Attention-deficit/Hyperactivity Disorder in a Prebariatric Surgery Sample

Autism, ADHD, and Their Traits in Adults with Obesity: A Scoping Review

Introduction: Autism and ADHD shape behaviours related to food, exercise, and body image, potentially influencing obesity treatment outcomes, as seen in eating disorder research. Resultantly, autistic and ADHD patients with obesity may have distinct experiences and differences compared to non-autistic and non-ADHD patients. This review maps existing literature on autism and ADHD in adults with obesity. Methods: Following PRISMA guidelines, six databases (Embase, MEDLINE, PsycINFO, Web of Science, CENTRAL, and Scopus) were searched for studies on autism and/or ADHD (diagnosed, probable, or traits) in adults with obesity. Screening and data extraction were conducted twice independently for each record. Results: Thirty-one studies were included, with 1,027,773 participants. Two case reports described successful use of weight loss drugs in autistic people with obesity. Eight prevalence studies suggested ADHD is overrepresented in obesity, regardless of binge eating status. Nineteen studies examined clinical profiles: ADHD patients had lower socioeconomic status, poorer health-related quality of life, increased impulsivity, cognitive inflexibility, and neuroticism, alongside lower agreeableness, conscientiousness, self-directedness, and cooperativeness. ADHD patients also exhibited higher psychopathology, problematic alcohol use, and disordered eating. Eight studies assessed treatment responses, noting poorer outcomes from behavioural programs and obesity pharmacotherapy, but similar post-surgical weight outcomes, despite increased complications. Two studies considered ADHD-specific treatment adaptions, one reporting a successful trial of ADHD medication for weight loss and the other reporting on switching to transdermal ADHD medications after bariatric surgery. Conclusions: This review underscores the need for more research on autism and obesity. For ADHD, findings suggest frequent co-occurrence with obesity, but lived experiences and tailored interventions remain underexplored.

Attention-deficit/hyperactivity disorder in adolescent and adult candidates for metabolic and bariatric surgery: A systematic review and meta-analysis

AIMS

Attention-deficit with hyperactivity disorder (ADHD) is associated with obesity and impacts the outcome of metabolic and bariatric surgery (MBS). This study aimed at calculating the prevalence in candidates for MBS, which is yet unclear.

METHODS

We conducted a systematic review and meta-analysis, searching three databases from their respective inception to December 2022 for studies reporting the prevalence of ADHD in adolescents and adults assessed before undergoing MBS. The protocol was registered in PROSPERO (CRD42022384914). We adhered to Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines; the quality of studies was assessed with the JBI Critical Appraisal checklist. Random-effect meta-analyses were performed; confidence intervals were computed with a binomial exact method, and the pooled estimate was calculated after double arcsine transformation.

FINDINGS

Fourteen studies (24,455 adults) and three studies (299 adolescents) were selected. The quality of studies was moderate to poor; meta-analyses were performed on subgroups according to the case definition used. The prevalence is 8.94% and 9.90% in adults, and 28.73% in adolescents.

CONCLUSIONS

ADHD is three times more frequent in adults and six times more frequent in adolescents than in the general population. Recommendations are provided to improve the quality of future studies and obtain more reliable estimates of prevalence.

Prevalence and Correlates of Self-Reported ADHD Symptoms in Bariatric Patients: Focus on Mood and Anxiety Comorbidity, Disordered Eating, and Temperamental Traits

PURPOSE

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity. A positive association between ADHD and obesity has been observed, especially in adult samples. In this study, prevalence and correlates of self-reported symptoms indicative of a positive screening for ADHD were examined in patients seeking bariatric treatment.

MATERIAL AND METHODS

The study sample was composed of 260 adult patients with obesity referred for bariatric surgery to the Obesity Center of the Endocrinology Unit in Pisa University Hospital between January 2006 and November 2016 (BMI ≥ 30 kg/m2; mean ± standard deviation = 46.27 ± 7.45 kg/m2). ADHD symptoms were identified using ADHD Symptom Check-List-90-R Screening Scale. Night-eating, binge-eating/purging behaviors, and temperamental and character traits were assessed in a subsample of 95 patients.

