = 35) women referred to a medical specialist for the non-surgical treatment of obesity. Subjects completed both a retrospective report of childhood symptoms of ADHD (Wender Utah Scale) and two standardized adult ADHD symptom scales.
RESULTS: The frequency of clinically suggestive elevations in ADHD scores was substantially and significantly higher than the normative samples in 9 out of 11 symptom subscales. Inattentive symptoms, but not hyperactive symptoms of ADHD, were frequently reported. Overall, 26.7% of the sample reported significant symptoms of ADHD in both childhood and adulthood.
CONCLUSIONS: This preliminary study suggests that severely obese women report significant symptomatology related to both childhood and adult ADHD.
I first read about this topic in a chapter (“Disordered Eating and ADHD,” contributed by Levy and Fleming) of Gender Issues and ADHD: Research, Diagnosis, and Treatment, edited by Patricia Quinn, M.D. and Kathleen Nadeau, Ph.D. 2002. (You can purchase the book or just the chapter here, and while you’re at it, check the other great hard-to-find resources for women with ADHD).
(By the way, psychologist Kathleen Nadeau, and physician Patricia Quinn teamed up originally to address the long-overlooked needs of women and girls with ADHD, founding The National Center for Girls and Women with ADHD. In the process — through their many books, lectures, and other efforts — this pioneering pair has expanded our knowledge in all aspects of ADHD, across genders and the lifespan. So, it’s not at all surprising to know they were on the vanguard of creating awareness on this ADHD-obesity issue. I can assure you that many men with untreated ADHD also suffer problems with keeping their weight in check.)
What Exactly is the Connection Between ADHD and Weight Challenges?
Consider this excerpt from article written by Nadeau, entitled “Diet and Weight Management Strategies for Adults with ADD (ADHD).”
“The ADHD/disordered eating connection is not difficult to understand. Healthy dietary regulation requires organization and planning – two areas of cognitive functioning that are typically difficult for those with ADHD. Good eating habits also require self-awareness – awareness of when one is hungry, awareness of when one is full. Many individuals with (ADHD) report that they skip meals because they were busy and distracted; these same individuals often report that later their hunger becomes so intense that they swing in the opposite direction, overeating well beyond the point of reasonable intake because they don’t know when to stop until they feel ‘stuffed.’ And individuals eat for many reasons besides hunger – including boredom, self-stimulation, anger, sadness, reward, simple food availability, and stress relief. It is easy to understand how consistent self-regulation, which is a well-documented difficulty for those with ADD (ADHD), can lead to patterns of chronic over-eating.”
The websites for Dr. Levy and Dr. Fleming include informative articles and video interviews.
How about you? Do you think ADHD has affected your or your partner’s ability to maintain a healthy weight? (And remember: some people with ADHD might be chronically underweight for reasons similar to those who are overweight — lack of planning, not paying attention to internal phenomenon, etc.)