Advertisement

Obesity and ADHD: Clinical and Neurobiological Implications

  • Samuele CorteseEmail author
  • Brenda Vincenzi
Chapter
Part of the Current Topics in Behavioral Neurosciences book series (CTBN, volume 9)

Abstract

Although quite overlooked, increasing evidence points to a significant association between attention-deficit/hyperactivity disorder (ADHD) and obesity. Here, we present an updated systematic review and a critical discussion of studies on the relationship between ADHD and obesity, with a particular emphasis on the possible behavioral, neurobiological, and genetics underlying mechanisms. Available empirically based studies indicate that the prevalence of ADHD in clinical samples of patients seeking treatment for their obesity is higher than that in the general population. Moreover, although still limited, current evidence shows that individuals with ADHD have higher-than-average body mass index z-scores and/or significantly higher obesity rates compared with subjects without ADHD. Three mechanisms underlying the association between ADHD and obesity have been proposed: (1) obesity and/or factors associated with it (such as sleep-disordered breathing and deficits in arousal/alertness) manifest as ADHD-like symptoms; (2) ADHD and obesity share common genetics and neurobiological dysfunctions, involving the dopaminergic and, possibly, other systems (e.g., brain-derived neurotropic factor, melanocortin-4-receptor); and (3) impulsivity and inattention of ADHD contribute to weight gain via dysregulated eating patterns. With regards to the possible clinical implications, we suggest that it is noteworthy to screen for ADHD in patients with obesity and to look for abnormal eating behaviors as possible contributing factors of obesity in patients with ADHD. If further studies confirm a causal relationship between ADHD and obesity, appropriate treatment of ADHD may improve eating patterns and, as a consequence, weight status of individuals with both obesity and ADHD.

Keywords

ADHD Binge eating BMI Eating disorders Obesity 

Abbreviations

ADD

Attention-deficit disorder

BDNF

Brain-derived neurotropic factor

BMI-SDS

Body mass index standard deviations scores

CAPA

Child and Adolescent Psychiatric Assessment

CI

Confidence interval

CPRS-R:S

Conners Parent Rating Scale-Revised:Short version

DRD2

Dopamine D2 receptor

DRD4

Dopamine D4 receptor

EDS

Excessive daytime sleepiness

MC4-R

Melanocortin-4-receptor

NSCH

National Survey of Children’s Health

OR

Odds ratio

SAD

Seasonal affective disorder

SDSC

Sleep Disturbance Scale for Children

WURS-25

Wender Utah Rating Scale-25

Notes

Acknowledgment

Dr. Cortese is supported by a grant from European Union “International outgoing fellowship, Marie Curie actions, FP7 Program, # PIOF-GA-2009-253103.”

