Obesity is a huge problem in the U.S., with two out of three Americans now classified as overweight and nearly one out of three as obese. No doubt you're familiar with those statistics. What you may not know is that excessive body weight is unusually prevalent among people who have attention-deficit disorder. And, given their impulsivity and their often-erratic eating habits, ADDers have an unusually difficult time losing excess weight once they’ve gained it. "For a significant number of overweight people, AD/HD may be a contributing factor," says psychologist John Fleming, Ph.D., of the Nutritional Disorders Clinic in Toronto.
Fleming should know. He is among the first scientists to link ADD and weight gain. In a 1990 study of overweight people who seemed unable to shed any pounds, Fleming found that these individuals exhibited "clearly disturbed eating habits, with typically no regularly planned meals or snacks, and an inability to follow dietary plans for any useful length of time."
Sounds a lot like ADD, right? Fleming thought so, too. And looking deeper, he discovered that the rate of AD/HD was, in fact, five to 10 times greater among these overweight individuals than in the general population (30 percent versus 3 to 6 percent).
In the ensuing years, Fleming's basic discovery -- that there are links between ADD and obesity -- has been corroborated by other scientists, including Jules Altfas, M.D., of the Behavioral Medical Center for Treatment and Research in Portland, Oregon. "At all levels of obesity," Dr. Altfas explains, "patients with ADD symptoms were less successful at losing weight than non-ADD peers."
In search of stimulus?
The precise mechanism underlying the link between obesity and ADD is yet to be discovered. But the evidence seems to suggest that the same low levels of the neurotransmitter dopamine that cause ADD also encourage overeating.
People with ADD are "chemically wired" to seek more dopamine, says John Ratey, M.D., professor of psychiatry at Harvard Medical School in Boston. "Eating carbohydrates triggers a rush of dopamine in the brain," he says. "It's the drive for the feeling of satiety."
Lance Levy, M.D., a frequent collaborator of Dr. Fleming, says that eating several mini-meals throughout the day (grazing) provides a "source of ongoing stimulation that may lessen feelings of restlessness in people with ADD."
On a behavioral level, possible links between obesity and ADD seem obvious. To avoid overeating, an individual must be capable of planning ahead; that's something ADDers have a hard time doing. What's more, the individual must be capable of paying attention to feelings of hunger and satiety -- in other words, to know when he is hungry and when he is full. Again, that’s hard for people with ADD.
Many individuals with ADD report that they frequently skip meals because they are too busy or distracted to eat. These same individuals also say that, once they do eat, they eat ravenously -- because they have become extremely hungry and have a hard time telling when their stomachs are full. And, because they need to eat "now," they’re more likely to indulge in fast-food or high-calorie snacks.
Of course, individuals eat for many reasons besides hunger, including boredom, sadness, anxiety, as a self-reward, and so on. Presumably, the less able one is to regulate his eating habits, the more likely one is to overeat.
Diets and formal weight-loss programs seldom work for people with ADD. If people who don’t have ADD find it difficult to keep detailed records, weigh their food, and adhere to exact portion sizes, what chance do ADDers stand? Other weight-loss programs involve pre-selected, or even pre-packaged foods, and may work well in the short-term. But they don’t teach the most important lesson--how to make consistently good choices in real-world food environments.
What does work? Treating ADHD with stimulant medication, for starters. By boosting the brain's so-called "executive functions," stimulants help ADDers become better at observing and regulating their behaviors and avoiding impulsive eating. They also make it easier for ADDers to follow through with their eating and exercise plans—to be consistent. (Dr. Ratey says that if you're obsessive enough to keep a detailed record of everything that you eat, that may help you plan meals.)
Another way to avoid impulsive eating is to set up a "food environment" that promotes healthy eating. That means ridding your home of chips, chocolates, and other snacks that encourage bingeing, while stocking up on nutritious meals and snacks that require little preparation. Part-skim mozzarella sticks, hard-boiled eggs, yogurt, protein bars, dried fruit, nuts and seeds, apples, and oranges are all great choices.
Many ADDers find it helpful to do their grocery shopping on a set day each week, and then prepare large batches of healthful food that can be frozen and reheated for meals.
Finally, fight the ADD tendency to be impatient. After all, you're not going to lose weight overnight that you spent years putting on. Accept the fact that it will be a gradual process, and you'll be less likely to become frustrated and lose your resolve.
This article appears in the Winter issue of ADDitude.
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To share your ADHD diet and weight loss tips, visit the ADHD Nutrition and Weight Loss support group on ADDConnect.