In 2006, at the age of 47, I was diagnosed with ADHD. I’ve been researching adult ADHD ever since. I was taken by surprise when a visitor to my blog, ADHD from A to Zoë, posted a comment about the connection between severe obesity and adult ADHD.
I hadn’t heard of the connection before. The writer, we’ll call him Jerry, is a 52-year-old male who’d undergone bariatric surgery a year ago. Recently, Jerry was diagnosed with ADHD. Jerry says the discovery of ADHD has been life-changing for him.
Jerry’s correspondence was a revelation to me, affirming the fact that the connection between severe obesity and adult ADHD is not widely known or understood.
Jerry pointed out that undiagnosed and untreated ADHD is a huge contributing factor in a significant number of cases of severe obesity. His comment that this is true “…especially (for) women since ADHD is often predominantly inattentive and less likely to be diagnosed,” struck a chord.
I could instantly see that, in a body-conscious society like ours, a woman may be highly likely to seek treatment for ongoing obesity. On the other hand, as Jerry suggests, women are often overlooked when it comes to receiving an ADHD diagnosis.
Some people, even some medical professional, still question the existence of adult ADHD. As a result, adult ADHD is not widely recogonized and remains largely untreated. The stereotype of ADHD being the sole purview of hyperactive little boys and reckless, race-car driving adult males naturally leads us away from suspecting that the morbidly obese middle-aged woman might also suffer from symptoms of ADD.
But in fact, she does. And according to rapidly accumulating research, the number of severely obese women suffering from underlying ADHD may be as high as 38 percent. A 2004 study of severely obese women by J.P. Fleming, L.D. Levy, and R.D. Levitan reported 26.7 percent of the subjects experienced significant ADHD symptoms in both childhood and adulthood. A January 2009 study that included both men and women echoed these results. Women made up 92 percent of the subjects in this study, and the results showed that up to 38 percent of these severely obese adults also suffered from ADHD.
Adding severe obesity to the list of co-morbid conditions that people with ADHD often experience is an important step in improving the lives of ADHD sufferers. If clinicians treating an individual for obesity are aware of this connection, they are much more likely to control for it prior to beginning treatment. This, according to research and common sense, will improve the individual’s chances of success in achieving and maintaining a healthy weight.
In a study cited in the International Journal of Obesity (2009), researchers J.P. Fleming and L.D. Levy conclude that “…screening for ADHD should become part of the diagnostic assessment for the management of severe obesity.” They suggest that underlying ADHD should be treated prior to intervention for obesity. This ties in to the risk factors which ADHD symptoms pose toward predisposing an individual to severe obesity; lack of treatment prevents them from experiencing optimal results from obesity treatment and intervention.
Classic symptoms of inattentive ADHD (the type most often found in women) include deficiencies of self-regulation (executive function); distractibility; poor organization, follow-through, and impulse control; forgetfulness; inability to maintain effort; and inattention. It’s easy to see how any one of these symptoms could lead to difficulty in creating and maintaining a healthy diet, sticking with a weight-loss regimen, or having ongoing self-awareness about physical health. This, combined with an inability to commit to a regular regimen of physical activity, could all contribute to ongoing, and worsening, problems with obesity.
I would suggest that another factor leading toward the predisposition of undiagnosed, untreated ADHDers to severe obesity may be the propensity to self-medicate in lieu of a bona fide treatment program. Adults may use substances with stimulant or sedative properties, including drugs and food, to ease ADHD symptoms.
It is suggested that lower than normal dopamine levels will lead an adult with ADHD to seek ways to increase dopamine, which is associated with reward states, including feelings of enjoyment and pleasure. Dopamine, a chemical messenger, is similar to adrenaline, and is released by rewarding experiences. For an undiagnosed and untreated adult with ADHD, food and alcohol, marijuana or other drugs, especially stimulants, often are among those experiences.
It’s no great secret that too much alcohol can lead to weight gain, while marijuana, another popular self-medication substance, can stimulate appetite. Both can lead to impaired decision-making, including dietary decisions; create a low or apathetic mood; decrease memory, organizational abilities and impulse control – all of which exacerbate pre-existing ADHD symptoms.
Clearly, ADHD screening and appropriate treatment for adults suffering from severe obesity would be beneficial.
Fleming, J.P., Levy L.D., and Levitan, R.D. Symptoms of attention deficit hyperactivity disorder in severely obese women. Eating Weight Disorders, Vol. 10: e10-e13, 2005
Kessler, Zoë. ADHD from A to Zoë, personal correspondence, 2010.
Levy, L.D. , Fleming, J.P. and Klar, D. Treatment of refractory obesity in severely obese adults following management of newly diagnosed attention deficit hyperactivity disorder. International Journal of Obesity, pp. 1-9, Macmillan Publishers Limited, 2009.
Stannard Gromisch, E. The link between ADHD and obesity.