While I am taking a brief break from clinics and other obligations (including daily blog posts), I will be reposting past articles, which I still believe to be relevant but may have escaped the attention of the 100s of new readers who have signed up in the past months.
The following was first posted on 04/01/08 (For more recent posts on this topic click here)
There are over 50 recent publications in PubMed on the possible link between Attention Deficit Disorder (ADD) and obesity. In my own anecdotal experience I continue to be surprised on how many patients presenting with obesity have clear signs of this disorder.
They are usually the patients who show up late for appointments because they locked their keys in their cars, did not fill the last prescription for their metformin because they lost it, started filling out food records but never got past the first day, used their new bike only once because they never got around to fixing the flat tire from their first ride, take a packed lunch to work but forget to eat it, enthusiastically start a new diet but lose interest three days later because weight loss is too slow - I could go on forever - you probably get the picture.
In my practice I have come to recognize that ADD is probably one of the most common and frustrating barriers to obesity management. By definition, individuals with ADD lack the ability to plan ahead and to follow through on their plans, easily lose interest, and are constantly sabotaged by their impulsiveness when it comes to making healthy choices.
There is now evidence to support the notion that alterations in the dopaminergic reward system may be common to both ADD and hedonistic hyperphagia. Not surprisingly there is some work showing that methylphenidate (ritalin) can sometimes reduce cravings for sweet and fatty foods.
It does not surprise me that someone with ADD is probably more prone to “mindless eating” and thus more likely to gain weight than someone with proper impulse control.
One of the most remarkable cases I recall was a patient, who after being started on ritalin, at his next visit for the first time brought in and proudly presented meticulously completed food records (he was also a couple of pounds lighter).
In medicine it is always easiest to blame the patient - not motivated, not interested, not focused, not following instructions, not compliant, not adherent, etc.
Recognizing that this behavior may be due to ADD and providing proper treatment for this condition may in these cases be the first step to obesity management.
AMS
Edmonton, Alberta
In The News
September 2nd, 2009 at 3:02 pm
As a obesity management specialist i found the obesity ADD link very interesting as yes we deal w unfinished notes and forgetfullness a lot w our obese patients and it was never thought that w a no of them obesity might be also accompanied by undiagnosed ADD-we keep asking them again and again to concentrate not to lose instructions or food diaries and after reading this very interesting article it just explained possibilities of knowing why we are not getting ahead w wt management strategies inspite of not pressuring our patient s and taking it one step at a time w lifestyle change but i felt w some they are not capable of keeping it up so logically they might not have ability to concentrate or follow up on what they are required to do -its not because they are messy and want to stay that way -this surely shows that when dealing w obesity a lot should be incorporated in therapy it is a complex disease and the broader our thoughts go the nearer we are to ridding our patients from compulsiveness