Search Results for "attention deficit"
Close Concerns: Stopping The Gain
Earlier this week, the influential healthcare information firm Close Concerns published a rather lengthy interview regarding my take on a wide range of issues related to the future of obesity management. The interviews were conducted by Joseph Shivers, Vincent Wu, Lisa Vance, and Kelly Close, who certainly challenged and stimulated my thinking with their well-informed questions. The following is another brief excerpt from this interview published in their newsletter Closer Look: JOSEPH: Is figuring out what obesity drug works for which person a matter of differential diagnosis? For instance, already we hear about personalizing drugs to a great extent, i.e., if patients are very hungry, then phentermine might be better for them, etc. DR. SHARMA: Yeah, there’s some of that. But again, I worked in hypertension for 20 years, where people have been trying to find that kind of link between the pathophysiology and the drug, and they’ve never figured that out. So I’m not holding my breath that this would work for obesity, although I’m sure people will be trying and there might be subsets where it might work. Unfortunately, we don’t currently have an etiological framework around obesity that opens up different pathways. Consider someone for whom overeating is more of an addiction problem. Drugs targeting addictive type of behavior would be more effective for that patient than in someone for whom overeating is a time-management problem: if you allow yourself to get hungry and that’s when you overeat. That is not going to be fixed by using a drug – unless perhaps the reason that you’re skipping meals and forget to eat is an underlying attention deficit disorder, which I could treat to help you better organize your meals and thus better avoid those hunger situations. Then if you take obesity in the elderly, for example, it’s most often related not to overeating, but to a lack of physical activity and other factors that may be approached in a very different way. There are lots of different reasons why people gain weight. But when you think about why people ‘regain’ weight, the story is very different, because irrespective of how you lose weight, the biological drivers of weight regain are pretty much a common denominator for everybody. So, regardless of how I lose weight, my leptin levels are going to drop, my appetite is going to go up, my hunger level’s will go up, my metabolism’s going… Read More »
Obesity and Mental Health – Beyond Pharmacotherapy
Continuing my posts on the recent articles on obesity and mental health published in the January issue of the Canadian Journal of Psychiatry, I now turn my attention to a paper by Valerie Taylor and colleagues on the many links between mental health issues and obesity. Whilst in the previous post I have focussed on the relationship between psychiatric medications and weight gain, a problem that is common knowledge to the mental health community, this article highlights many of the lesser known links between mental health problems and excess weight. These include interesting neurobiological, psychological, and sociological factors, that are now increasingly understood. For e.g. “‘Atypical’ depression, a type of major depressive disorder characterized by an increase in the need for sleep and food, may actually characterize the most ‘typical’ presentation of major depression For the majority of people with depression, therefore, a diagnosis of major depression is synonymous with a phenotype that increases vulnerability towards weight problems.” In fact, “The neurobiology of depression [also] confers increased risk of obesity. The most common biological perturbation associated with depression is an increase in cortisol. This increase, and the hypothalamic pituitary adrenal axis abnormalities that accompany it, is similar to changes seen in Cushing syndrome, an endocrinological illness caused by an increase in cortisol that is characterized phenotypically by excessive visceral weight gain. While levels of cortisol found in major depression disorders are much lower than that of Cushings, the biological impact of excess cortisol is similar; a predisposition towards increased deposition of centrally located adipose tissue.” In addition mood disorders often affect sleeping behaviour, which in turn affects important regulators of appetite and metabolism like ghrelin, leptin, adiponectin, and other hormones. Moreover, chronic inflammation may play a role in both major depression and obesity. In the case of schizophrenia, primary negative symptoms like amotivation, which can be observed even in the earliest stages of the illness, may lead to reduced physical capacity and altered self-perception. Hypodopaminergic activity may in part explain increased propensity for substance use, especially cannabis, which can promote hyperphagia. There is an increasingly recognized association between obesity and attention deficit disorder, and it may well be that impulsivity may play an important role in overeating. Also, “Poor planning and an inability to delay reward, processes largely mediated by the pre-frontal cortex, may lead individuals with ADHD to over-consume highly palatable, fattening foods. A related hypothesis is that individuals… Read More »
Dr. Sharma’s Obesity Notes: Weekend Roundup, October 11, 2010
As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts in order of popularity: Cognitive Behavioural Therapy for Attention Deficit Disorder Innovation and Sustainability in Health Systems Another APPLES Study Sibutramine Pulled From Market in US and Canada Meet the Canadians at Obesity 2010 Have a great Sunday! (or what’s left of it) AMS London, UK You can now also follow me and post your comments on Facebook
Clumsy Kids More Prone to Obesity?
