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Children with ADHD are energetic, playful, highly engaged, and… did we mention energetic? That’s the stereotype, anyway. But the reality is that ADHD (particularly the inattentive type) does not automatically bring with it calorie-burning energy and a sleek physique. Its symptoms may actually trigger and exacerbate serious weight problems.
Psychologist John Fleming, Ph.D., of the Nutritional Disorders Clinic in Toronto, is among the first scientists to link ADHD and weight gain. In a 1990 study of overweight people who seemed unable to shed any pounds, Fleming found that subjects with ADHD exhibited “disturbed eating habits, with typically no regularly planned meals or snacks, and an inability to follow dietary plans for any useful length of time.”
Indeed, decades of research show a strong correlation between ADHD and obesity — so strong, in fact, that someone with ADHD is four times more likely to become obese than is someone without ADHD. Brain chemistry, poor impulse control, and erratic sleeping habits all conspire to encourage unhealthy eating — and to make weight loss feel impossible.
That doesn’t mean a child with ADHD is doomed to a life of obesity. But it does necessitate a serious understanding of ADHD’s effect on food intake, exercise habits, and overall health. Here’s why ADHD may make your child or teen more prone to gaining unwanted weight — and what you can do to get and keep him healthy.
Despite their assumed hyperactivity, kids with ADHD are less physically active, eat fewer healthy foods, and have higher BMIs than do people without ADHD, according to studies. This may seem counter-intuitive, but understanding ADHD provides clarity: The symptoms of ADHD that make it difficult to focus at school or manage appropriate behavior at home also make it exceedingly hard to eat properly and exercise on a regular schedule.
Some factors of ADHD that make it easier to slide toward obesity include:
Executive function deficits: Maintaining a healthy weight requires robust executive functioning skills — used for everything from planning balanced meals to sticking with that daily bike ride. Kids with ADHD have naturally weaker executive functions, which makes starting (and keeping up with) a healthy daily routine much more taxing. Right now, you can micro-manage what your child eats and when he exercises, but your child must be able to manage that successfully on his own one day, and executive function deficits make it very hard.
Impulsivity: The ADHD symptom of impulsivity can have a devastating effect on an individual’s health. We are all bombarded with tantalizing (i.e. high-fat, high-sugar, high-carb) food daily. Most people can successfully manage their food-related impulses — and say no to a daily doughnut, for instance. Individuals with ADHD-fueled impulsivity cannot. Their impulses take the wheel and they reach for (and devour) the junk food before their minds catch up to say, “No!”
Poor interoceptive awareness: Interoceptive awareness helps us sense what’s going on inside our bodies — whether that’s hunger cues, thirst markers, or physical fatigue. A child with ADHD, however, is oriented outward — always looking for the next source of stimulation. As a result, she may struggle to pay attention to and make sense of what her body is telling her. Individuals with ADHD are more likely to interpret thirst (or boredom, or exhaustion) as hunger, and will often turn to food to fulfill that unclear internal need.
Poor sleep habits: A brain that’s constantly whirring will find it hard to “shut down” at the end of the day and fall asleep, so it’s no surprise that ADHD brings with it fitful or disordered sleep. And a wealth of research finds that sleep deprivation is a large factor in promoting obesity. When our bodies are sleep deprived, our brains release hormones that push us to overeat — particularly unhealthy foods that are high in fat and sugar. Simultaneously, our metabolism drops as our bodies attempt to conserve fat. This is an evolutionary relic of our caveman past — when lack of sleep usually meant famine — but in modern times, it backfires on sleep-deprived ADHD bodies.
“Procrastin-eating:” There’s an ADHD tendency to put off boring tasks by eating instead, a phenomenon that’s been dubbed “procrastineating.” Devouring a cheesy pizza is infinitely more interesting to the ADHD brain than is writing a term paper. Therefore, snacking becomes a tempting — albeit unhealthy — form of procrastination.