References

  1. Agranat-Meged AN, Deitcher C, Goldzweig G, Leibenson L, Stein M, Galili-Weisstub E (2005) Childhood obesity and attention deficit/hyperactivity disorder: a newly described comorbidity in obese hospitalized children. Int J Eat Disord 37:357–359PubMedCrossRefGoogle Scholar
  2. Agranat-Meged A, Ghanadri Y, Eisenberg I, Ben NZ, Kieselstein-Gross E, Mitrani-Rosenbaum S (2008) Attention deficit hyperactivity disorder in obese melanocortin-4-receptor (MC4R) deficient subjects: a newly described expression of MC4R deficiency. Am J Med Genet B Neuropsychiatr Genet 147B:1547–1553PubMedCrossRefGoogle Scholar
  3. Albayrak O, Albrecht B, Scherag S, Barth N, Hinney A, Hebebrand J (2011) Eur J Pharmacol 660(1):165–70Google Scholar
  4. Altfas JR (2002) Prevalence of attention deficit/hyperactivity disorder among adults in obesity treatment. BMC Psychiatry 2:9PubMedCrossRefGoogle Scholar
  5. Anderson SE, Cohen P, Naumova EN, Must A (2006) Relationship of childhood behavior disorders to weight gain from childhood into adulthood. Ambul Pediatr 6:297–301PubMedCrossRefGoogle Scholar
  6. Bazar KA, Yun AJ, Lee PY, Daniel SM, Doux JD (2006) Obesity and ADHD may represent different manifestations of a common environmental oversampling syndrome: a model for revealing mechanistic overlap among cognitive, metabolic, and inflammatory disorders. Med Hypotheses 66:263–269PubMedCrossRefGoogle Scholar
  7. Biederman J, Faraone SV, Monuteaux MC, Plunkett EA, Gifford J, Spencer T (2003) Growth deficits and attention-deficit/hyperactivity disorder revisited: impact of gender, development, and treatment. Pediatrics 111:1010–1016PubMedCrossRefGoogle Scholar
  8. Blum K, Sheridan PJ, Wood RC, Braverman ER, Chen TJ, Comings DE (1995) Dopamine D2 receptor gene variants: association and linkage studies in impulsive-addictive-compulsive behaviour. Pharmacogenetics 5:121–141PubMedCrossRefGoogle Scholar
  9. Braet C, Claus L, Verbeken S, Van VL (2007) Impulsivity in overweight children. Eur Child Adolesc Psychiatry 16:473–483PubMedCrossRefGoogle Scholar
  10. Chen AY, Kim SE, Houtrow AJ, Newacheck PW (2010) Prevalence of obesity among children with chronic conditions. Obesity (Silver Spring) 18:210–213CrossRefGoogle Scholar
  11. Comings DE, Blum K (2000) Reward deficiency syndrome: genetic aspects of behavioral disorders. Prog Brain Res 126:325–341PubMedCrossRefGoogle Scholar
  12. Cortese S, Isnard P, Frelut ML, Michel G, Quantin L, Guedeney A, Falissard B, Acquaviva E, Dalla BB, Mouren MC (2007a) Association between symptoms of attention-deficit/hyperactivity disorder and bulimic behaviors in a clinical sample of severely obese adolescents. Int J Obes (Lond) 31:340–346CrossRefGoogle Scholar
  13. Cortese S, Maffeis C, Konofal E, Lecendreux M, Comencini E, Angriman M, Vincenzi B, Pajno-Ferrara F, Mouren MC, Dalla Bernardina B (2007b) Parent reports of sleep/alertness problems and ADHD symptoms in a sample of obese adolescents. J Psychosom Res 63:587–590PubMedCrossRefGoogle Scholar
  14. Cortese S, Angriman M, Maffeis C, Isnard P, Konofal E, Lecendreux M, Purper-Ouakil D, Vincenzi B, Bernardina BD, Mouren MC (2008a) Attention-deficit/hyperactivity disorder (ADHD) and obesity: a systematic review of the literature. Crit Rev Food Sci Nutr 48:524–537PubMedCrossRefGoogle Scholar
  15. Cortese S, Konofal E, Bernardina BD, Mouren MC, Lecendreux M (2008b) Does excessive daytime sleepiness contribute to explaining the association between obesity and ADHD symptoms? Med Hypotheses 70(1):12–16PubMedCrossRefGoogle Scholar
