Abstract
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.
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References
Cortese S, Angriman M, Maffeis C, Isnard P, Konofal E, Lecendreux M et al. Attention-Deficit/Hyperactivity Disorder (ADHD) and Obesity: A Systematic Review of the Literature. Crit Rev Food Sci Nutr 2008; 48: 1–14.
Waring ME, Lapane KL . Overweight in Children and Adolescents in Relation to Attention –Deficit/Hyperactivity Disorder: Results From a National Sample. Pediatrics 2008; 122 (1): e1–e6.
Liu LL, Li BM, Yang J, Wang YW . Does dopaminergic reward system contribute to explaining comorbidity obesity and ADHD. Med Hypotheses 2008; 70: 1118–1120.
Davis C, Levitan RD, Smith M, Tweed S, Curtis C . Associations among over eating, overweight, and attention deficit hyper activity disorder: a structural equation modelling approach. Eat Behav 2006; 7 (3): 266–274.
Altfas JR . Prevalence of attention deficit hyperactivity disorder among adults in obesity treatment. BMC Psychiatry 2002; 2: 9.
Fleming JP, Levy LD . Disordered Eating and ADHD. Presented at National Attention Deficit Disorder Association (ADDA) Conference Annual Meeting; Seattle 2001; May 3–6.
Fleming JP, Levy LD, Levitan RD . Symptoms of Attention Deficit Hyperactivity Disorder in severely obese women. Eat Weight Disord 2005; 10 (1): e10–e13.
Fleming JP, Levy LD . Attention Deficit Hyperactivity Disorder, Depression and Sleepiness in Adults Referred for the Treatment of Obesity. Presented at the North American Association for the Study of Obesity (NAASO) Conference Annual Meeting; New Orleans, 2007.
Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E et al. The World Health organization adult ADHD self-report scale (ASRS): a short screening scale for use in the general population. Psychol Med 2005; 35: 245–256.
Radloff LS . The CES-D scale. A self-report depression scale for research in the general population. Applied Physiological Measurement 1977; 1: 385–401.
Johns MW . A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991; 14 (6): 540–545.
Heymsfield SB, van Mierlo CA, van den Knaap HC, Heo M, Frier HI . Weight management using a meal replacement strategy: meta and pooling analysis from six studies. Int J Obes Relat Metab Disord 2003; 27 (5): 537–549.
Rucker D, Padwal R, Li SK, Curioni C, Lau DCW . Long term pharmacotherapy for obesity and overweight: updated meta-analysis. Brit Med J 2007; 335 (7631): 1194–1199.
Norris SL, Zhang X, Avenell A, Gregg E, Schmid CH, Lau J . Pharmacotherapy for weight loss in adults with type 2 diabetes mellitus. Cochrane Database Syst Rev 2005; (1): CD004096. DOI:10.1002/14651858.CD004096.pub2.
Norris SL, Zhang X, Avenell A, Gregg E, Bowman B, Schmid CH et al. Long term effectiveness of weight loss interventions in adults with pre-diabetes: a review. Am J Prev Med 2005; 28 (1): 126–139.
Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR et al. Comparisons of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A To Z Weight Loss Study: a randomized trial. JAMA 2007; 297 (9): 969–977.
Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E et al. The World Health Organization Adult ADHD Self report Scales (ASRS): a short screening scale for use in the general population. Psychol Med 2005; 35 (2): 245–256.
Ward MF, Wender PH, Reimherr FW . The Wender Utah Rating Scale: an Aid in the Retrospective Diagnosis of Childhood Attention Deficit Hyperactivity Disorder. Am J Psychiatry 1993; 150: 885–890.
Magnusson P, Smari J, Sigurdardottir D, Baldursson G, Sigmundsson J, Kristjansson K et al. Validity of self-report and informant rating scales of adult ADHD symptoms in comparison with a semi-structured diagnostic interview. J Atten Disord 2006; 9 (3): 494–503.
Reynolds CR, Kamphaus RW . Reynolds Intellectual Assessment Scales and the Reynolds Intellectual Screening Test; Professional manual, Psychological Assessment Resources Inc, 2003.
Spitzer RL, Yanovski S, Wadden T, Wing R, Marcus MD, Stunkad A et al. Binge Eating Disorder: its' further validation in a multi site study. Int J Eat Disord 1993; 13 (2): 137–153.
Lundorff L, Peuckmann V, Sjogren p . Pain management of opioid treated cancer patients in hospital settings in Denmark. Acta Anaesthesiol Scand 2008; 52 (1): 137–142.
Holen JC, Lydersen S, Klepstad P, Loge JH, Kaasa S . The Brief Pain Inventory. Clin J Pain 2008; 24 (3): 219–225.
Harris JA, Benedict FG . A biometric Study of Basal Metabolism in Man. Carnegie Institution of Washington: Washington, 1919.
Haugen HA, Chan LN, Li F . Indirect Calorimetry: a practical guide for clinicians. Nutr Clin Pract 2007; 22 (4): 377–388.
DaRocha EE, Alves VG, Da Fonseca RB . Indirect Calorimetry: methodology, instruments and clinical application. Curr Prin Clin Nutr Metab Care 2006; 9 (3): 247–256.
Shetty PS, Henry CJK, Black AE, Prentiss EM . Energy requirements in adults: an update of basal metabolic rate (BMR) and physical activity levels (PALs). Eur J Clin Nutr 1996; 50: S11–S23.
Jenkins DJ, Kendall CW, Augustin LS, Franceschi S, Hamidi M, Marchie A et al. Glycemic Index: overview of implications in health and disease. Am J Clin Nutr 2002; 76 (1): 266s–273s.