RESULTS

Thirty participants had a positive screening for ADHD (11.5%, 95% CI = 7.9-16.1%). Patients with a positive screening showed significantly higher rates of anxiety disorders (40% vs. 16.5%, χ2 = 7.97, p = 0.005) panic disorder (40% vs. 14.3%, χ2 = 10.48, p = 0.001), and a higher severity of psychopathological symptoms and sleep disturbances than those without. In subsample analyses, ADHD symptoms severity was associated with more bulimic behaviors (r = 0.31-0.46), greater harm avoidance (r = 0.45-0.66), less self-directedness (r =  - 0.44-0.63), and cooperativeness (r =  - 0.26-0.42).

CONCLUSION

ADHD symptoms may be common in patients with obesity seeking bariatric treatment and are positively associated with disordered eating, internalizing features, and maladaptive character traits.

LEVEL OF EVIDENCE

V, cross sectional descriptive study.

Eating behaviors, depression, and anxiety levels of pre bariatric surgery patients with obesity comorbid with or without Attention deficit and hyperactivity disorder: ADHD or Major Depression? Which is more related with eating behaviors?

OBJECTIVE

A high rate of attention deficit and hyperactivity disorder (ADHD) has been reported in patients undergoing obesity treatment. It is controversial whether ADHD solely or its comorbid disorders account for eating behaviors associated with obesity.

METHODS

After presurgery psychiatric assessment, 100 severely obese patients (50 with ADHD and 50 without ADHD) were administered Adult Attention Deficit Hyperactivity Disorder Self-Report Scale(ASRS), Wender Utah Rating Scale(WURS), Three-Factor Eating Questionnaire(TFEQ), and Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI).

RESULTS

Patients with obesity and ADHD had significantly greater emotional eating, susceptibility to hunger, depression, and anxiety but less restraint of eating scores than those without ADHD. Disinhibition of eating scores and presence of Binge Eating Disorder(BED) did not differ significantly between ADHD and non-ADHD groups. Obese patients with major depression had significantly higher ASRS, WURS, TFEQ, BAI scores, disinhibition of eating control, emotional eating, susceptibility to hunger, and diagnosis of BED than nondepressed ones.

CONCLUSIONS

Major depression and anxiety disorder have associations with disinhibition of eating control, emotional eating, susceptibility to hunger and BED, ADHD. Disinhibition of eating and BED did not differ according to the presence of ADHD; thus, depression was associated with eating control on more constructs than ADHD in our study.

High prevalence of attention-deficit/hyperactivity disorder in adolescents with severe obesity seeking bariatric surgery

AIM

To examine the prevalence of attention-deficit/hyperactivity disorder (ADHD) and related post-surgical weight loss in adolescents with severe obesity seeking bariatric surgery.

METHODS

The study population included 84 adolescents (age 13-19 years; 44 males, 40 females) with severe obesity who sought bariatric surgery at the Sheba Medical Centre in Israel during the years 2011-2017. Anthropometric and clinical data were collected from medical records. A subgroup of 20 participants filled questionnaires that evaluated ADHD-like symptoms, eating behaviours and quality of life. Data on adolescents that ultimately underwent surgery (n = 45) were also obtained.

RESULTS

The prevalence of ADHD was 28.6% in adolescents seeking bariatric surgery, much higher than that of the general adolescent population of Israel (17.1%, P < .001). There were no significant differences in reductions of weight, body mass index, body mass index standard deviation scores and body fat percent between participants with or without ADHD. In the subgroup that filled questionnaires, higher scores on ADHD-Rating Scale at baseline were associated with greater excess weight loss.

CONCLUSION

The prevalence of ADHD in adolescents seeking bariatric surgery was very high. Diagnosed ADHD was not related to post-surgical weight loss, whereas baseline ADHD-related behaviour was associated with higher post-surgical weight loss.

Attention-deficit/hyperactivity disorder and clinically diagnosed obesity in adolescence and young adulthood: a register-based study in Sweden

BACKGROUND

A recent family study of young adult males suggests a shared familial liability between attention-deficit/hyperactivity disorder (ADHD) and high body mass index (BMI), and a genome-wide meta-analysis reported a genetic correlation of 0.26 between ADHD and BMI. To date, it is unclear whether these findings generalize to the relationship between ADHD and clinically diagnosed obesity.

METHOD

By linking the Swedish national registers, we identified 25 38 127 individuals born between 1973 and 2000, together with their siblings and cousins. The risk of clinical obesity in individuals with ADHD was compared with the risk in those without ADHD. The relative contributions of genetic and environmental factors to the association between ADHD and clinical obesity were examined via assessment of the familial co-aggregation of the two conditions and quantitative genetic analysis.

