Characteristics and outcomes of weight loss patients with

Characteristics and outcomes of weight loss patients with ADHD Sherry L. Pagoto, Carol Curtin, Linda Bandini, Sarah Anderson, Kristin Schneider, Jamie Bodenlos, and Yunsheng Ma Division of Preventive and Behavioral Medicine Eunice Kennedy Shriver Center University of Massachusetts Medical School

ADHD and obesity Higher than expected rates of ADHD (25 -30%) reported in obese clinic samples (Altfas et al 2002; Agranat et al 2005; Fleming et al 2005) Higher than expected BMI in clinic samples of children with ADHD (Holtkamp et al 2004) Four population-based studies of association between ADHD and obesity: two positive associations, one no association, one association dependent on stimulant medication (Cortese 2008; Pagoto et al 2007)

ADHD: A Problem of Behavioral Disinhibition (Russell Barkley) • Impulse control (emotional eating, fast food) • Delaying gratification (emotional eating, diet relapse) • Keeping information in mind to guide actions (meal planning) • Self-control (fast food, diet relapse) • Regulating emotions (emotional eating) • Generating motivation for tasks that have no immediate payoff (low motivation for exercise) • Problem-solving ability (meal planning) • Following through on long-term goals (adherence) • Variability in task or work performance (meal skipping, diet relapse)

Study Questions Are the diet and weight-related habits of patients with ADHD different than those of patients with no ADHD? Does ADHD affect outcomes following a structured weight loss attempt ? N= 63 patients agreed to participate in a study about difficulties people have in weight loss (from a list of 155 total patients who were contacted) 75% female; mean age = 49. 9, mean BMI = 40 Pagoto et al (manuscript under review)

Measures Adult ADHD Symptoms Rating Scale (ASRS) (Kessler et al 2005) Weight and Lifestyle Inventory (Wadden et al 2006) Dietary habits, physical activity Perceived difficulty of lifestyle changes (PDI) Self-efficacy for weight control (WEL) (Clark et al 1991) Weight loss following 4 months of treatment (medical record)

Results ADHD + (n=19) ADHD - (n=44) P value BMI baseline 40. 75 (6. 51) 41. 67 (6. 94) . 47 Depression dx 31% 20% . 34 Short-lived (lasting <3 days in past year 10. 07 (15. 28) 2. 18 (4. 08) . 007 Sustained (lasting >3 days in past year 5. 00 (5. 78) 2. 37 (2. 81) . 08 WEIGHT LOSS ATTEMPTS DIET HABITS Meals skipped per week 1. 57 (2. 00) 1. 40 (2. 17) . 59 Fast food meals per week 1. 94 (1. 92) . 81 (1. 78) . 04

Results ADHD + (n=19) ADHD - (n=44) P value Days per week of > 20 mins moderate physical activity 2. 50 (2. 61) 3. 48 (1. 79) . 26 Perceived Difficulty Index 29. 78 (6. 35) 23. 02 (8. 53) . 01 Self-efficacy for weight control 75. 73 (42. 72) 103. 87 (29. 32) . 001 Percent weight change -3. 34 (3. 53) -5. 59 (3. 43) . 02 Percent losing 5% weight or more 31% 61% . 03

Discussion Weight loss patients who screen positive for ADHD make frequent short-lived weight loss attempts, eat fast food more frequently, have lower self-efficacy for weight control, find weight loss skills more difficult, have higher emotional eating scores, and lost less weight in a structured program. People with attentional problems may represent a treatment resistant sub-population of the obese. Is it ADHD or are attentional problems related to: Menopause? Metabolic disturbances? Other medical conditions?

Future research Explore the roles of executive function, impulsivity, inattention, and behavioral disinhibition in obesity and eating behavior Does treating ADHD reduce risk for obesity in adults with ADHD? How to treat a patient with ADHD who is presenting for weight loss?