Associations among overeating, overweight, and attention deficit/hyperactivity disorder: a structural equation modelling approach

Body weight and ADHD: examining the role of self-regulation

OBJECTIVE

Attention-Deficit/Hyperactivity Disorder (ADHD) is a complex and heterogeneous childhood disorder that often coexists with other psychiatric and somatic disorders. Recently, a link between ADHD and body weight dysregulation has been reported and often interpreted as impaired self-regulation that is shared between the two conditions. The objective of this study is to investigate the relation between body weight/BMI and cognitive, emotional and motor characteristics in children with ADHD.

METHODS

284 ADHD children were stratified by weight status/BMI according to WHO classification and compared with regard to their neurocognitive characteristics, motivational style, and motor profile as assessed by a comprehensive battery of tests. All comparisons were adjusted for demographic characteristics of relevance including, socioeconomic status (SES).

RESULTS

Both Obese and overweight ADHD children exhibited significantly lower SES compared to normal weight ADHD children. No significant differences were observed between the three groups with regards to their neurocognitive, emotional and motor profile.

CONCLUSIONS

Our findings provide evidence that differences in weight/BMI are not accounted for by cognitive, motivational and motor profiles. Socio-economic characteristics are strongly associated with overweight and obesity in ADHD children and may inform strategies aimed at promoting healthier weight.

Successful treatment with atomoxetine of an adolescent boy with attention deficit/hyperactivity disorder, extreme obesity, and reduced melanocortin 4 receptor function

OBJECTIVE

Recent case reports suggest a link between reduced melanocortinergic tone and both obesity and attention deficit / hyperactivity disorder (ADHD). We present the case of a 13-year-old, male, obese MC4R mutation carrier with ADHD.

CASE REPORT

The boy carries a heterozygous mutation in the melanocortin 4 receptor gene (MC4R; Met281Val), that leads to a reduced receptor function. Dominant mutations of this type represent major gene effects for obesity. He participated in a lifestyle intervention program for obesity and received treatment with the selective norepinephrine re-uptake inhibitor atomoxetine for 31 months. The boy markedly reduced his BMI from 47.2 to 29.6 kg/m².

CONCLUSION

Atomoxetine proved to efficiently reduce weight in a severely obese MC4R mutation carrier with ADHD. We briefly discuss possible mechanisms for our observation, including evidence for the functional connectivity between melanocortinergic, dopaminergic, and norepinephrinergic brain circuitries.

Reduction of bulimia nervosa symptoms after psychostimulant initiation in patients with comorbid ADHD: five case reports

Studies reveal a higher occurrence of bulimia nervosa (BN) in patients with attention deficit/hyperactivity disorder (ADHD) compared to controls. Due to this high degree of comorbidity, some clinicians have used psychostimulants in this population. The goal of this article is to describe five patients with comorbid BN and ADHD and their responses to a course of psychostimulants. After medication initiation, all five patients experienced a decrease in binge/purging and an improvement in ADHD symptoms. Overall, the medications were well tolerated. Possible mechanisms underlying the relationship between ADHD and BN, and words of caution are discussed. The need for clinical trials to further evaluate the efficacy of psychostimulants in this population is warranted.

FTO at rs9939609, food responsiveness, emotional control and symptoms of ADHD in preschool children

The FTO minor allele at rs9939609 has been associated with body mass index (BMI: weight (kg)/height (m)²) in children from 5 years onwards, food intake, and eating behaviour. The high expression of FTO in the brain suggests that this gene may also be associated with behavioural phenotypes, such as impulsivity and control. We examined the effect of the FTO minor allele (A) at rs9939609 on eating behaviour, impulsivity and control in young children, thus before the BMI effect becomes apparent. This study was embedded in the Generation R Study, a population-based cohort from fetal life onwards. 1,718 children of European descent were genotyped for FTO at rs9939609. With logistic regression assuming an additive genetic model, we examined the association between the FTO minor allele and eating behaviour, impulsivity and control in preschool children. There was no relation between FTO at rs9939609 and child BMI at this age. The A allele at rs9939609 was associated with increased food responsiveness (OR 1.21, p = 0.03). Also, children with the A allele were less likely to have symptoms of ADHD (OR 0.74, p = 0.01) and showed more emotional control (OR 0.64, p = 0.01) compared to children without the A allele. Our findings suggest that before the association between FTO and BMI becomes apparent, the FTO minor allele at rs9939609 leads to increased food responsiveness, a decreased risk for symptoms of ADHD and better emotional control. Future studies are needed to investigate whether these findings represent one single mechanism or reflect pleiotropic effects of FTO.

The effects of aerobic exercise on psychosocial functioning of adolescents who are overweight or obese

OBJECTIVES

To evaluate effects of stationary cycling to music versus interactive video game cycling on psychosocial functioning in obese adolescents.

