Please Pay Attention – You May Have Obesity

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… Read More »

Obesity and Restless Legs Syndrome

Restless legs syndrome (RLS) is a not uncommon pervasive and unpleasant disorder characterized by a burning, tickling or itching sensation in the feet associated with an irresistible urge to move. The disorder, of which I used to see many cases in my patients on hemodialysis, is difficult to treat and can become so severe that it results in sleep deprivation and severe distress. Although its aetiology remains obscure, it has been linked to nutritional deficiencies (most commonly iron) but also to hypofunction of the dopaminergic system in the brain (as has obesity). In this month’s issue of Neurology, Xiang Gao and colleagues from Harvard Medical School, Boston, MA, USA, report a higher incidence of RLS in both the 65,000 women in the Nurses’ Health Study as well as the 23,000 Men in the Health Professionals Follow-up Study. Participants were considered to have RLS if they met four RLS diagnostic criteria recommended by the International RLS Study Group and had restless legs > or =5 times/month. RLS was present in 6.4% of women and 4.1% of men. Despite multivariate adjustment for age, smoking, use of antidepressant, phobic anxiety score, and other covariates, the odds for RLS were 1.42 for participants with BMI >30 vs <23 and 1.60 for the highest vs lowest waist circumference quintiles. The association was even stronger for individuals with greater BMI in early adulthood (age 18-21 years). The authors conclude that both overall and abdominal adiposity are associated with greater likelihood of RLS. This may not be surprising, because many of the conditions associated with RLS including nutritional deficiencies, sleep apnea, ADHD and others, are likewise more common in obese individuals. Clinicians should specifically explore the presence of symptoms of RLS in patients present with obesity and weight gain. AMS Edmonton, Alberta p.s for more information on RLS go to the RLS Foundation Website – click here for a patient information sheet in English or French