RESULTS

Individuals with ADHD were at an increased risk of clinical obesity compared with those without (risk difference 3.73%, 95% confidence interval (CI) 3.55-3.90%; risk ratio 3.05, 95% CI 2.95-3.15). Familial co-aggregation of ADHD and clinical obesity was detected and the strength of the co-aggregation decreased by decreasing genetic relatedness. The correlation between the liabilities to ADHD and clinical obesity can be entirely attributed to their genetic correlation (rg 0.30, 95% CI 0.17-0.44).

CONCLUSION

The association between ADHD and clinical obesity in adolescence and young adulthood can be entirely attributed to genetic underpinnings shared by the two conditions. Children with ADHD should be monitored for weight gain so that preventive measures can be taken for those on a suboptimal trajectory.

Attention-deficit/hyperactivity disorder symptoms and psychological comorbidity in eating disorder patients

PURPOSE

There is some evidence that eating disorders (ED) and Attention-deficit/hyperactivity disorder (ADHD) share common clinical features and that ADHD might contribute to the severity of eating disorders. A greater understanding of how the presence of comorbid ADHD may affect the psychopathological framework of eating disorder seems of primary importance. The aim of our study was to evaluate rates of ADHD in three ED subgroups of inpatients: anorexia nervosa restricting type (AN-R), anorexia nervosa binge-eating/purging type (AN-BP) and bulimia nervosa (BN). The secondary aim was the evaluation of the associated psychological characteristics.

METHOD

The sample consisted of 73 females inpatients (mean age 28.07 ± 7.30), all with longstanding histories of eating disorder (ED). The presence of a diagnosis of ADHD was evaluated in a clinical interview based on DSM-IV-TR criteria. The following psychometric instruments were used: the eating attitude test (EAT-40), the Bulimic Investigatory Test, Edinburgh (BITE), the Eating Disorder Inventory (EDI-2), the Wender Utah Rating Scale (WURS), the Brown Attention Deficit Disorder Scale (BADDS), the Hamilton scales for Anxiety (HAM-A) and Depression (HAM-D), and the Barrat Impulsivity Scale (BIS-10).

RESULTS

Among the three ED subgroups, 13 patients reported comorbidity with ADHD; three in the AN-R subtype, nine in the AN-BP and one in the BN. The remaining 60 patients (n = 34 AN-R; n = 19 AN-BP; n = 7 BN) presented only a diagnosis of ED. The EAT (p = 0.04) and HAM-A (p = 0.02) mean scores were significantly higher in patients with comorbid ADHD.

CONCLUSIONS

In our study the comorbidity between ADHD and ED appeared to be frequent, particularly among patients with AN-BP. ED inpatients with higher level of anxiety and more abnormal eating attitudes and bulimic symptoms should be assessed for potentially associated ADHD.

The Association Between Metabolic Syndrome, Obesity-Related Outcomes, and ADHD in Adults With Comorbid Affective Disorders

OBJECTIVE

ADHD may predispose to obesity, a metabolic syndrome component. Affective disorders are also associated with MetSyn and ADHD. This study examined whether ADHD confers any added risk of MetSyn and obesity-related associations in a large sample with varying stages of affective disorders.

METHOD

Participants included 2,303 adults from the Netherlands Study of Depression and Anxiety. Three groups were compared (controls, those with depressive/anxiety disorders without ADHD; and those with depressive/anxiety disorders and ADHD) for presence of MetSyn risk factors, body mass index, and waist-hip ratio. ADHD symptoms were identified by using a T-score > 65 (Conners Adult ADHD Rating Scale).

RESULTS

Multivariable analyses were additionally adjusted for sociodemographic, lifestyle, health factors, and affective disorders. Analyses showed no significant association between MetSyn, obesity-related variables, and comorbid ADHD. High Inattention and Hyperactivity/Impulsivity symptoms were not associated with MetSyn.

CONCLUSION

This study did not confirm that MetSyn and obesity-related parameters are increased in comorbid ADHD.

Association Between Restless Legs Syndrome and Adult ADHD in a German Community-Based Sample

OBJECTIVE

Previous research in clinical samples indicated a significant association between ADHD and restless legs syndrome (RLS). The present study examined the association between adult ADHD and RLS in the German population.

METHOD

Self-rating instruments to assess RLS, childhood ADHD, and adult ADHD were administered to a community-based sample ( N = 1,632). In addition, current depression and anxiety, sleep disturbances, weight, and height were assessed by self-report.