Low levels of neurotransmitters: ADHD is a neurological condition traced back to the brain’s neurotransmitters. The precise mechanism underlying the link between obesity and ADHD is yet to be discovered, but the evidence suggests that the same low levels of the neurotransmitter dopamine that cause ADHD also encourage overeating. The chemicals dopamine and GABA exist in insufficient amounts in the brains of people with ADHD. Dopamine regulates and promotes arousal; low levels of dopamine result in an under-aroused, “bored” brain. GABA controls inhibition. A person with adequate levels of these neurotransmitters can typically stop himself from eating an entire box of cookies. Someone with low levels does not receive the brain signals alerting him to potential long-term harm — his brain focuses only on how delicious (and stimulating) the cookies are right now.
“Hormones and puberty definitely play a role in weight gain, as well,” says Roberto Olivardia, Ph.D., clinical psychologist at Harvard Medical School. “Sometimes pre-teens can gain weight as the body prepares for a growth spurt in height. Therefore, BMI normalizes as they gain height.”
People with ADHD are “chemically wired” to seek more dopamine, says John Ratey, M.D., professor of psychiatry at Harvard Medical School in Boston. “Eating carbohydrates triggers a rush of dopamine in the brain,” he says. “It’s the drive for the feeling of satiety.”
Lance Levy, M.D., a frequent collaborator of Dr. Fleming, says that eating several mini-meals throughout the day (grazing) provides a “source of ongoing stimulation that may lessen feelings of restlessness in people with ADHD.”
Of course, individuals eat for many reasons besides hunger, including boredom, sadness, anxiety, as a self-reward, and so on. Olivardia reminds us that teens with ADHD have more independent access to food and bigger portions of food, which can result in unhealthy choices. “Parents have less control over what teenagers eat since they are not always with them,” he says, “and this most likely plays a bigger role in weight gain.”
Presumably, the less a child can regulate his eating habits, the more likely he is to overeat.
Is your child’s ADHD brain working against his health? Yes. Is it pointless to fight back? No.
Healthy eating habits may lead to improved ADHD symptoms, which in turn leads to healthier eating. Getting started is the hardest part; here are some simple strategies to begin:
Then, explain how eating healthy supports each one of those goals, and choose one behavior at a time to focus on. “For example,” Olivardia says, “if your child says he wants to be strong, [you] can say that it is a fact that eating eggs supports that, and donuts do not. So, one goal this week can be for your child to ask himself, ‘Will this support making me strong?’ when making food choices. Create a list of foods that support this goal — and ones that do not — and post that on the refrigerator.”
Within that plan, be sure you’re setting up a “food environment” that promotes healthy eating. That means not buying chips, chocolates, and other snacks that encourage bingeing, while stocking up on nutritious, easy-to-grab meals and snacks that require little preparation.
One simple way to practice mindful eating: Put down your fork in between bites. Or ask your child to describe what they’re eating as though the person listening has never tasted that food before — talking after chewing slows down a busy child.
The rate at which sugar from a particular food enters brain cells, and other cells of the body, is called its “glycemic index” (GI). Foods with a high glycemic index cause sugar to empty quickly from the blood into the cells. Insulin regulates the ups and downs of blood sugar, and the rollercoaster behavior and food cravings that sometimes go with them. Low-glycemic foods, snacks, and meals deliver a limited but steady supply of sugar, helping a child with ADHD to control behavior and eat more mindfully.
Try meals and snacks high in protein, complex carbs, and fiber – like oatmeal and a glass of milk, scrambled eggs with whole-grain toast, or peanut butter on a piece of whole grain bread. The sugars from these carbohydrates are digested more slowly, because protein, fiber, and fat eaten together result in a more gradual and sustained blood sugar release. That means your child will be more satiated and for longer.
It’s not about eating fewer calories, it’s about eating the right foods and the right portions. It’s about using food mindfully to meet personal goals.