METHODS

30 obese adolescents aged 12-17 years were randomized to twice weekly laboratory-based sessions of stationary cycling to music or interactive video game cycling for a 10-week trial. Participant's self-reported measures of scholastic competence, social competence, athletic competence, body image, and self-esteem were obtained. Aerobic fitness and body composition were directly measured.

RESULTS

Although no differences emerged between exercise groups over time, when collapsed across exercise modality, significant pre-post improvements were found for body image, perceived scholastic competence and social competence. Changes in aerobic fitness, but not body composition, were positively associated with psychosocial functioning.

CONCLUSIONS

Aerobic exercise was associated with improvements in body image, perceived academic performance, and social competence in obese adolescents, and these psychological benefits were related to improved aerobic fitness but not changes in body composition.

Attention deficit hyperactivity disorder increases the risk of having abnormal eating behaviours in obese adults

OBJECTIVE

To determine the rate of abnormal eating behaviours in obese adult patients with attention deficit hyperactivity disorder (ADHD) in comparison with obese adult patients without ADHD.

METHOD

This case-control study includes: obese adult patients defined by a body mass index (BMI) ≥30 kg/m², screening positive in the adult ADHD self-report scale-V1.1. (ASRS-V1.1), attending the Nutrition Section, as cases; and obese adult patients screening negative, as controls. Weight, height and BMI were determined in all the participants. The rate of abnormal eating behaviours was determined using an eating pattern questionnaire.

RESULTS

Forty-five out of 51 (88.2%) cases vs 127 out of 179 (70.9%) controls had abnormal eating behaviours (p=0.01). Eating between-meal snacks was found in 39 (76.5%) cases vs 107 (59.8%) controls (p=0.03), going on binge eating episodes in 28 (54.9%) vs 42 (23.5%) (p=0.00), waking up at night to eat in 11 (21.6%) vs 16 (8.9%) (p=0.01), eating large amounts of food in 13 (25.5%) vs 38 (21.2%) (p=0.52), and eating in secret in 11 (21.6%) vs 16 (8.9%) (p=0.01), respectively.

CONCLUSION

This is the first study that determines the rate of these abnormal eating behaviours in obese adult patients with ADHD in comparison with obese adult patients without ADHD. A high rate of abnormal eating behaviours was observed in obese patients with ADHD. Our results suggest that ADHD is a risk factor for the development of these abnormal eating behaviours, which may be contributing factors of obesity and the unsuccessful treatment of obese patients.

Obesity and risk taking. A male phenomenon

There is a growing tendency to regard overeating as an addiction, with obesity as its primary symptom. We propose that similar to other addictions, obesity is associated with excessive risk-taking in men, though not in women. To examine this suggestion we conducted two studies, one involving a sample of overweight and normal-weight students, and the other involving obese adults drawn from a dataset of health care clients, and a control sample of normal-weight adults. In both of these studies, we found that overweight and obese men took more risk in a laboratory task than normal-weight men, while overweight and obese women did not differ from normal-weight women in this respect. At the same time, obese women (but not overweight women) displayed higher impulsivity levels than normal-weight women. These findings shed light on the cognitive characteristics of obesity in men, and accent the importance of taking gender into account when developing research paradigms and treatment methods for obesity.

Possible association of the DRD4 gene with a history of attention-deficit/hyperactivity disorder in women with bulimia nervosa

OBJECTIVE

Up to one-third of patients with bulimia nervosa (BN) report a history of attention-deficit/hyperactivity disorder (ADHD) symptoms, and the dopaminergic genes, especially the dopamine receptor D4 (DRD4), have been associated independently with both binge eating and ADHD.

METHOD

The purpose of this study was to (1) compare the frequency of DRD4 exon III VNTR variants in 157 BN probands and equal number of healthy controls; (2) assess transmission of DRD4 alleles in 68 families of patients with BN; and (3) explore the possible role of DRD4 gene in childhood ADHD history in a subgroup of 81 women with BN.

RESULTS

Our results showed that the BN probands and controls did not differ in DRD4 allele frequency. We also did not find evidence for preferential transmission of any DRD4 variant to the affected offspring with BN. However, the presence of either the 2-repeat or 7-repeat allele was associated with a history of childhood ADHD in BN (p = .038, odds ratio = 3.2).

DISCUSSION

Our findings suggest that although DRD4 may not be associated with the diagnosis of BN, its variants are associated with a history of childhood ADHD in BN probands. This may have relevance for the understanding, prevention, and treatment of BN that evolves in the context of childhood ADHD.

