# ADD and obesity?



## Tad (Mar 24, 2009)

I saw this article in the newspaper this morning:

http://www.theglobeandmail.com/serv...sity0324/BNStory/specialScienceandHealth/home

It is more of a 'lifestyles' section article than a science section article, so although it references a study it doesn't give any details about how people were selected, and makes only fairly vague statements. Relevent bits include:



> attention-deficit hyperactivity disorder, a neuro-developmental irregularity that causes people to behave impulsively and seek constant stimulation. They nibble to counter feelings of restlessness,





> "ADHD is a primary cause of failing to lose weight for tens of thousands of people," said Dr. Levy, who is with the Nutritional and Eating Disorders Clinic. "Obese people are three to five times more likely to have it than the regular population. And if you treat them, you will see a significant weight loss."Dr. Levy and his co-authors - psychologist John Fleming and dietitian Doreen Klar - have just published their groundbreaking research in the International Journal of Obesity, a peer-reviewed scholarly journal.





> Their study of 242 obese patients found that 32 per cent had ADHD, compared with 4 to 7 per cent in the general population.



Has anyone read a more detailed article on this, or know if that "international journal of obesity" is at all credible?


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## KendraLee (Mar 24, 2009)

edx said:


> I saw this article in the newspaper this morning:
> 
> http://www.theglobeandmail.com/serv...sity0324/BNStory/specialScienceandHealth/home
> 
> ...



Not sure if its credible but I am going to look into it because it makes sense for me. I have recently come to the realization after starting nursing school that I probably have ADD and I know the adderall makes me not snack and pick constantly


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## MuleVariationsNYC (Mar 25, 2009)

edx said:


> I saw this article in the newspaper this morning:
> 
> http://www.theglobeandmail.com/serv...sity0324/BNStory/specialScienceandHealth/home
> 
> ...




I went to the journal and read the article, and have a few reservations about their methodology. Bear with me.

The study authors initially used questionaires to determine who among a group of volunteers (Average BMI of 41, had desire to lose weight but unable to do so, overwhelmingly female) met criteria for ADHD. Almost no-one who studies ADHD thinks this is a reliable way to diagnosis it in adults, and the results bore it out: 46% (112 out of 242) people were suspected to have ADHD after completing the questionaire. That's a ridiculously high percentage, and suggests an overly sensitive and non-specific test.

The study authors even acknowledge that this was a bad test by saying that in order to confirm the diagnosis, they sent people who were positive by the questionaire method to independent psychologists. But, (here's the kicker), the "volunteers" had to pay to see the psychologists themselves. So not everyone went, and they don't tell us how many didn't go. And then worst of all, they essentially acknowledge that if they felt it was justified, they could just ignore the psychologists assessment. It is entirely possible that people who were thought by the psychologists NOT to have ADHD were included anyways.This is what they say in their methods section: 

*"However, the main diagnostic consideration was whether the subject had a convincing history of difficulties throughout life, in the areas where ADHD most exerts a negative influence*."

I can think of lots of conditions or circumstances that "exert negative influences" on someone's performance. If one's theory is that ADHD is underdiagnosed in the obese, and a root cause of weight gain, then you should not be sloppy in your diagnostic methods. Using an overly sensitive test, making subjects *pay *for a confirmatory test, and then using arbitrary criteria to decide what information you use is bad science, in my view. 

The other thing that makes the study results murky is that ADHD is treated with stimulants, which are all generally different formulations of amphetamine or a cousin compound mexylphenidate. These medications are known to suppress appetite and speed metabolism in everyone, fat or not, ADHD or not. (To their credit, the authors do acknowlede this, though they argue it's a temporary effect. I'm not sure about that). So just because someone's appetite decreases or weight goes down when they are treated with a medication for ADHD, doesn't mean they had ADHD, and that ADHD was related to them being fat. It _might _mean that, but it might not. It's hard to separate it out.

I would have liked to see them be more rigorous in trying to prove a causal  link between ADHD and putting on weight. It's all theory and no data. What they argued was that when people start a diet they do so with a lot of enthusiasm, energy, and focus, but that they eventually get bored, or caught up with the demands with their jobs or daily lives, and that people with ADHD are particularly prone to these failures, and hence more apt to be obese without the ability to lose weight. The problem with that conclusion is that it's not just fat people who don't stick with diets, or exercise regimens, or doing the dishes every night, or paying our bills as soon as they come in the mail, or any other act that requires diligence and devotion while being somewhat onerous. I think that's humanity, and that you have to be very precise about whom you determine is having that kind of difficulty because of ADHD, more careful than the authors were. Especially if you're going to prescribe medcation, because every drug has its potential drawbacks.

Other technical objections are, 1)the absence of placebo controls, 2)the relatively small size of the control group (1/4 the size of the medication arm), and 3) the fact that selection of the control group was not random, hence hard to argue that medication was the only difference.

And finally, the study authors in their introduction still adhere to the mantra of, "Losing weight occurs when caloric balance is negative." It's nearly unanimous in the scientific community at this point that it's a more complicated equation than this. So this also makes me skeptical.

To give the study its due, those who received the medication lost an average of 35 lbs over 16 months (so not a dangerous rate), and these were people who had a sustained desire to lose weight and had tried several other methods, including counseling, before being referred to the study. So I imagine there were many people who participated who felt the trial was a success.

In short, interesting hypothesis, potentially helpful, but complicated enough that it needs a better study than this one. I'll stop now.


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## KendraLee (Mar 25, 2009)

MuleVariationsNYC said:


> I went to the journal and read the article, and have a few reservations about their methodology. Bear with me.
> 
> 
> In short, interesting hypothesis, potentially helpful, but complicated enough that it needs a better study than this one. I'll stop now.



:bow: always a voice of knowledge and rationality


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## Tad (Mar 25, 2009)

Thank you, Mule!


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## blackghost75 (Mar 26, 2009)

As someone with ADHD I truly think and believe that a link between ADD and obesity,is a bunch of BS!! Just like a few years ago some doctors tried to get people to believe that if your child watches too much tv,that they could adhd. 
I have to tell you the CDC and NIH will tell you there is no evidents or anything to back this up!!! Again pure BS!!!! And if there is a link between ADHD and obesity,how come is it that I've always had a slender to athletic build? I know other people with adhd who also have the same build as i do!! Ok now I going to name so well known people who have adhd. Micheal Jordan,Jamie Fox,Howie Mandel,Ty Pennington and Michael Phelps just to name a few


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