Barclay AW, Petocz P, McMillan-Price J, Flood VM, Prvan T, Mitchell P et al. Glycemic Index, Glycemic Load, and chronic disease risk—a meta analysis of observational studies. Am J Clin Nutr 2008; 87 (3): 627–637.
Elliott AC . Winks(™) SDA, 6th edn. Texasoft: Cedar Hill, Texas, 2007.
Garner DM, Olmstead MP, Polivy J . Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Disord 1983; v.2 (2): 15–34.
Munro JF, MacCuish AC, Wilson EM, Duncan LJP . Comparison of Continuous Anorectic Therapy in Obesity. Brit Med J 1968; 1: 352–354.
Levy LD . Conquering Obesity: Your Guide to Healthy and Successful Weight Management. Key Porter Books: Toronto, 2002.
Svrakic DM, Whitehead C, Przybeck TR, Cloninger CR . Differential diagnosis of personality disorders by the seven-factor method of temperament and character. Arch Gen Psychiatry 1993; 50 (12): 991–999.
Pearson JR . Drugs for obesity. Br Med J 1963; 2: 853–855.
Hawirko L, Sprague PH . Treatment of Obesity by Appetite Depressing Drugs. CMAJ 1946; v 54: 26–29.
LeRiche WH, van Belle GE . A long term study on the use of appetite suppressants. CMAJ 1961; 85 (12): 673–675.
Resnick M, Joubert L . A Double Blind Evaluation of an Anorexiant, a Placebo, and Diet alone in Obese Subjects. CMAJ 1967; 97: 1011–1015.
Hubel R, Jass J, Marcus A, Laessle RG . Over weight and basal metabolic rate in boys with attention deficit hyperactivity disorder. Eat Weight Disord 2006; 11 (3): 139–146.
Schertz M, Adesman AR, Alfieri NE, Bienkowski RS . Predictors of weight loss in children with attention deficit hyperactivity disorder treated with stimulant medication. Pediatrics 1996; 98 (4 Pt1): 763–769.
Boomstra AM, Kooij JJ, Oosterlaan J, Sergeant JA, Buitelaar JK, Van Someren EJ . Hyperactive night and day? Actigraphy studies in adult ADHD: a baseline comparison and the effects of methylphenidate. Sleep 2007; 30 (4): 433–442.
Baltrus PT, Lynch JW, Everson-Rose S, Raghunathan TE, Kaplan GA . Race/Ethnicity, Life Course Socioeconomic Position, and Body Weight Trajectories over 34 Years: The Alameda County Study. Am J Public Health 2005; 95: 1595–1601.
Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B et al. Lifestyle, Diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351 (26): 2683–2693.
Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean AP et al. Surgery decreases long term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 2004; 240 (3): 416–423.
Sampalis JS, Liberman M, Auger S, Christou NV . The impact of weight reduction surgery on health care costs in morbidly obese patients. Obes Surg 2004; 14 (7): 939–947.
Angrisani L, Lorenzo M, Borrelli V . Laparoscopic adjustable gastric banding versus Roux en Y gastric bypass: 5-year results of a prospective randomized trial. Surg Obes Relat Dis 2007; 3 (2): 127–132.
Muller MK, Attigah N, Wildi S, Hahnloser D, Hauser R, Clavien PA et al. High secondary failure rate of rebanding after failed gastric banding. Surg Endosc 2008; 22 (2): 448–453.
Carlin AM, Rao DS, Meslemani AM, Genaw JA, Parikh NJ, Levy S et al. Prevalence of vitamin D depletion among morbidly obese patients seeking gastric bypass surgery. Surg Obes Relat Dis 2006; 2 (2): 98–103.
Carlin AM, Rao DS, Yager KM, Genaw JA, Parikh NJ, Szymanski W . Effect of gastric bypass surgery on vitamin D nutritional status. Surg Obes Relat Dis 2006; 2 (6): 638–642.
Ames BN . Low micro nutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage. Proc Natl Acad Sci USA 2006; 103 (47): 17589–17594.
Ames BN . A role for supplements in optimizing health: the metabolic tune up. Arch Biochem Biophys 2004; 423 (1): 227–234.
Linde JA, Erickson DJ, Jeffery RW, Pronk NP, Boyle RG . The relationship between prevalence and duration of weight loss strategies and weight loss among overweight managed care organization members enrolled in a weight loss trial. Int J Behav Nutr Phys Act 2006; 3: 3.
Rucker D, Padwal R, Li SK, Curioni C, Lau DCW . Long term pharmacotherapy for obesity and overweight: updated meta analysis. Brit Med J 2007; 335: 1194–1199.
Kopelman PG, Grace C . New thoughts on Managing Obesity. Gut 2004; 53: 1044–1053.
Strychar I . Diet in the management of weight loss. CMAJ 2006; 174 (1): 56–63.
Jamal MK, DeMaria EJ, Johnson JM, Carmody BJ, Wolfe LG, Kellum JM et al. Insurance-mandated preoperative dietary counseling does not improve outcome and increases drop-out rates in patients considering gastric bypass surgery for morbid obesity. Surg Obes Relat Dis 2006; 2 (2): 122–127.
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Levy, L., Fleming, J. & Klar, D. Treatment of refractory obesity in severely obese adults following management of newly diagnosed attention deficit hyperactivity disorder. Int J Obes 33, 326–334 (2009). https://doi.org/10.1038/ijo.2009.5
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DOI: https://doi.org/10.1038/ijo.2009.5
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