Adhd, Overweight and Obesity: the Chicken or the Egg?

 Attention-deficit/hyperactivity disorder isand overweight and obesity in the US population.
associated  with over weight and obesity.  ThisCross-sectional data from the Collaborative
relationship has been established in the scientificPsychiatric Epidemiology Surveys were used.
literature yet not well understood.  We see fromParticipants were 6,735 US residents (63.9%
the studies below that children and adults withwhite; 51.6% female) aged 18-44 years. A
ADHD are more likely to be overweight when notretrospective assessment of childhood ADHD and
medicated.  We also see that ADHD children a self-report assessment of adult ADHD were
who are medicated are more likely to beadministered. Diagnosis was defined by three
underweight.  This is expected as the mostcategories: never met diagnostic criteria, met full
common medication for ADHD is methylphenidatechildhood criteria with no current symptoms, and
a drug knows to have side effects indicatedmet full childhood criteria with current symptoms.
decrease appetite and weight loss.  So much soThe prevalence of overweight and obesity was
that methylphenidate has potential and reputation33.9 and 29.4%, respectively, among adults with
for abuse.  Here are two recent studiesADHD, and 28.8 and 21.6%, respectively, among
regarding to the relationship between ADHD andpersons with no history of ADHD. Adult ADHD
weight.was associated with greater likelihood of
Department of Community Health, Brown Medicaloverweight, (odds ratio (OR) = 1.58; 95%
School, Box G-S121, Providence, RI 02912, USA.confidence interval (CI) = 1.05, 2.38) and obesity
OBJECTIVE: As the prevalence of childhood(OR = 1.81; 95% CI = 1.14, 2.64). Results were
obesity increases, identifying groups of childrensimilar when adjusting for demographic
who are at increased risk of overweight ischaracteristics and depression. Mediation analyses
important. The current study estimated thesuggest that binge eating disorder (BED), but not
prevalence of overweight in children anddepression, partially mediates the associations
adolescents in relation to attention-deficitbetween ADHD and both overweight and obesity.
hyperactivity disorder and medication use.Results suggest that adult ADHD is associated
PATIENTS AND METHODS: This study was awith overweight and obesity. Obesity (2008)
cross-sectional analysis of 62 887 children anddoi:10.1038/oby.2008.587.
adolescents aged 5 to 17 years from theThe question remains: Does having ADHD
2003-2004 National Survey of Children's Health, apredispose you to being overweight or does being
nationally representative sample of children andoverweight predisposed you to ADHD?  Our
adolescents in the United States. Attention-deficitmodel proposes that it is the thing associated with
disorder/attention-deficit/hyperactivity disorderbeing overweight predisposes you to ADHD. 
was determined by response to the question "HasThat is modern society’s lack of exercise and
a doctor or health professional ever told you thatincrease screen time (T.V., video games,
your child has attention-deficit disorder orinternet).  If we look at the last 2 decades when
attention-deficit/hyperactive disorder, that is, ADDAttention-deficit/hyperactivity disorder and Autism
or ADHD?" Children and adolescents wereSpectrum Disorder have increase drastically we
classified as underweight, normal weight, at risk offind that during this time in western cultures, fast
overweight, or overweight according to BMI forfood, video games and computers also have
age and gender. RESULTS: After adjustment forincreased.  Our model proposes that it is the lack
age, gender, race/ethnicity, socioeconomic status,of exercise (kids playing video games instead of
and depression/anxiety, children and adolescentsbeing outside playing) which disturbs motor
with attention-deficit disorder/attention-deficitdevelopment as well as input from the  postural
hyperactivity disorder not currently usingand antigravity muscles to the brain which is a
medication had approximately 1.5 times the oddsfactor in the under connectivity and functional
of being overweight, and children and adolescentsdisconnect syndrome associated with ADHD and
currently medicated for attention-deficit disorderASD. 
attention-deficit/hyperactivity disorder hadAt a recent lecture I attended regarding childhood
approximately 1.6 times the odds of beingneurobehavioral disorders a clever cartoon was
underweight compared with children andput up on the screen to make a point.  The
adolescents without either diagnosis.cartoon  showed an overweight boy drinking a
CONCLUSIONS: This study provides heightenedcoke and eating a bag of chips while sitting in a
awareness for pediatric providers about thechair playing a video game.  This child’s
relationship between attention-deficit disordermother tells the child that it’s time to take his
attention-deficit/hyperactivity disorder, medicationmedication.  The boy’s response “not
use, and weight status. Future work is needed tonow Mom I’m playing football.”  Exercise
better understand the longitudinal andhas been shown to not only reduce weight and
pharmacologic factors that influence theimprove health but also improve cognitive
relationship between attention-deficit disorderfunction. 
attention-deficit/hyperactivity disorder and weightThis is not to say that enrolling the child in soccer
status in children and adolescents.is going to be the magic pill that solves
1Division of Preventive and Behavioral Medicine,everything.  It is simply a suggestion that in a
Department of Medicine, University ofcondition with many associated possible causes
Massachusetts Medical School, Worcester,this may be a contributing factor or at least an
Massachusetts, USA.aggravator.  Let’s face it these kids are
Attention deficit hyperactivity disorder (ADHD) ispicky eaters and at times letting them play video
a neurobehavioral disorder that affects ~2.9-4.7%games is the only thing that calms them down
of US adults. Studies have revealed high rates ofand helps mom and dad not pull their hair out. 
ADHD (26-61%) in patients seeking weight lossBut it seems at times as if they may be locked
treatment suggesting an association betweeninto things that can hurt them long term and all of
ADHD and obesity. The objective of the presentus involved with these children need to be aware.
study was to test the association between ADHD