  16. Cortese S, Faraone SV, Konofal E, Lecendreux M (2009) Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. J Am Acad Child Adolesc Psychiatry 48:894–908PubMedGoogle Scholar
  17. Curtin C, Bandini LG, Perrin EC, Tybor DJ, Must A (2005) Prevalence of overweight in children and adolescents with attention deficit hyperactivity disorder and autism spectrum disorders: a chart review. BMC Pediatr 5:48PubMedCrossRefGoogle Scholar
  18. Davis C, Levitan RD, Smith M, Tweed S, Curtis C (2006) Associations among overeating, overweight, and attention deficit/hyperactivity disorder: a structural equation modelling approach. Eat Behav 7:266–274PubMedCrossRefGoogle Scholar
  19. Davis C, Patte K, Levitan RD, Carter J, Kaplan AS, Zai C, Reid C, Curtis C, Kennedy JL (2009) A psycho-genetic study of associations between the symptoms of binge eating disorder and those of attention deficit (hyperactivity) disorder. J Psychiatr Res 43:687–696PubMedCrossRefGoogle Scholar
  20. Engel SG, Corneliussen SJ, Wonderlich SA, Crosby RD, le Grange D, Crow S, Klein M, Bardone-Cone A, Peterson C, Joiner T, Mitchell JE, Steiger H (2005) Impulsivity and compulsivity in bulimia nervosa. Int J Eat Disord 38:244–251PubMedCrossRefGoogle Scholar
  21. Erermis S, Cetin N, Tamar M, Bukusoglu N, Akdeniz F, Goksen D (2004) Is obesity a risk factor for psychopathology among adolescents? Pediatr Int 46:296–301PubMedCrossRefGoogle Scholar
  22. Faraone SV, Biederman J, Monuteaux M, Spencer T (2005) Long-term effects of extended-release mixed amphetamine salts treatment of attention- deficit/hyperactivity disorder on growth. J Child Adolesc Psychopharmacol 15:191–202PubMedCrossRefGoogle Scholar
  23. Fleming JP, Levy LD, Levitan RD (2005) Symptoms of attention deficit hyperactivity disorder in severely obese women. Eat Weight Disord 10:e10–e13PubMedGoogle Scholar
  24. Friedel S, Horro FF, Wermter AK, Geller F, Dempfle A, Reichwald K, Smidt J, Bronner G, Konrad K, Herpertz-Dahlmann B, Warnke A, Hemminger U, Linder M, Kiefl H, Goldschmidt HP, Siegfried W, Remschmidt H, Hinney A, Hebebrand J (2005) Mutation screen of the brain derived neurotrophic factor gene (BDNF): identification of several genetic variants and association studies in patients with obesity, eating disorders, and attention-deficit/hyperactivity disorder. Am J Med Genet B Neuropsychiatr Genet 132:96–99Google Scholar
  25. Gadde KM, Yonish GM, Wagner HR, Foust MS, Allison DB (2006) Atomoxetine for weight reduction in obese women: a preliminary randomised controlled trial. Int J Obes (Lond) 30:1138–1142CrossRefGoogle Scholar
  26. Gray J, Yeo GS, Cox JJ, Morton J, Adlam AL, Keogh JM, Yanovski JA, El GA, Han JC, Tung YC, Hodges JR, Raymond FL, O'rahilly S, Farooqi IS (2006) Hyperphagia, severe obesity, impaired cognitive function, and hyperactivity associated with functional loss of one copy of the brain-derived neurotrophic factor (BDNF) gene. Diabetes 55:3366–3371PubMedCrossRefGoogle Scholar
  27. Heiligenstein E, Keeling RP (1995) Presentation of unrecognized attention deficit hyperactivity disorder in college students. J Am Coll Health 43:226–228PubMedCrossRefGoogle Scholar
  28. Holtkamp K, Konrad K, Muller B, Heussen N, Herpertz S, Herpertz-Dahlmann B, Hebebrand J (2004) Overweight and obesity in children with Attention-Deficit/Hyperactivity Disorder. Int J Obes Relat Metab Disord 28:685–689PubMedCrossRefGoogle Scholar
  29. Hubel R, Jass J, Marcus A, Laessle RG (2006) Overweight and basal metabolic rate in boys with attention-deficit/hyperactivity disorder. Eat Weight Disord 11:139–146PubMedGoogle Scholar
