Evolutionary Psychiatry

The hunt for evolutionary solutions to contemporary mental health problems.

ADHD and Obesity

If you have ADHD, are you more likely to be overweight?

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If you were to guess, would you think that people with ADHD are more likely to be obese or skinny?

I would have thought skinny, just on first hunch.  Calories in = calories out, right?  And a lot of folks with ADHD are very fidgety!  Never sit still. In fact I seem to remember some press a few years back about how fit people tend to fidget and burn more calories than sedentary people, and how it might be the key to staying lean. One of the most telling sights on an adolescent inpatient psychiatric unit where there are girls struggling with anorexia is the amount of fidgeting during groups. These young ladies do not sit still, not for a moment, as they try every possible method to burn calories.

Well, when it comes to ADHD, the fidgeting does not seem to be enough to fight the fat.  In fact there are actually a number of studies linking ADHD to childhood and adulthood obesity.  One of the largest studies came out in late 2010 in the International Journal of Obesity.  About 12,000 people were followed over a decade or so from adolescence into adulthood, and records were kept of ADHD hyperactive and inattentive symptoms, along with waist circumference, BMI, blood pressure, physical activity, smoking, and alcohol use.  One weakness of the study is that no one tracked any measure of diet, but the results were telling nevertheless.

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Folks with ADHD symptoms in childhood were 41 percent likely to be obese as adults, whereas kids without ADHD symptoms were only 34 percent likely to be obese (still an appalling number—these are young adults, after all, with a mean age at the last wave of the study of 28.9 years), and the more ADHD symptoms you had, the more likely you were to be obese—those with three or more inattentive or hyperactive symptoms were 50 percent more likely to be obese as adults.

The discussion of the paper is interesting.  Quite a while back in my personal blog, I had a post on antidepressants and weight gain or loss. The take-home point is that medicines that seem to increase the dopamine response make you skinnier over time. Well, one of the theorized problems in a brain with ADHD is that dopamine isn't handled well or efficiently. As we know, dopamine is a neurotransmitter that helps us focus, plan ahead, and stay motivated. Here's a pertinent quote from the study:

"Genetic association studies have found that ADHD and obesity are both associated with genes regulating dopamine availability. Furthermore, in two separate studies using Positron emission tomography with [11C]...have shown that individuals with ADHD and those who are obese both show lower than normal dopamine (D2) receptor availability. This lower dopamine receptor availability could reflect the common dispositions in both ADHD and obesity."

The lack of self-restraint and impulsivity characteristic of ADHD could theoretically make it harder to restrain one's eating habits and leave one vulnerable to obesity.

I have some more theories about the association between ADHD and obesity.  ADHD is associated with food additives and a genetic vulnerability to highly processed diets.  There is a rather large Australian study showing a link between a processed foods "Western Diet" and the risk of ADHD in young people.  Twinkies aside, it's pretty clear that highly processed food diets are associated with more obesity in the long term.  (In the short term, most of us can severely cut calories any which way and lose weight. High carb, low carb, Twinkies, Slim-Fast TM, South Beach TMthey all work in the short term but typically have a 95 percent failure rate in the longer term. The key is what works to keep weight off for more than five years, which is the holy grail of obesity research at the moment.)

And then, of course, there is the fact that having ADHD is stressful, and one might end up with depression or anxiety, and then be more vulnerable to obesity via the inflammation pathway. Yikes! So many ways to get in trouble. How do we stay healthy and happy?

The answer is always the same. Practice stress reduction, sensible exercise, restorative sleep, and eat wholesome, nutrient-rich food because the causes all boil down to the same thing.  Eat what you are designed to eat, exercise, and chill out when you get the chance.  Enjoy family and friends. When things are already deranged it may not be a cure, but in most cases it will help. And unlike so many other Western medicine interventions that seem like good ideas at the time, real food and good sleep are unlikely to cause harm.

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Copyright Emily Deans, M.D.

Emily Deans, M.D., is a psychiatrist with a practice in Massachusetts.

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