RESULTS

Adult ADHD was associated with statistically significant increases in the odds of meeting diagnostic criteria for RLS even when adjusting for potential confounding variables such as weight (odds ratio [OR] = 3.18, 95% confidence interval [CI] = [1.29, 7.63], p< .001). However, the association did not hold true after adjusting for the presence of sleep disturbances (OR = 2.02, 95% CI = [0.82, 4.96], p = .13).

CONCLUSION

The findings suggest a strong link between RLS and adult ADHD symptoms. Clinicians should be aware of RLS among adult ADHD patients, especially as there might be a negative interactive effect.

Does the Attention Deficit Hyperactivity Disorder interfere with bariatric surgery results?

Objective

to analyze possible negative effects of Attention Deficit Hyperactivity Disorder (ADHD) on the success of bariatric surgery.

Methods

we evaluated forty patients undergoing bariatric surgery and with regular post-operative follow-up of at least one year. To all, we applied the questionnaire advocated in the fourth edition of the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association for ADHD, as well as analyzed their postoperative data.

Results

fifteen (38%) patients presented a positive questionnaire for ADHD. Patients with ADHD presented higher BMI than patients without the disorder (45.8 vs. 40.9 kg/m2, p=0.017), and the difference remained in all postoperative stages. There was no statistically significant difference in surgery success (33.3% x 66.7%, p=0.505) or in BMI reduction (30.71% x 31.88%, p=0.671) one year after the procedure.

Conclusion

ADHD patients have a higher BMI. However, the presence of ADHD does not influence the success of bariatric surgery and the reduction of BMI.

Attention Deficit Hyperactivity Disorder Prevalence and Correlates Pre- and Post-Bariatric Surgery: A Comparative Cross-Sectional Study

OBJECTIVE

Previous research shows an association between obesity and attention deficit hyperactivity disorder (ADHD). The present study compares pre- and post-bariatric surgery patients using the internationally used Conners' Adult ADHD Rating Scale (CAARS™) to screen for ADHD.

METHODS

Matched samples pre- (N = 120) and post-bariatric surgery (N = 128) were compared using self-rating instruments to assess ADHD-relevant symptomatology, depression, eating-related psychopathology, and BMI.

RESULTS

Prevalence of probable ADHD did not differ between groups using the CAARS Index Scale T-scores; however, CAARS subscales Inattention/Memory and Self-Concept showed significantly lower scores in post-surgery patients. All CAARS subscales correlated significantly with each other, with depression and eating-related psychopathology. There was no correlation between ADHD and excess BMI loss in post-surgery patients.

CONCLUSION

The findings suggest that a considerable number of patients before and after bariatric surgery screened positive for ADHD. It can be hypothesized that some core ADHD symptoms improve after surgery. Future studies are warranted to investigate the influence of ADHD on long-term surgery outcomes.

Neurodevelopmental disorders are highly over-represented in children with obesity: A cross-sectional study

OBJECTIVE

To investigate prevalence of neurodevelopmental disorders in children with obesity and to compare body mass index (BMI) and metabolic profile in the children.

METHODS

Seventy-six children (37 girls, 39 boys) were consecutively recruited from a university outpatient clinic specialized in severe obesity. Neurodevelopmental disorders including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and developmental coordination disorder (DCD) were assessed using interviews and questionnaires. Neurodevelopmental diagnoses were collected retrospectively in medical records.

RESULTS

BMI ranged between 1.9 and 5.9 SDS and age between 5.1 and 16.5 years. In 13.2% and 18.4% ASD and ADHD was assigned, respectively. In addition, 25% screened positive for DCD, 31.6% had at least one neurodevelopmental disorder, and 18.4% had a parent who screened positive for adult ADHD. Girls with ASD/ADHD had higher BMI SDS than girls without neurodevelopmental disorder (P = 0.006).

CONCLUSIONS

One third of children with obesity referred to specialist centers have a neurodevelopmental disorder including deviant motor skills, and these problems may deteriorate weight status. One fifth of the parents exhibit ADHD symptomatology which could partly explain the poor adherence by some families in obesity units. Future obesity therapy could benefit from incorporating a neurodevelopmental treatment approach.