The availability of snack food displays that may trigger impulse purchases in Melbourne supermarkets

Background

Supermarkets play a major role in influencing the food purchasing behaviours of most households. Snack food exposures within these stores may contribute to higher levels of consumption and ultimately to increasing levels of obesity, particularly within socioeconomically disadvantaged neighbourhoods. We aimed to examine the availability of snack food displays at checkouts, end-of-aisle displays and island displays in major supermarket chains in the least and most socioeconomically disadvantaged neighbourhoods of Melbourne.

Methods

Within-store audits of 35 Melbourne supermarkets. Supermarkets were sampled from the least and most socioeconomically disadvantaged suburbs within 30 km of the Melbourne CBD. We measured the availability of crisps, chocolate, confectionery, and soft drinks (diet and regular) at the checkouts, in end-of-aisle displays, and in island bin displays.

Results

Snack food displays were most prominent at checkouts with only five stores not having snack foods at 100% of their checkouts. Snack foods were also present at a number of end-of-aisle displays (at both the front (median 38%) and back (median 33%) of store), and in island bin displays (median number of island displays: 7; median total circumference of island displays: 19.4 metres). Chocolate items were the most common snack food item on display. There was no difference in the availability of these snack food displays by neighbourhood disadvantage.

Conclusions

As a result of the high availability of snack food displays, exposure to snack foods is almost unavoidable in Melbourne supermarkets, regardless of levels of neighbourhood socioeconomic disadvantage. Results of this study could promote awareness of the prominence of unhealthy food items in chain-brand supermarkets outlets.

A systematic review of global publication trends regarding long-term outcomes of ADHD

There is increased global recognition of attention deficit hyperactivity disorder (ADHD) as a serious medical condition with long-term consequences. Although originally conceived of as a childhood disorder, ADHD is being increasingly recognized in adults. Individual geographic regions may have specific interests and objectives for the study of ADHD. A systematic review of long-term outcomes (LTOs) in ADHD was conducted to evaluate research on ADHD LTOs on a global scale. Studies that were at least 2 years in duration were examined. A total of 351 studies were identified in the final analysis. We identified nine outcomes of interest and classified studies by specific geographical regions, age groups studied and study design by region and over time. Published studies of LTOs in ADHD have increased in all geographical regions over the past three decades, with a peak number of 42 publications in 2008. This rise in publications on ADHD LTOs may reflect a rise in global interest and recognition of consequences and impairment associated with ADHD. Although many world regions have published on ADHD LTOs, the majority of studies have emerged from the US and Canada, followed by Europe. While investigators in the US and Canada were predominantly interested in drug addiction as a LTO, European researchers were more interested in antisocial behavior, and Eastern Asian investigators focused on both of these LTOs as well as self-esteem. Geographical differences in the focus of ADHD LTO studies may reflect regional variations in cultural values. Proportionally fewer prospective longitudinal studies and proportionally more retrospective and cross-sectional studies have been published in more recent decades. Finally, more studies focusing on ADHD in adolescents and adults have been conducted in recent years, and particularly adolescents in Eastern Asia. These changes in basic study design may reflect an increase in the recognition that ADHD is a lifetime chronic disorder. This systematic review analysis of publication trends in ADHD LTOs reflects geographically based interests that change over time.

Examining the relationship between attention-deficit/hyperactivity disorder and overweight in children and adolescents

Although a higher prevalence of overweight/obesity was reported in clinical samples of patients with Attention-Deficit/Hyperactivity Disorder (ADHD), an association between overweight and ADHD has yet not been established in the general population in childhood. As both disorders are common and significantly affect psychosocial functioning, we investigated the prevalence of ADHD in overweight/obese youth and vice versa. In a cross-sectional nationally representative and community based survey 2,863 parents and their children aged 11-17 years rated symptoms on the Diagnostic and Statistical Manual of Mental Disorders-based German ADHD Rating scale. Weight and height were assessed by professionals. Body mass index was categorized according to national age and sex specific reference values. Overall, 4.2% of the respondents met criteria for ADHD. The prevalence of ADHD was significantly higher for overweight/obese (7%) than for normal weight (3.5%) and underweight (4.9%) children. In a logistic regression analysis controlling for age, gender, and socio-economic status, overweight/obese children were twice as likely to have an ADHD diagnosis (OR = 2.0). Vice versa, adjusting for all covariates, children with ADHD had an OR of 1.9 for overweight/obesity status. For all weight-status groups, children with ADHD more frequently reported eating problems as compared to their non-clinical counterparts. Overweight/obese respondents with ADHD displayed the highest level of health services utilization. A clinician should be aware of the significant risk for a child with ADHD to become overweight and for an overweight child to have ADHD. Longitudinal studies are needed to better understand the mechanisms underlying the association between ADHD and overweight/obesity.

