Obese patient's case leads to research suggesting link between ADHD and obesity.

[MSD]

globeandmail.com: Attention-deficit disorder linked to obesity

Paige Gilmore used to be so large she couldn't buckle up a seat belt in a car, or go on a roller-coaster ride with her son. No chair was big enough to hold her 420-pound, 5-foot-7-inch frame.

Dieting had never helped Ms. Gilmore, who has been overweight since the age of 9. "Once you get past 350 pounds, you can't even be weighed on a regular scale," she said. "I was desperate. I was hiding food and eating it for comfort. It was like a tic."

Then her doctor made an astonishing discovery - one that is revolutionizing the way morbidly obese people are treated, and viewed by society.

He diagnosed her with attention-deficit hyperactivity disorder, a neuro-developmental irregularity that causes people to behave impulsively and seek constant stimulation. They nibble to counter feelings of restlessness, explains her physician, Lance Levy, a Toronto specialist in nutritional medicine.

"ADHD is a primary cause of failing to lose weight for tens of thousands of people," said Dr. Levy, who is with the Nutritional and Eating Disorders Clinic. "Obese people are three to five times more likely to have it than the regular population. And if you treat them, you will see a significant weight loss."Dr. Levy and his co-authors - psychologist John Fleming and dietitian Doreen Klar - have just published their groundbreaking research in the International Journal of Obesity, a peer-reviewed scholarly journal.

Their study of 242 obese patients found that 32 per cent had ADHD, compared with 4 to 7 per cent in the general population. When treated for ADHD, the patients were able to lose 12 per cent of their body weight within 14 months. These patients, who were given psycho-stimulants to increase the dopamine in their brains, had tried and failed to lose weight for at least a decade.

Obese people with ADHD cannot respond to the signals in their brains that tell them when they are hungry and when they are full. "Their stomachs stretch and they can tolerate a degree of fullness that would make the average person throw up," Dr. Levy said.

Someone who weighs 420 pounds has to eat about 3,200 calories a day just to maintain that weight. They often suffer from other health issues, including depression, sleep disorders, chronic pain and gastrointestinal problems.

Ms. Gilmore, now 41, calls the diagnosis "a gift" that has changed every aspect of her life. "I used to eat to calm myself down. It was a way to self-medicate," she said. "I don't even remember how much I used to eat."

Weight-loss programs stressing lifestyle and dietary changes didn't work for her because she didn't have the perseverance to follow them.

After being diagnosed with ADHD in 2004, Ms. Gilmore was able to stabilize her health and reduce her blood pressure enough to be a candidate for gastric bypass surgery, which she had two years later.

At 225 pounds today, she is half of her former self. She no longer suffers from sleep apnea, diabetes or high blood pressure. And she has learned to read the hunger cues her brain sends out, and no longer binges on potato chips and chocolate bars, or eats over-large portions.

Better able to concentrate at work, she has also been promoted to administrative assistant in her role with the federal government. Even the nail biting has stopped.

Ms. Gilmore was never screened for ADHD as a child because there was a perception the disorder afflicted only young boys who acted out in class.

"I associated it with people running around crazily. I never imagined it was something I have," she said. "In high school I was labelled a daydreamer and lazy."

Yet all the classic symptoms were there: difficulty absorbing information, managing her time and finishing assignments.

A prejudice against ADHD persists to this day - even though it is a genetic, neuro-developmental problem that shows up in brain scans, Dr. Levy said. Afflicted people have a lack of dopamine and noradrenalin receptors in the area of their brain that is in charge of deciding how they attach and detach their attention. "It was thought that you 'grow' out of it. But it doesn't go away and can even worsen in menopause," he said.

The link between ADHD and obesity is so crucial, according to Dr. Fleming and Dr. Levy, that their centre will open a special screening program for the disorder next month. "Physicians should consider ADHD as a key contributing cause of obesity and the inability to lose weight," Dr. Fleming said.

Today, Ms. Gilmore shops for groceries and cooks healthy meals for her family. She gardens, climbs stairs, and fits into restaurant booths and chairs. "I've even had people flirt with me," she said, laughing.

When her son's weight climbed dramatically a few years ago, she took him straight to the doctor. "Turns out he also has ADHD," she said.

Unlike his mother, he won't have to wait until he is an adult to be treated.

I'm overweight and have ADHD. I sympathize with the poor impulse control when it comes to eating, and I can easily see how a connection between overeating and ADHD is possible. On the other hand, medications tend to be stimulants. Of course amphetamines (Adderall is a blend of 4 amphetamine salts) and methylphenidate (Ritalin, et. al, which act on the same neurotransmitter transporters as cocaine, in a somewhat similar way,) will suppress appetite and boost your metabolism since that's what stimulants do. During finals week in college, I would sleep 3 hours a night and subsist on Gatorade with a piece of fruit once or twice a day because I was so hopped up on Concerta that I had no appetite and was dehydrated. All I can say at this point is that I'm looking forward to further research on the subject, because I don't really know where we stand after only one study. From experience, the ADHD people I know tend to be really skinny and/or athletic guys who channel their energy into physical activity.

Does anyone else have experience with ADHD and obesity? You, friends, family?
Is anyone an expert with formal education on the subject? How about teachers who almost certainly deal with a handful of ADHD kids every year/semester/whatever?

[genuinegirly]

Fascinating!
I hope that more studies are done on this correlation. Just the idea of testing an obese person for ADHD is a new one - why not?

My sister has ADHD. She is far from obese. Her hyperactivity is let out by constant foot-tapping and running. She also spends lots of time chasing her children, playing in playgrounds, etc. She tends to forget to eat more than overeat. But when she thinks to eat, goodness she has a huge meal. All those calories she burns during a day really catch up with her.

[Shaindra]

It could also be the other way around. Obesity affects your body chemistry in thousands of ways. Why not attention?

[Willravel]

The theory, that increased impulse control problems cause increased snacking and binging, make sense, but I'd really like to see data before making up my mind. It could just be that obesity and ADHD are so common.

BTW, MSD, just do what I do: schedule every meal and snack for the month, and only buy that food. So long as you can keep yourself from diving into a McDonalds on the way home, you'll learn to eat right. I'm eating carrot sticks as I write this and it's just as satisfying as chowing down on Doritos. It's less about taste and more about having something to do in the moment.

[SecretMethod70]

It makes perfect sense. Also notice, she was diagnosed only recently and hasn't been taking medication. I think it's fair to say that if someone is already diagnosed and taking medication but still overweight, it's not the ADHD as the root cause.