How ADHD Contributes to Obesity in Children
Appetite loss is a common and well-known side effect of ADHD medications. But did you know that ADHD may substantially increase a child’s odds of becoming overweight later in life? Learn why, and what parents can do to encourage a lifetime of healthy, mindful eating.
Children with ADHD are energetic, playful, highly engaged, and… did we mention energetic? That’s the stereotype, anyway. But the reality is that ADHD (particularly the inattentive type) does not automatically bring with it calorie-burning energy and a sleek physique. Its symptoms may actually trigger and exacerbate serious weight problems.
Psychologist John Fleming, Ph.D., of the Nutritional Disorders Clinic in Toronto, is among the first scientists to link ADHD and weight gain. In a 1990 study of overweight people who seemed unable to shed any pounds, Fleming found that subjects with ADHD exhibited “disturbed eating habits, with typically no regularly planned meals or snacks, and an inability to follow dietary plans for any useful length of time.”
Indeed, decades of research show a strong correlation between ADHD and obesity — so strong, in fact, that someone with ADHD is four times more likely to become obese than is someone without ADHD. Brain chemistry, poor impulse control, and erratic sleeping habits all conspire to encourage unhealthy eating — and to make weight loss feel impossible.
That doesn’t mean a child with ADHD is doomed to a life of obesity. But it does necessitate a serious understanding of ADHD’s effect on food intake, exercise habits, and overall health. Here’s why ADHD may make your child or teen more prone to gaining unwanted weight — and what you can do to get and keep him healthy.
Why ADHD Often Leads to Obesity
Despite their assumed hyperactivity, kids with ADHD are less physically active, eat fewer healthy foods, and have higher BMIs than do people without ADHD, according to studies. This may seem counter-intuitive, but understanding ADHD provides clarity: The symptoms of ADHD that make it difficult to focus at school or manage appropriate behavior at home also make it exceedingly hard to eat properly and exercise on a regular schedule.
Some factors of ADHD that make it easier to slide toward obesity include:
Executive function deficits: Maintaining a healthy weight requires robust executive functioning skills — used for everything from planning balanced meals to sticking with that daily bike ride. Kids with ADHD have naturally weaker executive functions, which makes starting (and keeping up with) a healthy daily routine much more taxing. Right now, you can micro-manage what your child eats and when he exercises, but your child must be able to manage that successfully on his own one day, and executive function deficits make it very hard.
Impulsivity: The ADHD symptom of impulsivity can have a devastating effect on an individual’s health. We are all bombarded with tantalizing (i.e. high-fat, high-sugar, high-carb) food daily. Most people can successfully manage their food-related impulses — and say no to a daily doughnut, for instance. Individuals with ADHD-fueled impulsivity cannot. Their impulses take the wheel and they reach for (and devour) the junk food before their minds catch up to say, “No!”
Poor interoceptive awareness: Interoceptive awareness helps us sense what’s going on inside our bodies — whether that’s hunger cues, thirst markers, or physical fatigue. A child with ADHD, however, is oriented outward — always looking for the next source of stimulation. As a result, she may struggle to pay attention to and make sense of what her body is telling her. Individuals with ADHD are more likely to interpret thirst (or boredom, or exhaustion) as hunger, and will often turn to food to fulfill that unclear internal need.
Poor sleep habits: A brain that’s constantly whirring will find it hard to “shut down” at the end of the day and fall asleep, so it’s no surprise that ADHD brings with it fitful or disordered sleep. And a wealth of research finds that sleep deprivation is a large factor in promoting obesity. When our bodies are sleep deprived, our brains release hormones that push us to overeat — particularly unhealthy foods that are high in fat and sugar. Simultaneously, our metabolism drops as our bodies attempt to conserve fat. This is an evolutionary relic of our caveman past — when lack of sleep usually meant famine — but in modern times, it backfires on sleep-deprived ADHD bodies.
“Procrastin-eating:” There’s an ADHD tendency to put off boring tasks by eating instead, a phenomenon that’s been dubbed “procrastineating.” Devouring a cheesy pizza is infinitely more interesting to the ADHD brain than is writing a term paper. Therefore, snacking becomes a tempting — albeit unhealthy — form of procrastination.
Low levels of neurotransmitters: ADHD is a neurological condition traced back to the brain’s neurotransmitters. The precise mechanism underlying the link between obesity and ADHD is yet to be discovered, but the evidence suggests that the same low levels of the neurotransmitter dopamine that cause ADHD also encourage overeating. The chemicals dopamine and GABA exist in insufficient amounts in the brains of people with ADHD. Dopamine regulates and promotes arousal; low levels of dopamine result in an under-aroused, “bored” brain. GABA controls inhibition. A person with adequate levels of these neurotransmitters can typically stop himself from eating an entire box of cookies. Someone with low levels does not receive the brain signals alerting him to potential long-term harm — his brain focuses only on how delicious (and stimulating) the cookies are right now.
“Hormones and puberty definitely play a role in weight gain, as well,” says Roberto Olivardia, Ph.D., clinical psychologist at Harvard Medical School. “Sometimes pre-teens can gain weight as the body prepares for a growth spurt in height. Therefore, BMI normalizes as they gain height.”
People with ADHD 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 ADHD.”
Of course, individuals eat for many reasons besides hunger, including boredom, sadness, anxiety, as a self-reward, and so on. Olivardia reminds us that teens with ADHD have more independent access to food and bigger portions of food, which can result in unhealthy choices. “Parents have less control over what teenagers eat since they are not always with them,” he says, “and this most likely plays a bigger role in weight gain.”
