In my clinical practice I remain impressed by the surprisingly high incidence of attention deficit hyperactivity disorder (ADHD) in my obese patients. Many have had symptoms all their lives, many have kids diagnosed and treated for ADHD, but have never considered that they may have this condition themselves.
Long-time readers of this blog will recall several previous postings on this issue - there is little doubt that ADHD is a major handicap in dealing with a weight problem. Lack of impulse control, difficulty planning and following through on lifestyle changes, compliance problems - all make it difficult for someone with ADHD to tackle their weight problem.
But how close is the relationship between ADHD and obesity in the general population?
Based on previous observations that while ADHD affects ~2.9-4.7% of US adults, this condition is reported to be present in 26-61% of patients seeking weight loss treatment, Sherry Pagoto and colleagues from the University of Massachusetts, MA, USA, revisited this issue in a paper published in this month’s issue of OBESITY.
Using cross-sectional data from the Collaborative Psychiatric Epidemiology Surveys, which includes data from 6,735 US residents (63.9% white; 51.6% female) aged 18-44 years, a retrospective assessment of childhood ADHD and a self-report assessment of adult ADHD were administered.
The prevalence of overweight and obesity was 33.9 and 29.4%, respectively, among adults with ADHD, and 28.8 and 21.6%, respectively, among persons with no history of ADHD. Thus, adult ADHD was associated with a 58% greater likelihood of overweight and 81% greater likelihood of obesity.
Further analyses suggested that binge eating disorder (BED), but not depression, partially mediates the associations between ADHD and excess weight. This is not surprising, given that poor impulse control is likely to affect binge-eating behaviour.
The study underlines what I have long proposed: assessment for ADHD should be part of routine work up for obesity and weight-related health problems. When present, ADHD can pose a major barrier to obesity management and should be addressed by CBT and/or medications.
AMS
Edmonton, Alberta
In The News
March 30th, 2009 at 7:21 am
[...] Original post by Dr. Sharma’s Obesity Notes » blog [...]
March 30th, 2009 at 9:21 am
is CBT cognitive behavior therapy?
March 30th, 2009 at 9:37 am
yes
AMS
March 31st, 2009 at 6:08 am
[...] response to yesterday’s post on ADHD and obesity, I was made aware of two recent studies, both relevant to this [...]
April 1st, 2009 at 11:11 am
Dear Dr. Sharma,
I just happened to come across your page. I actually work at UAH. I want to thank you for all you’re doing in the bariatric medicine and research. I had VBG surgery in Ontario back in its relative infancy in 1985. To make a long story short, it didn’t work. I lost weight for a while, but it just crept back on (and then some). The reason, I believe, was in not addressing the underlying emotional problems associated with obesity. In other words — treating the symptom and not the cause. I have; however, been sticking to a plan and since early February, have lost close to 40 pounds. I have not been tested for ADHD and I am wondering if this might be something I should look into. Again — thank you for your work!
May 8th, 2009 at 3:47 pm
Very interesting article! From what you have read and or seen, is there anything to suggest that obesity itself contributes to worsened effects of ADHD and could thus cause a cyclical loop that would be difficult to break out of? Given the often-stated comment that those with obesity suffer from bad nutrition, it would be interesting to know whether this poor nutrition impaired the cognitive function associated with decision making and restraint.