Attention-deficit/hyperactivity disorder and eating disorders across the lifespan: A systematic review of the literature

Attention-deficit/hyperactivity disorder (ADHD) and eating disorders are common and concerning mental health disorders. There is both empirical and theoretical support for an association between ADHD and eating disorders or disordered eating. This systematic review aims to summarize the extant literature on the comorbidity of ADHD and eating disorders across the lifespan, including the influences of sex, age, eating disorder diagnosis, and potential mediators. A total of 37 peer-reviewed studies on diagnosed ADHD and eating disturbances were identified through key research databases. Twenty-six studies supported a strong empirical association between ADHD and eating disorders or disordered eating. The systematic review findings suggest that children with ADHD are at risk for disordered eating, while adolescents, emerging adults, and adults are at risk for both eating disorders and disordered eating. Methodological considerations, future research, and clinical implications are discussed.

Psychological contributors to noncompletion of an adolescent preoperative bariatric surgery program

BACKGROUND

Noncompletion of preoperative bariatric programs is a significant problem among adolescents. Adult studies suggest that psychological factors contribute to noncompletion of preoperative bariatric programs.

OBJECTIVE

The aim of this study was to determine the association between adolescent psychological functioning and completion of the preoperative phase of a bariatric program.

SETTING

The study was conducted at a tertiary care children's hospital affiliated with a university medical center.

METHODS

Seventy-four adolescents and their parents completed an assessment measure of psychological functioning with the Behavior Assessment System for Children, Second Edition. We compared these scores between adolescents who completed the preoperative phase of the bariatric program and proceeded to surgery (completers) to those who did not (noncompleters) using multivariate analysis of covariance and logistic regression analyses, adjusting for demographic characteristics and baseline body mass index.

RESULTS

The mean age was 16.0 (1.1) years, most were female (79.8%), and the group was diverse (48.6%, Caucasian; 33.8%, black; 17.6%, other, including Hispanic, Asian, and biracial). Average body mass index was 50.5 (7.6) kg/m². Forty-two percent of participants were noncompleters. Noncompleters were reported by parents to have more clinically significant externalizing and internalizing behaviors and fewer adaptive behaviors. Noncompleters self-reported more clinically significant internalizing symptoms, emotional problems, and poor personal adjustment.

CONCLUSION

Adolescents who did not complete the preoperative phase of a bariatric surgery program had more clinically significant psychological symptoms across multiple domains compared with those who successfully proceeded to bariatric surgery. Early identification and treatment of psychological symptoms may be important in helping adolescents successfully proceed to surgery.

Attention deficit hyperactivity disorder and disordered eating behaviors: links, risks, and challenges faced

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often persists in adulthood. It is defined by inattention and/or hyperactivity-impulsivity. ADHD is associated with many comorbidities, including eating disorders (EDs). In the last decade, studies have reported that ADHD is linked with binge EDs, bulimia nervosa, and anorexia nervosa. Many postulates have been proposed to explain the association: 1) impulsive behavior in ADHD patients leads to disordered eating behavior; 2) other psychologic comorbidities present in ADHD patients account for eating behavior; 3) poor eating habits and resulting nutritional deficiencies contribute to ADHD symptoms; and 4) other risk factors common to both ADHD and EDs contribute to the coincidence of both diseases. Additionally, sex differences become a significant issue in the discussion of EDs and ADHD because of the higher incidence of bulimia nervosa and anorexia nervosa in females and the ability of females to mask the symptoms of ADHD. Interestingly, both EDs and ADHD rely on a common neural substrate, namely, dopaminergic signaling. Dopaminergic signaling is critical for motor activity and emotion, the latter enabling the former into a combined motivated movement like eating. This linkage aids in explaining the many comorbidities associated with ADHD. The interconnection of ADHD and EDs is discussed from both a historical perspective and the one based on the revealing nature of its comorbidities.

Excessive daytime sleepiness in patients with ADHD--diagnostic and management strategies

The links between attention-deficit hyperactivity disorder (ADHD) and sleep disorders remain unclear. Specific sleep disorders are a frequent comorbid condition associated with ADHD according to a categorical approach. However, sleep disorders can also induce ADHD-like symptoms according to a dimensional approach and are thought to be the consequence of excessive daytime sleepiness. It may thus be difficult for clinicians to differentiate the diagnosis of ADHD comorbid with a sleep disorder from sleep disorders with ADHD-like symptoms. This distinction could be important for the appropriate management of patients with dual complaints of trouble maintaining attention and daytime sleepiness. This paper summarizes the main sleep disorders associated with ADHD: sleep-related breathing disorders, sleep-related movement disorders, circadian rhythm sleep-wake disorders, and central disorders of hypersomnolence (aka hypersomnias). The history of presenting symptoms should be taken into account since ADHD is a neurodevelopmental disorder whereas ADHD symptoms comorbid with sleep disorder are not. Finally, we propose a model to clarify the links between ADHD, ADHD symptoms, and excessive daytime sleepiness induced by sleep disorders. Clinicians should therefore routinely assess, monitor, and manage the sleep problems of patients with ADHD who have both comorbidities and should search for the presence of ADHD symptoms in subjects with sleep disorders.