  30. Hudson JI, Lalonde JK, Berry JM, Pindyck LJ, Bulik CM, Crow SJ, McElroy SL, Laird NM, Tsuang MT, Walsh BT, Rosenthal NR, Pope HG Jr (2006) Binge-eating disorder as a distinct familial phenotype in obese individuals. Arch Gen Psychiatry 63:313–319PubMedCrossRefGoogle Scholar
  31. Kernie SG, Liebl DJ, Parada LF (2000) BDNF regulates eating behavior and locomotor activity in mice. EMBO J 19:1290–1300PubMedCrossRefGoogle Scholar
  32. Lam LT, Yang L (2007) Overweight/obesity and attention deficit and hyperactivity disorder tendency among adolescents in China. Int J Obes (Lond) 31:584–590Google Scholar
  33. Levitan RD, Masellis M, Lam RW, Muglia P, Basile VS, Jain U, Kaplan AS, Tharmalingam S, Kennedy SH, Kennedy JL (2004) Childhood inattention and dysphoria and adult obesity associated with the dopamine D4 receptor gene in overeating women with seasonal affective disorder. Neuropsychopharmacology 29:179–186PubMedCrossRefGoogle Scholar
  34. Levy LD, Fleming JP, Klar D (2009) Treatment of refractory obesity in severely obese adults following management of newly diagnosed attention deficit hyperactivity disorder. Int J Obes (Lond) 33:326–334CrossRefGoogle Scholar
  35. Lourenco BH, Arthur T, Rodrigues MD, Guazzelli I, Frazzatto E, Deram S, Nicolau CY, Halpern A, Villares SM (2008) Binge eating symptoms, diet composition and metabolic characteristics of obese children and adolescents. Appetite 50:223–230PubMedCrossRefGoogle Scholar
  36. Lyons WE, Mamounas LA, Ricaurte GA, Coppola V, Reid SW, Bora SH, Wihler C, Koliatsos VE, Tessarollo L (1999) Brain-derived neurotrophic factor-deficient mice develop aggressiveness and hyperphagia in conjunction with brain serotonergic abnormalities. Proc Natl Acad Sci U S A 96:15239–15244PubMedCrossRefGoogle Scholar
  37. Mitsuyasu H, Hirata N, Sakai Y, Shibata H, Takeda Y, Ninomiya H, Kawasaki H, Tashiro N, Fukumaki Y (2001) Association analysis of polymorphisms in the upstream region of the human dopamine D4 receptor gene (DRD4) with schizophrenia and personality traits. J Hum Genet 46:26–31PubMedCrossRefGoogle Scholar
  38. Mustillo S, Worthman C, Erkanli A, Keeler G, Angold A, Costello EJ (2003) Obesity and psychiatric disorder: developmental trajectories. Pediatrics 111:851–859PubMedCrossRefGoogle Scholar
  39. Nafiu OO, Burke C, Lee J, Voepel-Lewis T, Malviya S, Tremper KK (2010) Neck circumference as a screening measure for identifying children with high body mass index. Pediatrics 126:e306–e310PubMedCrossRefGoogle Scholar
  40. Nasser JA, Gluck ME, Geliebter A (2004) Impulsivity and test meal intake in obese binge eating women. Appetite 43:303–307PubMedCrossRefGoogle Scholar
  41. Noble EP (2003) D2 dopamine receptor gene in psychiatric and neurologic disorders and its phenotypes. Am J Med Genet B Neuropsychiatr Genet 116:103–125CrossRefGoogle Scholar
  42. Pagoto SL, Curtin C, Lemon SC, Bandini LG, Schneider KL, Bodenlos JS, Ma Y (2009) Association between adult attention deficit/hyperactivity disorder and obesity in the US population. Obesity (Silver Spring) 17:539–544CrossRefGoogle Scholar
  43. Poston WS, Ericsson M, Linder J, Haddock CK, Hanis CL, Nilsson T, Astrom M, Foreyt JP (1998) D4 dopamine receptor gene exon III polymorphism and obesity risk. Eat Weight Disord 3:71–77PubMedGoogle Scholar
  44. Ptacek R, Kuzelova H, Paclt I, Zukov I, Fischer S (2009) Anthropometric changes in non-medicated ADHD boys. Neuro Endocrinol Lett 30:377–381PubMedGoogle Scholar