Obesity and ADHD: clinical and neurobiological implications

Although quite overlooked, increasing evidence points to a significant association between attention-deficit/hyperactivity disorder (ADHD) and obesity. Here, we present an updated systematic review and a critical discussion of studies on the relationship between ADHD and obesity, with a particular emphasis on the possible behavioral, neurobiological, and genetics underlying mechanisms. Available empirically based studies indicate that the prevalence of ADHD in clinical samples of patients seeking treatment for their obesity is higher than that in the general population. Moreover, although still limited, current evidence shows that individuals with ADHD have higher-than-average body mass index z-scores and/or significantly higher obesity rates compared with subjects without ADHD. Three mechanisms underlying the association between ADHD and obesity have been proposed: (1) obesity and/or factors associated with it (such as sleep-disordered breathing and deficits in arousal/alertness) manifest as ADHD-like symptoms; (2) ADHD and obesity share common genetics and neurobiological dysfunctions, involving the dopaminergic and, possibly, other systems (e.g., brain-derived neurotropic factor, melanocortin-4-receptor); and (3) impulsivity and inattention of ADHD contribute to weight gain via dysregulated eating patterns. With regards to the possible clinical implications, we suggest that it is noteworthy to screen for ADHD in patients with obesity and to look for abnormal eating behaviors as possible contributing factors of obesity in patients with ADHD. If further studies confirm a causal relationship between ADHD and obesity, appropriate treatment of ADHD may improve eating patterns and, as a consequence, weight status of individuals with both obesity and ADHD.

Beyond pharmacotherapy: understanding the links between obesity and chronic mental illness

While differences in weight-gain potential exist, both between and within classes of psychiatry medications, most commonly used atypical antipsychotics, mood stabilizers, and antidepressants result in some degree of weight gain. This is not new information and it requires an understanding of the tolerability profiles of different treatments and their goodness of fit with specific patient phenotypes. However, this iatrogenic association represents only a piece of this obesity-mental illness dyad. The complex interplay between psychiatric illness and weight involves neurobiology, psychology, and sociological factors. Parsing the salient variables in people with mental illness is an urgent need insofar as mortality from physical health causes is the most common cause of premature mortality in people with chronic mental illness. Our review examines issues associated with common chronic mental illnesses that may underlie this association and warrant further study if we hope to clinically intervene to control this life-threatening comorbidity.

Differential patterns of disordered eating in subjects with ADHD and overweight

OBJECTIVES

Despite growing evidence for an association between overweight and attention-deficit/hyperactivity disorder (ADHD), still little is known about the mechanisms underlying this relationship.

METHODS

Within a two (no ADHD, ADHD) × two (normal weight, overweight) factorial design (n = 94) we tested disordered eating behaviour in a laboratory breakfast procedure as well as delay aversion (DA) in male children aged 7-15 years.

RESULTS

While children with ADHD tended to eat above the normal level particularly at the beginning of the meal, children with overweight tended to eat above the normal level throughout the whole meal. Furthermore, preference for immediately available food was predicted by parental ratings of inattention and neuropsychological measures of DA in overweight children, and by impulsivity in children with ADHD.

CONCLUSIONS

Our results suggest distinct neuropsychopathological pathways to abnormal eating in ADHD and overweight. Thus, children with overweight might benefit more from specialized treatment programmes that aim at improving attention functions while in children with ADHD the treatment should focus on impulsivity.

COMT Val158Met variant and functional haplotypes associated with childhood ADHD history in women with bulimia nervosa

Up to one third of patients with bulimia nervosa (BN) report a history of ADHD symptoms, and both disorders may also be associated with dopaminergic abnormalities. COMT gene, coding for an enzyme responsible for the degradation of dopamine, may play a part in the etiology of ADHD and BN. This study aimed to (1) examine if certain variants of the COMT genetic markers (rs6269, rs4633, rs4818 and rs4680) are more common in BN versus controls; (2) assess transmission of COMT alleles in BN families; and (3) explore the role of COMT genotypes and haplotypes in bulimic women with childhood ADHD history. 72 BN probands and unaffected relatives were genotyped for COMT rs4680 (Val158Met) and three adjacent markers. The remaining 165 probands were matched with nonpsychiatric controls. We also investigated if COMT variants and haplotypes were associated with childhood ADHD history in a subgroup of 86 BN probands who completed the Wender Utah Rating Scale (WURS). Our results showed that cases and controls did not differ in COMT allele and haplotype frequencies. In contrast, specific alleles of all four COMT markers and the medium-activity haplotype were preferentially transmitted to the offspring with BN. COMT Val158 allele was overrepresented and the medium-activity haplotype was underrepresented in BN with childhood ADHD history (p=0.010). These findings suggest a possible role for COMT variants and related haplotypes in BN and its subphenotypes. If replicated, these preliminary findings may have implications for the prevention and treatment of BN that emerges in the context of childhood ADHD.