Is age a better predictor of weight loss one year after gastric bypass than symptoms of disordered eating, depression, adult ADHD and alcohol consumption?

INTRODUCTION

Findings regarding psychological risk factors for low weight loss after bariatric surgery have been inconsistent. The association between gender and weight outcome is unclear while younger age has been consistently shown to be associated with better weight outcome. The aim of this study was to analyze the interactions between gender and age on the one hand and symptoms of disordered eating, depression, adult ADHD and alcohol consumption on the other hand in regard to weight loss after gastric bypass.

METHODS

Bariatric surgery patients were recruited and asked to fill out self-report questionnaires regarding behavioral risk factors before and twelve months after surgery. Data from one hundred and twenty-nine patients were analyzed.

RESULTS

After controlling for age, no psychological variable measured prior to surgery could predict weight loss after twelve months. After surgery, there was an interaction effect between age, gender and specific eating disorder symptoms. Specifically, loss of control over eating was a risk factor for low weight loss among older, but not among younger, female participants. Symptoms of adult ADHD were associated with elevated alcohol consumption after surgery.

DISCUSSION

These results indicate that age and gender may moderate the effects of potential risk factors for inferior weight outcome. This interaction could potentially be one of the reasons behind the mixed findings in this field. Thus, there are important gender differences in the bariatric population that should be considered. The present study is the first to show that symptoms of adult ADHD may not be a risk factor for inferior weight loss but for alcohol risk consumption after gastric bypass.

Dionne M, E. Cassin S, Wnuk S, Taube-Schiff M, Sockalingam S. Psychopathology in severely obese women from a Canadian bariatric setting

Purpose

– Evidence suggests high rates of psychiatric disorders in bariatric surgery candidates (e.g. Mitchell et al., 2012), although no rigorous studies have examined the prevalence in a Canadian sample. Improved understanding of the prevalence of psychopathology among female patients is an important area of study, as females comprise approximately 80 percent of surgical candidates (Martin et al., 2010; Padwal, 2005). The purpose of this paper is to assess the prevalence of Axis I disorders and associations with quality of life in a Canadian sample of female bariatric surgery candidates.

Design/methodology/approach

– Female patients (n=257) were assessed using a structured psychodiagnostic interview and completed a health-related quality of life questionnaire.

Findings

– Results indicated that 57.2 percent of patients met DSM-IV-TR criteria for a lifetime psychiatric disorder and 18.3 percent met criteria for a current psychiatric disorder. Major depressive disorder was the most common lifetime psychiatric disorder (35.0 percent) and binge eating disorder was the most prevalent current psychiatric disorder (6.6 percent). Patients scored significantly lower than Canadian population norms on all domains of the SF-36 (all p's<0.001). Patients with a current Axis I disorder also reported significantly worse functioning on four mental health domains and one physical health domain (p's<0.01) compared to patients without a current Axis I disorder.

Originality/value

– Results confirm high rates of psychiatric disorders in Canadian female bariatric surgery candidates and provide evidence for associated functional health impairment. Further study is needed to elucidate how pre-operative psychopathology may impact female patients’ post-operative outcomes.

Neuropsychological factors and bariatric surgery: a review

Obesity has become a global epidemic with associated physical, psychological, and cognitive deficits that tax the healthcare system and result in a significant economic burden. These costs have necessitated treatment measures to reduce the incidence of obesity as well as comorbidities associated with obesity. We review the current literature in order to describe the pre-surgical psychological and cognitive characteristics of individuals undergoing bariatric surgery and the possible changes in these functions following surgery. We discuss the importance of a pre-surgical evaluation that adequately evaluates cognitive and emotional functioning and what this evaluation should entail. Finally, we discuss recent trends in the types of bariatric surgeries being performed and how these changes may influence subsequent physical, cognitive, and emotional health.

Attention-deficit/hyperactivity disorder and impairment in executive functions: a barrier to weight loss in individuals with obesity?

