Are You “Chemically Wired” to Gain Weight?
Impulsive or disordered eating and unplanned meals are partially to blame for ADHD’s strong correlation with obesity. And then there’s your dopamine-seeking brain, which loves carbs and sugar. Learn how to lose weight the ADD way.
The Link Between Disordered Eating and ADHD
Obesity is a significant problem in the U.S., with two out of three Americans now classified as overweight1 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 hyperactivity disorder (ADHD or ADD). And, given their impulsivity and their often-erratic eating habits, people with ADHD have an unusually difficult time losing excess weight once they’ve gained it.
“For a significant number of overweight people, ADHD may be a contributing factor,” says psychologist John Fleming, Ph.D., of the Nutritional Disorders Clinic at Toronto General Hospital.
Fleming is among the first scientists to link ADHD and weight gain. In the 2002 book Gender Issues and AD/HD: Research, Diagnosis and Treatment (#CommissionsEarned), Fleming references an unpublished pilot study2 of obese clients conducted at the Nutritional Disorders Clinic in 1988-90. In studying these individuals, Fleming found that they 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 ADHD, right? Fleming thought so, too. And looking deeper, he discovered in a 2005 study3 that the rate of ADHD 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 ADHD 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-ADHD peers.”
ADHD Dopamine and Disordered Eating
The precise mechanism underlying the link between obesity and ADHD is yet to be discovered. But the evidence seems to suggest4 that the same low levels of the neurotransmitter dopamine that cause ADHD also encourage overeating.
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.”
Sources of Disordered Eating
On a behavioral level, possible links between obesity and ADHD seem obvious. To avoid overeating, an individual must be capable of planning ahead; that’s something people with ADHD 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 ADHD.
In my practice, individuals with ADHD frequently tell me they 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.
Disordered Eating and Weight Regulation
Diets and formal weight-loss programs seldom work for people with ADHD. If people who don’t have ADHD find it difficult to keep detailed records, weigh their food, and adhere to exact portion sizes, what chance do those with ADHD 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 adults with ADHD become better at observing and regulating their behaviors and avoiding impulsive eating. They also make it easier 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 with ADHD. 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 with ADHD 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 ADHD 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.
Kathleen Nadeau, Ph.D., is a member of the ADDitude ADHD Medical Review Panel.
1 Overweight & Obesity Statistics. National Institute of Diabetes and Digestive and Kidney Diseases. (Aug. 2017). https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity
2 John Fleming, Lance Levy. ADHD and Disordered Eating. (1988-90). http://drjohnfleming.com/adhd-and-disordered-eating
3 Fleming JP, Levy LD, Levitan RD. Symptoms of attention deficit hyperactivity disorder in severely obese women. Eating and Weight Disorder. (Mar. 2005). https://www.ncbi.nlm.nih.gov/pubmed/16682849
4 Patte, K. A., Davis, C. A., Levitan, R. D., Kaplan, A. S., Carter-Major, J., & Kennedy, J. L. A Behavioral Genetic Model of the Mechanisms Underlying the Link Between Obesity and Symptoms of ADHD. Journal of Attention Disorders. (Jan. 2016). https://doi.org/10.1177/1087054715618793
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