Yesterday, I blogged about the finding that increased body fat appears to precede lower activity levels and not the other way round (which is probably why attempts to increase physical activity in kids has so far not done much in terms of obesity prevention). Almost on cue, the latest issue of the Canadian Medical Association Journal (CMAJ) publishes a study by McMaster University’s John Cairney and colleagues, suggesting that kids with developmental coordination problem (perhaps unfairly described as “clumsiness”) may be particularly prone to weight gain. The study builds on previous reports that kids with developmental coordination disorder were found to be less likely to participate in physical activities. The researchers studied 2278 (95.8%) of 2378 fourth grade kids (ages 9 to 10) from 75 schools in southwestern Ontario, Canada. Children were followed up over two years, from the spring of 2005 to the spring of 2007. Not only did the 111 children (46 boys and 65 girls) who had possible developmental coordination disorder have a higher mean BMI and waist circumference at baseline than the other kids, but these differences persisted or increased slightly over time. In fact, kids with with possible developmental coordination disorder were four times more likely to become obese over the course of the study. While this study is of course strongly suggestive of less physical activity being a risk factor for childhood obesity, it should be noted that the researchers did not directly measure activity levels. There was also no report of their energy intake or their mental health status (e.g. cognitive ability, depression, attention deficit disorder, etc.), which may significantly affect ingestive behaviours. There was also no mention of low birth weight, which may be associated both with developmental coordination disorder and excess post-partum weight gain. Finally, as the authors themselves are careful to note, obese kids have been noted to be less coordinated – so again, it is not clear if the sequence here is “clumsiness -> inactivity -> obesity” or “obesity -> inactivity -> clumsiness” or even “obesity -> clumsiness -> inactivity”. As always, solving ‘chicken or egg’ questions from cross-sectional or even longitudinal data remains challenging. This is exactly why we need more intervention studies. AMS Edmonton, Alberta p.s. You can now also follow me and post your comments on Facebook
DSM-5: Binge Eating in, Obesity Out
Yesterday, the draft version of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released for public comment until April 20. The book, which serves mental health professionals, is also used by insurance companies making decisions on treatment coverage and in courtrooms and schools. It was last revised in 1994. From what I’ve been able to garner from the news wires, the new Manual now clearly lists and identifies binge eating but not obesity as a mental health disorder. This is probably a good thing. While there is no doubt that binge eating disorder is a syndrome that requires specific mental health intervention, the same cannot necessarily be said for all of obesity. This is not to say that a large proportion of overweight and obese individuals may also have mental health problems ranging from poor body image to major depression, addictions or attention deficit disorder – I have often blogged about this before. But clearly, not everyone with excess weight also has a mental health diagnosis and certainly not all overweight patients need to be seen by a mental health professional. Indeed, as previously noted, obesity is really only the clinical manifestation of caloric excess, and is as such more a clinical sign than a discrete entity in itself. It would therefore make no sense to list obesity as a mental illness or to expect that all obese individuals must now seek help from a mental health professional. Nevertheless, given the importance of mental health problems either as promoters and/or consequences of weight gain or as important barriers to weight management, having mental health expertise in a weight management program is absolutely essential. I am sure that the DSM-5 will prompt a wide range of debates and discussions and I will certainly take a closer look at the relevant segments of this intimidating document. The final version of the manual is due to be published in 2013. Certainly appreciate comments from any of my readers who work in mental health. AMS Vienna, Austria