Association between obesity and adult attention-deficit/hyperactivity disorder in a German community-based sample

OBJECTIVE

The goal of the present study was to examine the association between attention-deficit/hyperactivity disorder (ADHD) and obesity in a representative community based sample of the German population.

METHOD

Participants were 1,633 German residents (53.6% female) aged 18-64 years. A retrospective assessment of childhood ADHD and a self-report assessment of adult ADHD were administered for diagnosis of adult ADHD. In addition, binge eating and purging behaviors as well as depression and anxiety were assessed using self-rating instruments.

RESULTS

The estimated prevalence of ADHD in obese participants was 9.7% compared to 3.8% in overweight and 4.3% in under-/normal-weight participants. The prevalence of obesity was 22.1% among adults with ADHD and 10.2% among persons without ADHD. Adult ADHD was significantly associated with a greater likelihood of being obese but not overweight even after adjusting for sociodemographic characteristics. Results were similar when adjusting for depression and anxiety symptoms and for purging behaviors. Odds ratios decreased after adjusting for binge eating; however, the results were still significant which shows that the relationship between obesity and ADHD in adulthood is not fully explained by binge eating.

CONCLUSION

Overall, the results indicate that adult ADHD is associated with obesity in a community-based sample of the adult German population.

Childhood obesity and parental smoking as risk factors for childhood ADHD in Liverpool children

ADHD prevalence has risen in parallel with rising prevalence of pregnancy smoking and childhood obesity. The objective was to determine the epidemiological association of pregnancy smoking and childhood obesity with ADHD. A cross-sectional community study was conducted in 2006 using a parental questionnaire. A total of 1,074 schoolchildren aged 5-11 years were enrolled from 15 primary schools in a lower socio-economic area of Merseyside. ADHD was defined by the question "does your child have Attention Deficit Hyperactivity Disorder, (ADHD), which has been diagnosed by a doctor?" The prevalence estimates for childhood obesity, maternal smoking during pregnancy and childhood ADHD were 14.9% (116/777), 28.0% (269/955), and 3.4% (32/945), respectively. ADHD prevalence increased fivefold in children with obesity (RR, 4.80, 95% CI 2.2-10.4, P < 0.001) and more than twofold in children of mothers who smoked during pregnancy (RR, 2.44, 95% CI 1.2-4.9, P = 0.02). Regression analysis adjusting for obesity, overweight, maternal smoking during pregnancy, heavy maternal smoking, household member smoking during pregnancy, doctor-diagnosed asthma, preterm birth, and low birthweight showed significant independent associations of ADHD prevalence with obesity (AOR, 4.66, 95% CI 1.57-13.89, P = 0.006) and pregnancy smoking (AOR, 3.19, 95% CI 1.08-9.49, P = 0.04). There was a positive dose-response association of ADHD with the number of maternal cigarettes smoked during pregnancy. Measures to reduce both smoking among pregnant women and childhood obesity might reduce prevalence of childhood ADHD.

Comorbidity between ADHD and obesity: exploring shared mechanisms and clinical implications

Recent studies suggest an association between attention-deficit/hyperactivity disorder (ADHD) and obesity. In this article, we systematically review and critically discuss evidence on the prevalence of ADHD in obese patients as well as the weight status of individuals with ADHD. Relevant articles were searched in PubMed, PsychInfo, and ISI Web of Science (January 1980 to June 2010). We found that current evidence indicates a high prevalence of ADHD in clinical samples of patients seeking treatment for their obesity. Moreover, available studies show that individuals with ADHD have higher-than-average body mass index z scores and/or a significantly higher prevalence of obesity compared with subjects without ADHD. Three mechanisms underlying the association between ADHD and obesity have been proposed: 1) it is possible that obesity and/or factors associated with it (such as sleep-disordered breathing) manifest as ADHD-like symptoms; 2) ADHD and obesity share common biological dysfunctions; and 3) ADHD contributes to obesity. With regards to the possible clinical implications, our findings suggest that it is noteworthy to screen for ADHD in patients with obesity and to look for abnormal eating behaviors as possible contributing factors of obesity in patients with ADHD. Based on preliminary findings, appropriate treatment of ADHD may improve the weight status of individuals with both obesity and ADHD.

