All Obese Patients Should Be Screened For ADHD
Friday, August 31, 2012
Regular readers will recall previous posts on the association between attention deficit disorder (ADD) and obesity.
As this condition significantly affects impulse control, ability to plan, perseverance, time management, and many other factors and skills essential for weight management, this relationship should be no surprise.
In our own clinical experience (as suggested in several recent publications from others), managing ADD can often be the key step to managing weight gain.
Once you start systematically screening patients for ADD in an obesity clinic, it seems to be present in a surprisingly large number – almost 20-30%.
This number is consistent with the findings of another study, this time by Bruno Palazzo Nazar and colleagues from the Federal University of Rio de Janeiro, Brazil, published in the Journal of Attention Disorders.
The study sample consisted of women seeking nonsurgical treatment of obesity at a public endocrinology hospital with an eating disorders and obesity clinic, in Rio de Janeiro.
One hundred and fify-five consecutive patients presenting in the clinic were approached for this study. Exclusion criteria included less than 5 years of schooling/inability to read and fill out forms and questionnaires; current alcohol or drug abuse, history of bipolar or psychotic disorder; current treatment with psychoactive drugs; and presence of uncontrolled clinical, neurological, or endocrine disorders, especially if they interfere with weight, appetite, and attention; and patients older than 60 years.
Based on a battery of validated questionnaires and semi-structured interviews, 28.3% of patients were diagnosed with ADD, which, in turn, was significantly correlated with more severe binge eating, bulimic behaviors, and depressive symptoms.
As the authors note, this rate of almost 30% is far higher than the expected rate of less than 5% in the general population.
In fact, given the rather rigorous exclusion criteria, the actual prevalence of ADHD in this patient set may actually be even higher.
As a clinician, I’d certainly support the notion that we should be aware of the high prevalence of ADHD in patients presenting in obesity programs. Making this diagnosis and managing this issue, may make all the difference in long-term outcomes.
AMS
Cambridge, UK
photo credit: Peter Vidrine via photo pin cc
Nazar BP, Pinna CM, Suwwan R, Duchesne M, Freitas SR, Sergeant J, & Mattos P (2012). ADHD Rate in Obese Women With Binge Eating and Bulimic Behaviors From a Weight-Loss Clinic. Journal of attention disorders PMID: 22930790
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Friday, August 31, 2012
Dr. Sharma,
Today’s post on ADHD really hits home to me because I was not diagnosed with ADHD until I was in my early 50s, just starting nursing school to acquire my B.S. in nursing and earn my RN license. No one suspected or inquired about ADHD related symptoms, partly because I had already earned degrees in Liberal Arts, including an M.A. in English. It was assumed that someone suffering from ADHD could not have accomplished those academic feats. However, I did weigh over 300 lbs, and 2 of my children had been diagnosed and treated for ADHD. The medication was a godsend, and I was able to master high level maths (Algebra and Trig), which I had not encountered for over 30 years. Also, I was finally able to memorize all that was necessary to pass Chemistry, Anatomy and Physiology, and Microbiology. That’s a lot of memorization (not a strong area, typically, for ADHD patients.) I’m convinced the medications also helped me lose weight. Six years have first being diagnosed, I weigh a “normal” weight for my age and height. Sadly, the U.S. social policies which determine eligibility, access to, and costs of pharmaceuticals have made it impossible for me to obtain the medications which are most helpful—those which provide the greatest symptom coverage, those which allowed me to feel, briefly, NORMAL. It is another source of pain to be deprived of medications that have proven so beneficial, and that could even improve my functioning enough to obtain good-paying work. Without access to the most effective medications, my years of hard work in school and my great sense of accomplishment after passing my RN license test now yield no improvement in my material conditions of life. So, I blog. It sure doesn’t pay any bills. Proper diagnosis without proper, effective (long term) follow up treatment access can make the original disability much worse. With all my student loans, it would have been much better to have never been diagnosed, to have never spent all that time and effort —only to have it denied because of socioeconomic conditions and inadequate political policies covering health care access. God, I hope Canada is doing a better job with all this! THanks for letting my cry on your shoulder. I needed that.
Saturday, September 1, 2012
I tend toward avoiding to further pathologizing of patients, obese or otherwise. This study unfortunately does not take into account the cognitive impairments linked to metabolic resistance due to over use of fructose and high fructose corn syrup. I’d love to see a control group of people on a clean diet but people do not tend to binge on natural foods. It’s difficult to tease out obesity and related impairments from the high processed manufactured foods which may be contributing to the over eating cycle and causing said impairments.
Sunday, September 2, 2012
Dear RN –
As I read your comment, I felt every bit of pain, frustration and defeat you stated. After FINALLY being diagnosed with ADD and hypothyroidism in my late 30’s, getting my thyroid, taking the ADD meds and getting “ADD-Coaching”, my career actually started to take off and my health started to get better. I was not only able to go back and finish my Bachelor’s degree – but I was able to go to grad school and get my MBA – something I NEVER thought possible despite the many, many, many speeches from parents and teachers starting with the phrase “you’re so smart, why won’t you pay attention and focus..?” and ending with “… you need more discipline.” These speeches were very similar to the ones that started with “You’re so pretty, if only you’d lose weight”.
Now I have student loans, and I’m underemployed in a position that requires me to excel at things I’m not naturally good at (data entry, database management, filling out forms, etc…). Everyday I wonder if I should have just stayed in my dark hole, continuing to spin my wheels, feeling exhausted all the time and unable to meet the day to day challenges of life. Just this month I was diagnosed with a neurological disease and the one of the side effects of the meds to manage it is (yes, you guessed it…) weight gain. I’m tired of being a target of contempt because I’m obese, labeled as lazy because I’m obese and because I thought I filled in every box on a form but I missed one and criticized for alack of self-discipline when that isn’t the case. So much of the deck is stacked against me, and it’s just so hard to get up every day and start over.
Whew… it does feel good to get it off your chest! I wish the medical community in the US were in a better posiition to educate patients (and the communities they serve) when it comes to managing chronic conditions instead of furthering the idea that pills and surgery “fix” the problem and then you can just fall back into the habits/trends of the majority of the marketplace and “everything will be OK”.
Thank you.
Thursday, October 9, 2014
I actually sought treatment for ADD prior to bariatric surgery and was told to weight until after my surgery. I weighted 11 months post-op to seek treatment again. I firmly believe that the 10mg of generic adderall that I take daily has played a huge roll in my success.
Prior to surgery, and even prior to being medicated, I constantly felt like my self-diagnosed ADD was a major factor.
Thank you for shedding light on this. How can I help bring more awareness to this issue?
PS: The adderall does not server as much of an appetite suppressant for me. I can easily overeat/eat calorie dense foods if I want. I actually have a very GOOD appetite regardless of whether or not I take my medication, however, on the days when I’m not medicated I find myself making food choices that I don’t otherwise make. I’d say that’s pretty much proof of exactly what you wrote here.