ADHD and obesity. Treatment really makes a difference.

FoodMy last blog described a case history of a very obese male patient who could not manage any diet or lifestyle changes, while being very adept at running a complicated business.  Let me tell you what we found out about Peter.

To make a long story short, when we managed to put all the pieces of the puzzle together, we noted that while he could exert great focus on matters that were highly time sensitive, interesting, and important, he could not spend time on himself.  He was unable to change focus from work activities to self care needs if he was involved in the business.  He did not stop for food, got very hungry, and then binged once the work was over.  He recognized his problem, but seemed powerless to stop work for even 15 minutes to have lunch.

In time, we discovered that he suffered from ADHD, combined subtype.  Suddenly we had a reason for his weight loss failure.  He could not time manage.  He was impulsive, taking on the issues that were most interesting or time sensitive, and forgetting to eat, drink, or even sleep.  He buzzed along for 18 hours at a time oblivious to his hunger, thirst, or tiredness, and was always rushing somewhere to help out in the community once the trucks were ‘put to bed’.

He was well liked, but felt so inadequate he always sought approval, garnered by helping people day or night with their problems.  Aside from being exhausted and dangerously overweight, he was often quietly depressed, and angry with himself for being such a personal failure.  He lived in fear people would discover he was not really successful but a “phoney” who barely managed to hold everything together.  Once diagnosed and treated, he lost almost 200 pounds over the following 18 months, was no longer depressed, and was much more successful in having a personal life.

In 2001, Dr. John Fleming and I presented his case in at the annual ADHD convention in Seattle.  Since that time we have completed and published other research studies which confirmed that as BMI rises, the chance that ADHD is the primary cause of obesity rises as well.  Some of our patients began to have weight problems in childhood (generally those with more clinically severe ADHD symptoms), some in teen years, as demands for better school work or self regulation overcame their coping skills, or as adults, where life challenges also overwhelmed their ability to manage commitments, sleep, and so forth.

Eating became a way of managing anxiety, fatigue, inner restlessness when under-stimulated, and so on.  For example, where BMI is 40 or more (meaning a person weighs roughly twice what the weight tables say they should weigh) the chance that ADHD is the cause of weight gain, and of failure to lose weight, is 32% by very conservative measurements.  In the Paediatric field, it is now clear that at all ages kids with ADHD are fatter than their peers.  Fat kids generally become fat teens, who become fat adults, who have serious risks for early heart attack, hypertension, arthritis, diabetes, and sleep apnoea.  We have proven that ADHD pharmacotherapy of overweight kids and adults of all ages who have ADHD, results in significant weight loss that continues beyond 1 year.

In addition, treating ADHD vigorously also has the benefit of making people of all ages more productive, healthier, and safer.  With what we now know about ADHD as a primary cause of obesity and of inability to lose weight, everyone with a weight problem should be screened for ADHD as a matter of medical necessity. Dr. Fleming is going to be blogging about how the diagnosis is made.

10 Replies to “ADHD and obesity. Treatment really makes a difference.”

  1. I’m enjoying Dr. Fleming’s contributions to TotallyADD.com. The only point I’d like to mention is that I’ve learned that some ADD medicines have a side effect that serves as a form of appetite suppressant so that patient’s weight (regardless of it being within norms or not), is affected. Also I know several children taking prescription medications for ADD who are normal weighted so the “it is now clear that at all ages kids with ADHD are fatter than their peers.” seems to be a very broad brush to paint this population with. Activity levels and nutrition should be the focus then pharmacotherapy if needed. In Louisiana, 36% of the children are considered obese but I don’t believe they all have ADHD.

    Please correct me if I am wrong? Thank you, M

  2. This seems kind of weird to me, because I’ve gained about 30 pounds since going on medication. Before, I felt so restless I also had to walk a couple of miles a day. Now that I’m more calm, I tend not to get as much exercise. Also, my son is extremely thin, and on ADHD medication. So maybe there are other factors?

  3. These words are music to my ears!! Yes the meds used to treat ADHD can and usually does suppress the appetite, with that said we know we need to eat to be healthy, I (I can only speak for my self) can now sit down and give careful though to what I’m going to put into my body. I just started on Adderall, I’m still trying to find the right dose for me, but when that time comes I look forward to being able to sit down and plan my meals based on nutrition, and what my family and I need.
    This makes a lot of sense, I am at least 100lbs over weight and I really hope I’ll be able to loose this weight, and be healthy. This article has given me a lot of hope. Thank you!!

  4. I’m sorry, I do have a problem with the comment:
    “In the Paediatric field, it is now clear that at all ages kids with ADHD are fatter than their peers.”

    I have not found this to be true, however I have noticed it to be true in some cases of what appears to be undiagnosed adults. We tend to eat due to internal stress. The children, especially those with the combined or predominantly Hyperactive tend to be of normal weight, or in my son’s case – under weight. They don’t want to stop long enough to eat, or they forget to eat.

  5. I’ve been skinny and hyper all my life. But, just like the man in the example, I have trouble taking care of myself.

    How do I learn to do that? Really, HOW? It isn’t enough to point out the problem. It may seem obvious to the doctor, but I can’t seem to do it — not for very long anyway. How do I stop working long enough to exercise and eat right when I KNOW that I have to work longer and harder than everybody else? Really, HOW?

  6. I have been obese for a long time. I’m a successful attorney in NY, but have always had trouble balancing my personal/health needs with work. I’m great at solving everyone else’s problems, and I’ve made a career out of crisis management. But solving my own problems, not so much. Recently, I went to get clearance for gastric bypass surgery (my BMI is over 42). I found the screening interview helpful, so I decided to go back for regular therapy. She suggested I might have ADHD, and holy cow is she right. I’m going to get formally diagnosed, and hopefully avoid having the surgery. This is a real bell ringer for me. Thanks.

  7. I am a former smoker and when I was in my early 20s I probably drank too much. I rarely drink now. My remaining vices are inactivity and EATING. I will be going to see a professional in a few weeks, I hope to get a diagnosis for ADD and help with weight management. I am obese and not loving it. I’m only 30yrs old, I don’t want to live my life in, what I call, “my bear suit”.

  8. Dr. Flemming, can you be more specific about what you mean when you say you “treated” his ADD? Was there a particular med that was helpful? Did he have to have corrective surgery for the weight loss, or was it simply the meds?

  9. and all this time i thought i had an eating disorder.. i can’t stick to anything, i was raw vegan for a year and lost 115 pounds in like 7 months. i gained it all back of course cause eating raw is highly restrictive and it takes alot of disapline, which i have, but only for a short matter of time. once i fall off, it is all over.

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