  45. Riverin M, Tremblay A (2009) Obesity and ADHD. Int J Obes (Lond) 33:945CrossRefGoogle Scholar
  46. Rosval L, Steiger H, Bruce K, Israel M, Richardson J, Aubut M (2006) Impulsivity in women with eating disorders: problem of response inhibition, planning, or attention? Int J Eat Disord 39:590–593PubMedCrossRefGoogle Scholar
  47. Schweickert LA, Strober M, Moskowitz A (1997) Efficacy of methylphenidate in bulimia nervosa comorbid with attention-deficit hyperactivity disorder: a case report. Int J Eat Disord 21:299–301PubMedCrossRefGoogle Scholar
  48. Shinawi M, Sahoo T, Maranda B et al (2011) 11p14.1 microdeletions associated with ADHD, autism, developmental delay, and obesity. Am J Med Genet A 155:1272–1280CrossRefGoogle Scholar
  49. Sokol MS, Gray NS, Goldstein A, Kaye WH (1999) Methylphenidate treatment for bulimia nervosa associated with a cluster B personality disorder. Int J Eat Disord 25:233–237PubMedCrossRefGoogle Scholar
  50. Spencer TJ, Biederman J, Harding M, O'Donnell D, Faraone SV, Wilens TE (1996) Growth deficits in ADHD children revisited: evidence for disorder-associated growth delays? J Am Acad Child Adolesc Psychiatry 35:1460–1469PubMedCrossRefGoogle Scholar
  51. Spencer TJ, Faraone SV, Biederman J, Lerner M, Cooper KM, Zimmerman B (2006) Does prolonged therapy with a long-acting stimulant suppress growth in children with ADHD? J Am Acad Child Adolesc Psychiatry 45:527–537PubMedCrossRefGoogle Scholar
  52. Strimas R, Davis C, Patte K, Curtis C, Reid C, McCool C (2008) Symptoms of attention-deficit/hyperactivity disorder, overeating, and body mass index in men. Eat Behav 9:516–518PubMedCrossRefGoogle Scholar
  53. Surman CB, Randall ET, Biederman J (2006) Association between attention-deficit/hyperactivity disorder and bulimia nervosa: analysis of 4 case-control studies. J Clin Psychiatry 67:351–354PubMedCrossRefGoogle Scholar
  54. Swanson J, Greenhill L, Wigal T, Kollins S, Stehli A, Davies M, Chuang S, Vitiello B, Skrobala A, Posner K, Abikoff H, Oatis M, McCracken J, McGough J, Riddle M, Ghuman J, Cunningham C, Wigal S (2006) Stimulant-related reductions of growth rates in the PATS. J Am Acad Child Adolesc Psychiatry 45:1304–1313PubMedCrossRefGoogle Scholar
  55. Tsai SJ, Hong CJ, Yu YW, Chen TJ (2004) Association study of catechol-O-methyltransferase gene and dopamine D4 receptor gene polymorphisms and personality traits in healthy young chinese females. Neuropsychobiology 50:153–156PubMedCrossRefGoogle Scholar
  56. Vgontzas AN, Bixler EO, Chrousos GP (2006) Obesity-related sleepiness and fatigue: the role of the stress system and cytokines. Ann N Y Acad Sci 1083:329–344PubMedCrossRefGoogle Scholar
  57. Waring ME, Lapane KL (2008) Overweight in children and adolescents in relation to attention-deficit/hyperactivity disorder: results from a national sample. Pediatrics 122:e1–e6PubMedCrossRefGoogle Scholar
  58. Weinberg WA, Brumback RA (1990) Primary disorder of vigilance: a novel explanation of inattentiveness, daydreaming, boredom, restlessness, and sleepiness. J Pediatr 116:720–725PubMedCrossRefGoogle Scholar
  59. Zametkin AJ, Zoon CK, Klein HW, Munson S (2004) Psychiatric aspects of child and adolescent obesity: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 43:134–150PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.Institute for Pediatric NeuroscienceNew York University Child Study CenterNew YorkUSA
  2. 2.New YorkUSA
  3. 3.Ellern Mede CentreLondonUK
  4. 4.LondonUK

Personalised recommendations