Presumably, the less a child can regulate his eating habits, the more likely he is to overeat.
Behavioral Changes to Manage Your Child’s Weight
Is your child’s ADHD brain working against his health? Yes. Is it pointless to fight back? No.
Healthy eating habits may lead to improved ADHD symptoms, which in turn leads to healthier eating. Getting started is the hardest part; here are some simple strategies to begin:
- Be your child’s “binoculars.” Kids and teens inherently have a hard time seeing the future consequences of today’s actions; that’s especially true for anyone with ADHD. “A parent’s job is to be their child’s ‘binoculars,’ and help their child see through them,” Olivardia advises. Sit down together and ask your child to name his biggest goals for the coming year.
Then, explain how eating healthy supports each one of those goals, and choose one behavior at a time to focus on. “For example,” Olivardia says, “if your child says he wants to be strong, [you] can say that it is a fact that eating eggs supports that, and donuts do not. So, one goal this week can be for your child to ask himself, ‘Will this support making me strong?’ when making food choices. Create a list of foods that support this goal — and ones that do not — and post that on the refrigerator.”
- Plan your family’s meals and snacks. Since ADHD leads to poor interoceptive awareness, kids with ADHD may not notice they’re hungry until they’re starving. By that time, it’s often too late to prepare a well-balanced meal because your child is already raiding the pantry for carbs. Manage this (and overall impulsivity) by setting aside a time each week to plan your family meals and snacks; with planning, you’ll be prepared with healthier options when hunger strikes.
Within that plan, be sure you’re setting up a “food environment” that promotes healthy eating. That means not buying chips, chocolates, and other snacks that encourage bingeing, while stocking up on nutritious, easy-to-grab meals and snacks that require little preparation.
- Practice good sleep hygiene. The first step to losing weight? Get more sleep. Sleep is critical to rebuilding our bodies and keeping our brains running smoothly. In addition to regulating your child’s hormone levels, a good night of sleep will render him less moody, less stressed, and less likely to turn to food for comfort in fragile moments. To learn how to improve your child’s sleep hygiene, read this.
- Set healthy eating rules. Studies show that distracted eating — snacking while watching TV, for example — leads to greater food and/or calorie intake. Create family eating rules that encourage kids to eat attentively — for example, no eating while doing other things and no eating straight out of the bag. Requiring kids to eat only in the kitchen or dining area can help, as can serving food on smaller plates.
- Teach your child mindful eating. Keeping a food diary creates more eating awareness and, therefore, improves the chances of weight-loss success. Don’t just keep a log of what your child eats, but involve him so he learns how to keep his own food diary. The focus here is not on counting calories, but rather on practicing mindful eating and keeping a constant eye on long-term goals.
One simple way to practice mindful eating: Put down your fork in between bites. Or ask your child to describe what they’re eating as though the person listening has never tasted that food before — talking after chewing slows down a busy child.
- Set a good example. Kids learn by watching others, especially their parents. Be sure you’re setting a good example for your child by making smart food choices, dishing appropriate portion sizes, and not distractedly eating while engaging in another activity (like using your phone). Make exercise part of the family routine.
- Treat the ADHD. By boosting the brain’s so-called “executive functions,” ADHD stimulant medications help children better observe and regulate their behaviors, and avoid impulsive eating. They also make it easier to follow through with healthy eating and exercise plans — consistently driving toward a long-term goal is the ultimate executive function.
- Don’t use the word “diet.” The term “diet” has the negative connotation of deprivation, which causes many people to desire what’s forbidden even more, making it harder to achieve a healthy weight. Instead, your narrative should be about having a healthy relationship with food, and living a healthy lifestyle.
- Stick to a low GI eating plan. Since individuals with ADHD have a biological craving for carbs, trying to outright banish them seldom works. “Instead, explain carbs in a way your child can understand,” Olivardia says. “‘Simple carbs, like potato chips, taste good, but basically break down in the body as sugar. There is no nutritional value in simple carbs, and they get in the way of healthy weight, high energy, and other things that matter, like your complexion.’”
The rate at which sugar from a particular food enters brain cells, and other cells of the body, is called its “glycemic index” (GI). Foods with a high glycemic index cause sugar to empty quickly from the blood into the cells. Insulin regulates the ups and downs of blood sugar, and the rollercoaster behavior and food cravings that sometimes go with them. Low-glycemic foods, snacks, and meals deliver a limited but steady supply of sugar, helping a child with ADHD to control behavior and eat more mindfully.
Try meals and snacks high in protein, complex carbs, and fiber – like oatmeal and a glass of milk, scrambled eggs with whole-grain toast, or peanut butter on a piece of whole grain bread. The sugars from these carbohydrates are digested more slowly, because protein, fiber, and fat eaten together result in a more gradual and sustained blood sugar release. That means your child will be more satiated and for longer.
It’s not about eating fewer calories, it’s about eating the right foods and the right portions. It’s about using food mindfully to meet personal goals.
- Don’t micro-manage. “A parent cannot and should not micro-manage their child,” Olivardia warns. “It doesn’t teach the child anything and can create a hostile dynamic between parent and child.” Instead, be mindful of what foods are brought into the house in the first place, again, to create a healthy “food environment.” Display healthy snacks and fruits in plain view, and arrange the unhealthy food in the back of the refrigerator or pantry.