The relationship between executive function, AD/HD, overeating, and obesity

Attention-deficit/hyperactivity disorder (AD/HD) and obesity are complex, costly disorders affecting physical, emotional, and social well-being. Executive function (EF), the cognitive ability for self-understanding and regulation, is often impaired in AD/HD, yet rarely considered in treatment of obese individuals with AD/HD. The hypothesis for this study is that low EF is seen in individuals with 4 or more symptoms of adult AD/HD and is associated with overeating behaviors leading to obesity. A nonexperimental single group design was used. A volunteer convenience sample (n = 125) completed EF, AD/HD, eating, and BMI measures. Path analysis tested the hypothesized/ modified model. Chi square (χ(2) = 6.15, df = 6, p = .4) and RMSEA (0.014) indicated a very good fit for the data. Assessment of EF and AD/HD symptoms in obese individuals is supported. Further study is needed to more fully understand this relationship and to develop strategies to address overeating behaviors in obese individuals with AD/HD.

Attention-deficit/hyperactivity disorder: associations with overeating and obesity

In the past decade, we have become increasingly aware of strong associations between overweight/obesity and symptoms of attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults. This review addresses the prevalence of the comorbidity and discusses some of the mechanisms that could account for their relationship. It is suggested that the inattentive and impulsive behaviors that characterize ADHD could contribute to overeating in our current food environment, with its emphasis on fast food consumption and its many food temptations. It is also proposed-based on the compelling evidence that foods high in fat, sugar, and salt are as addictive as some drugs of abuse-that excessive food consumption could be a form of self-medication. This view conforms with the well-established evidence that drug use and abuse are substantially higher among those with ADHD than among the general population.

Weight status of children and adolescents in a telepsychiatry clinic

The prevalence of overweight and obesity is approximately 32% among children and adolescents in the United States. Comorbid conditions associated with pediatric overweight and obesity include psychiatric conditions. The purpose of this study was to determine the prevalence of overweight and obesity among children and adolescents presenting for consultation from rural communities to the UC Davis Telemedicine Program (UCDTP), as well as to collect preliminary data to design an integrated disease management program for children and adolescents with obesity and mental illness. Patients aged 21 and under seen for psychiatric consultation at the UCDTP between 2004 and 2006 were included. Retrospective medical record review was conducted to determine the major psychiatric diagnoses, height, weight, body-mass index, and weight status (underweight/at risk for underweight, normal weight, overweight, or obese) for each patient. Of the 230 patients referred, a total of 121 patients had both height and weight values documented. Three patients were underweight; 51 were normal weight; 28 were overweight; 39 were obese. The most common psychiatric diagnoses in the 121 patients were attention deficit/hyperactivity disorder (ADHD; n = 40), bipolar disorder (n = 36), and depression (n = 31). The most common psychiatric diagnoses in patients with available weight and height data who were overweight and obese were bipolar disorder (n = 20), depression (n = 18), and ADHD (n = 17). Approximately 55% of child and adolescent patients seen for telepsychiatry consultation whose charts documented height and weight measurements were overweight or obese. Psychiatric diagnoses in overweight youngsters need to be researched further to determine whether the weight change is primary or secondary to mood and/or to treatments, such as medication. At such a high rate of comorbidity, monitoring the weight status of young psychiatric patients in this population is indicated.

Obesity and its relationship to addictions: is overeating a form of addictive behavior?

Obesity is a major public health problem and notoriously difficult to treat. There are many parallels between obesity/overeating and addictions to alcohol and drugs. This paper discusses similarities between obesity and addictive disorders, including common personality characteristics, disruptive behavior syndromes, and brain mechanisms. Although there are important differences between overeating and other addictive behaviors, an addiction model of overeating may effectively inform prevention and treatment of obesity.

A psycho-genetic study of associations between the symptoms of binge eating disorder and those of attention deficit (hyperactivity) disorder

OBJECTIVE

Some recent studies have reported intriguingly strong correlations between ADHD and obesity. This study examined whether ADHD symptoms were more pronounced in adults with symptoms of binge eating disorder (BE) than in their non-binging obese counterparts, and whether the links were stronger with inattentive vs impulsive/hyperactive symptoms. We also assessed the role of the dopamine D3 receptor in ADHD symptoms since the DRD3 gene has been associated with impulsivity and drug addiction - both relevant features of ADHD.

METHODS

A case (BE: n=60) double-control (normal weight: n=61 and obese: n=60) design was employed. Assessments of both childhood and adults ADHD symptoms were made, as well as genotyping of seven markers of DRD3 including the functional Ser9Gly polymorphism.

RESULTS

Three DRD3 genotypes, including Ser/Ser, had significantly elevated scores on the hyperactive/impulsive symptom scale. In turn, the four ADHD symptom scales were all significantly elevated in the BE and obese groups, who did not differ from each other, compared to those with normal weight.

CONCLUSIONS

Results indicated a role for the D3 receptor in the manifestation of the hyperactive/impulsive symptoms of ADHD, and that symptoms of ADHD are significantly, but not differentially, elevated in obese adults with and without binge eating. Our findings suggest that ADHD screening in adults seeking treatment for obesity, including those with BE, may be warranted as methods used to treat ADHD may help some to better manage overeating and other factors contributing to weight gain.