BACKGROUND

An increasing body of research points to a significant association of obesity to Attention-Deficit/Hyperactivity Disorder (ADHD) and deficits in executive functions. There is also preliminary evidence suggesting that children with ADHD may be at risk of obesity in adulthood.

DISCUSSION

In this article, we discuss the evidence showing that ADHD and/or deficits in executive functions are a barrier to a successful weight control in individuals enrolled in weight loss programs. Impairing symptoms of ADHD or deficits in executive functions may foster dysregulated eating behaviors, such as binge eating, emotionally-induced eating or eating in the absence of hunger, which, in turn, may contribute to unsuccessful weight loss. ADHD-related behaviors or neurocognitive impairment may also hamper a regular and structured physical activity. There is initial research showing that treatment of comorbid ADHD and executive functions training significantly improve the outcome of obesity in individuals with comorbid ADHD or impairment in executive functions.

SUMMARY

Preliminary evidence suggests that comorbid ADHD and deficits in executive functions are a barrier to a successful weight loss in individuals involved in obesity treatment programs. If further methodologically sound evidence confirms this relationship, screening and effectively managing comorbid ADHD and/or executive functions deficits in individuals with obesity might have the potential to reduce not only the burden of ADHD but also the obesity epidemics.

Self-reported symptoms of adult attention deficit hyperactivity disorder among obese patients seeking bariatric surgery and its relation to alcohol consumption, disordered eating and gender

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Symptoms of adult attention deficit hyperactivity disorder (ADHD) are common among people with obesity. Symptoms of ADHD are associated with other impulsive behaviours. Impulsivity can manifest differently in women and men.

WHAT THIS STUDY ADDS

The prevalence of ADHD symptoms was equal in both sexes in this patient group. ADHD symptoms were associated with hazardous alcohol consumption in men but not in women. It may be important to investigate several comorbid conditions simultaneously instead of a single diagnosis. Eating disorders and adult attention deficit hyperactivity disorder (ADHD), both characterized by deficits in impulse control, are common among bariatric surgery patients. Previous studies in other groups have found gender differences in how symptoms of ADHD and eating disorders manifest as women show more disordered eating and men show more risk consumption of alcohol. In the present study, the association between symptoms of adult ADHD, eating disorders and hazardous alcohol consumption was investigated, while considering gender differences. Self-report questionnaires were obtained from 276 bariatric surgery patients 3-6 months before surgery. The prevalence rates of adult ADHD and binge eating disorder (BED) were 8.6% and 6.3%, respectively, with no evidence of gender difference in the prevalence rates. Hazardous alcohol consumption was reported by a significantly larger portion of men (16.9%) than women (8.6%). There was an association between adult ADHD and both BED and hazardous alcohol consumption. However, symptoms of adult ADHD were associated with hazardous alcohol consumption in men but not in women. Our results suggest gender differences in hazardous alcohol consumption and self-reported symptoms of disordered eating despite similar prevalence rate of BED, but no gender difference in symptoms of adult ADHD. Finally, as the associations between these variables seem to be different in women and men, future studies need to investigate potential gender-specific functional and temporal relations between these variables.

ADHD symptomatology in eating disorders: a secondary psychopathological measure of severity?

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) has commonly been described in psychiatric disorders. Although several studies have found positive associations between abnormal eating patterns during childhood and ADHD, there is a lack of studies on ADHD and Eating Disorders (ED). The aims of this exploratory study were 1) to assess the ADHD symptoms level in ED and to ascertain whether there are differences among ED subtypes; 2) to analyze whether the presence of ADHD symptoms is associated with more severe eating disorder symptoms and greater general psychopathology; and 3) to assess whether the ADHD symptoms level is associated with specific temperament and character traits.

METHODS

191 female ED patients were included. Assessment was carried out with the EDI-2, ASRS-v1.1, the SCL-90-R and the TCI-R.

RESULTS

The ADHD symptoms level was similar in bulimia, eating disorder not otherwise specified and binge eating subtypes, and lower in anorexic patients. Obsessiveness and Hostility were significantly positively associated with ADHD symptoms. A path model showed that ADHD was associated with high Novelty Seeking and low Self-Directedness, whereas ED severity was influenced by ADHD severity and low Self-Directedness.

CONCLUSIONS

Bingeing/purging ED subtypes have a high ADHD symptoms level, also related with more severe eating, general and personality psychopathology.