Association between adult attention deficit/hyperactivity disorder and obesity in the US population

Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder that affects approximately 2.9-4.7% of US adults. Studies have revealed high rates of ADHD (26-61%) in patients seeking weight loss treatment suggesting an association between ADHD and obesity. The objective of the present study was to test the association between ADHD and overweight and obesity in the US population. Cross-sectional data from the Collaborative Psychiatric Epidemiology Surveys were used. Participants were 6,735 US residents (63.9% white; 51.6% female) aged 18-44 years. A retrospective assessment of childhood ADHD and a self-report assessment of adult ADHD were administered. Diagnosis was defined by three categories: never met diagnostic criteria, met full childhood criteria with no current symptoms, and met full childhood criteria with current symptoms. The prevalence of overweight and obesity was 33.9 and 29.4%, respectively, among adults with ADHD, and 28.8 and 21.6%, respectively, among persons with no history of ADHD. Adult ADHD was associated with greater likelihood of overweight, (odds ratio (OR) = 1.58; 95% confidence interval (CI) = 1.05, 2.38) and obesity (OR = 1.81; 95% CI = 1.14, 2.64). Results were similar when adjusting for demographic characteristics and depression. Mediation analyses suggest that binge eating disorder (BED), but not depression, partially mediates the associations between ADHD and both overweight and obesity. Results suggest that adult ADHD is associated with overweight and obesity.

Treatment of refractory obesity in severely obese adults following management of newly diagnosed attention deficit hyperactivity disorder

OBJECTIVE

To determine whether attention deficit hyperactivity disorder (ADHD) pharmacological treatment of severely obese subjects with newly diagnosed ADHD would result in sustained weight loss.

DESIGN

Longitudinal clinical intervention study of the effects of ADHD medication on weight change over 466 days.

SUBJECTS

78 subjects (6 male, 72 female, mean age 41.3 years, BMI 42.7 kg m(-2)) out of 242 consecutively referred severely obese, weight loss refractory individuals were diagnosed as having ADHD. Sixty-five subjects received treatment and 13 remained as controls.

METHODS

Standard screening tests identified subjects likely to have ADHD. A diagnosis was made in 78 subjects by semi-structured clinical interview. ADHD subjects were screened for comorbid conditions (binge eating disorder, mood disorder, sleep apnea, chronic pain, gastroesophageal reflux disease). Satisfactory resolution of symptoms of comorbid conditions was achieved prior to the introduction of pharmacotherapy for ADHD. Subjects not accepting, tolerating or remaining on ADHD medication served as controls. Weight was measured at sequential clinic visits after initiation of pharmacotherapy.

RESULTS

Comorbid conditions were found to be highly prevalent (sleep apnea 56.4%, binge eating disorder 65.4%, mood disorder 88.4%). After an average of 466 days (s.d.=260) of continuous ADHD pharmacotherapy, weight change in treated subjects was -12.36% of initial weight and in controls +2.78%, P<0.001. Weight loss in treated subjects was 15.05 kg (10.35%) and weight gain 3.26 kg (7.03%) in controls, P<0.001.

CONCLUSIONS

ADHD is a highly prevalent condition in the severely obese population. Treatment of ADHD is associated with significant long-term weight loss in individuals with a lengthy history of weight loss failure. This result is likely because of the positive effects of treatment on self-directedness, persistence and novelty-seeking behaviors. ADHD should be considered as a primary cause of weight loss failure in the obese. Individuals seeking medical or surgical weight loss should be evaluated for ADHD and treated appropriately before intervention. This may improve the outcome for medically managed patients and avoid complications in surgical subjects because of poor compliance with diet and supplement requirements.

Association between energy intake and viewing television, distractibility, and memory for advertisements

BACKGROUND

The effect of television viewing (TVV) with and without advertisements (ads) on energy intake is unclear.

OBJECTIVE

The objectives were to test 1) the effect of TVV, with and without ads, on energy intake compared with a control and reading condition and 2) the association of distractibility and memory for ads with energy intake and body weight.

DESIGN

Forty-eight (26 female) adults (age: 19-54 y) with a body mass index (in kg/m(2)) of 20-35 completed this laboratory-based study. All participants completed 4 buffet-style meals in random order in the following conditions: 1) control, 2) while reading, 3) while watching TV with food and nonfood ads (TV-ads), and 4) while watching TV with no ads (TV-no ads). Energy intake was quantified by weighing foods. Distractibility and memory for ads in the TV-ads condition were quantified with a norm-referenced test and recognition task, respectively.

RESULTS

Repeated-measures analysis of variance indicated that energy and macronutrient intake did not differ significantly among the 4 conditions (P > 0.65). Controlling for sex, memory for ads was associated with body weight (r = 0.36, P < 0.05) and energy intake but only when viewing TV (r = 0.39, P < 0.05 during the TV-no ads condition, and r = 0.29, P = 0.06 during the TV-ads condition). Controlling for sex, distractibility was associated with body weight (r = 0.36, P < 0.05) but not energy intake. Distractibility, however, accounted for 13% of the variance in men's energy intake (P = 0.11).

CONCLUSIONS

TVV did not affect energy intake, but individual characteristics (memory for ads) were associated with body weight and energy intake in certain conditions. These characteristics should be considered in food intake and intervention studies.

Symptoms of attention-deficit/hyperactivity disorder, overeating, and body mass index in men

BACKGROUND

The high prevalence of obesity currently poses a global health crisis. Previous research has identified a novel link between obesity and Attention-Deficit/Hyperactivity Disorder (AD(H)D). Davis, Levitan, Smith, Tweed and Curtis [Davis, C., Levitan, R. D., Smith, M., Tweed, S., & Curtis, C. (2006). Associations among overeating, overweight, and attention deficit/hyperactivity disorder: A structural equation modeling approach. Eating Behaviors, 7, 266-274] recently tested a structural equation model predicting that AD(H)D symptoms foster overeating and subsequently contribute to the variation in Body Mass Index (BMI) in a sample of healthy adult females. The data were an excellent fit to the model.

PURPOSE

In order to extend the generalizability of these findings, the present study tested the same model in 145 non-clinical adult males.

RESULTS

Similar to the findings in females, AD(H)D symptoms positively predicted overeating in males, which in turn positively predicted BMI.

CONCLUSIONS

Results highlight mechanisms whereby AD(H)D symptoms could influence body mass and stress the importance of addressing AD(H)D symptoms in both the prevention and treatment of overeating and obesity.

Endophenotypes in eating disorders: moving toward etiologically based diagnosis and treatment focused on pathophysiology

It is hoped that the greater understanding neuroscience will bring to the field of psychiatry will lead to a more biologically based system of classification and diagnosis for psychiatric disorders. The clarification of endophenotypes might produce the ‘macros’ from which such a system could be constructed. The aim of this paper is to discuss the evidence for continuities between eating disorders and developmental disorders of childhood (autistic spectrum disorders and attention-deficit hyperactivity disorder) and possible shared endophenotypes. We review the evidence for obsessive–compulsive traits and disinhibition as intermediate phenotypes, and for information-processing styles such as weak set shifting, central coherence, disinhibition and reward sensitivity as possible endophenotypes. Finally we discuss the implications that this has for treatment.

Dopamine transporter gene (DAT1) associated with appetite suppression to methylphenidate in a case-control study of binge eating disorder

Response to psychomotor stimulants is highly variable across individuals. Such inconsistencies are influenced by many factors including drug dose and polymorphic differences in genes that encode proteins, such as the dopamine transporter (DAT1), which are relevant to the site of action of these substances. The current study used a double blind, crossover (methylphenidate vs placebo) design to assess DAT1 genotype differences on appetite ratings to a snack-food cue in subjects with binge eating disorder (BED) (n=32) and healthy age-matched controls (n=46). ANOVA results indicated a significant genotype x diagnostic group interaction whereby BED subjects with at least one copy of the 9-repeat allele showed a significant suppression of appetite in response to methylphenidate compared with controls with this allele, or to subjects with the 10/10 genotype (irrespective of diagnosis) whose drug response was indistinguishable from placebo. The most probable explanation for these findings is that some, currently unknown, genetic variant, which is overrepresented in those with BED, interacts with DAT1 to suppress appetite in response to stimulant administration. The current findings have implications for treatment response to drugs currently in use (or being developed) for the treatment of overeating and overweight.

The influence of trait and induced state impulsivity on food intake in normal-weight healthy women

Previous research has linked overeating and overweight/obesity to impulsivity. To find out whether impulsivity causes overeating and hence overweight and obesity, we attempted to prime the concept of impulsivity in healthy participants. In a within-subjects design one sample participated in two conditions. In both conditions participants did a priming task that either hinted subtly at the concept of impulsivity or that was neutral in content. Each time the priming task was followed by a bogus taste test. Trait impulsivity was measured by means of a behavioural task and self-report. Firstly, we hypothesized that participants would eat more during the taste test after they had been primed with the concept "impulsivity" compared to after the control session. Secondly, we expected that a more impulsive personality would predict a heightened food intake. Thirdly, we expected that impulsivity would predict food intake better than restraint. The results showed that both the self-report measure of impulsivity and the behavioural task predicted food intake. Restraint did not significantly predict food intake. Primed impulsivity did not increase food intake, possibly because the priming effect did not last long enough.