Prevalence of attention deficit/hyperactivity disorder among adults in obesity treatment

BMC Psychiatry

Jules R Altfas¹ 

[1] Behavioral Medical Center for Treatment and Research Portland, Oregon, USA

关键词: obesity treatment failure;    obesity treatment;    ADHD prevalence;    ADHD;   

Others  :  1125170
DOI  :  10.1186/1471-244X-2-9

 received in 2002-04-20, accepted in 2002-09-13,  发布年份 2002

【 摘 要 】

Background

Bariatric patients showing poor "focus" during treatment more often failed to lose weight or maintain reduced weight. Evaluation of these patients identified a number having attention deficit/hyperactivity disorder (ADHD), evidently a potent factor limiting successful weight control. After searches found no published reports describing comorbid ADHD and obesity, this report was conceived to begin exploring the prevalence and characteristics of these patients.

Method

Clinical records of 215 patients receiving obesity treatment during 2000 were reviewed. Data collected and analyzed included age, sex, beginning and ending body mass index (BMI), number of clinic visits, months of treatment, and diagnostic category (ADHD, some ADHD symptoms, non-ADHD). DSM-IV criteria were used, except age of onset was modified to <= 12 years.

Results

Whole sample ADHD prevalence was 27.4% (CI:21.1,32.9), but 42.6% (CI: 36.3% to 48.9%) for BMI >= 40. Mean weight loss among obese patients with ADHD (OB+ADHD) was 2.6 BMI (kg/m²) vs. 4.0 for non-ADHD (NAD) (p < 0.002). For BMI >= 40, OB+ADHD had BMI loss 2.9 vs. 7.0 (NAD) (p < 0.004). OB+ADHD had more clinic visits, with a trendtoward longer treatment duration.

Conclusions

ADHD was highly prevalent among obese patients and highest in those with extreme obesity. Comorbid obesity and ADHD symptoms rendered treatment less successful compared to NAD counterparts. Reasons for the comorbidity are unknown, but may involve brain dopamine or insulin receptor activity. If replicated in further studies, these findings have important implications for treatment of severe and extreme obesity.

【 授权许可】

   
2002 Altfas; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 参考文献 】

• [1]Mokdad AH, Serdula MK, Dietz WH, Bowman BA, Marks JS, Koplan JP: The continuing epidemic of obesity in the United States. JAMA 2000, 284:1651-2.
• [2]McGinnis JM, Foege WH: Actual causes of death in the United States:. JAMA 1993, 270:2207-12.
• [3]National Institutes of Health: clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults – the evidence report. Obes Res 1998, 6(Suppl 2):71-79S.
• [4]Perusse L, Chagnon YC, Weisnagel SJ, et al.: The human obesity gene map: the 2000 update. Obes Res 2001, 9:135-169.
• [5]Reaven GM: Banting lecture: role of insulin resistance in human disease. Diabetes 1988, 37:1595-1607.
• [6]Bruning JC, Gautum D, Burks DF, et al.: Role of brain insulin receptors in control of body weight and reproduction. Science 2000, 289:2122-5.
• [7]Gibbs WW: Gaining on fat. Sci Am 1996, 275:88-94.
• [8]National Institutes of Health Technology Assessment Conference: Methods for voluntary weight loss and control. Office of Medical Applications of Research, National Institutes of Health, Bethesda, MD 1992.
• [9]Stunkard SE: The current status of treatment of obesity in adults. In Eating and its disorders. Edited by Stunkard AJ, Stellar E. New York, Raven Press; 1984.
• [10]Wilson GT: Behavioral treatment of obesity: thirty years and counting. Adv Behav Res Ther 1994, 16:31-75.
• [11]Nolan EE, Gadow KD, Sprafkin J: Teacher reports of DSM-IV ADHD, ODD and CD symptoms in schoolchildren. J Am Acad Child Adolesc Psychiatry 2001, 40:241-249.
• [12]Wolraich ML, Hannah JN, Baumgaertel A, Feuer ID: Examination of DSM-IV criteria for attention deficit/hyperactivity disorder in a county-wide sample. J Dev Behav Pediatr 1998, 19:162-168.
• [13]Searight HR, Burke JM, Rottnek F: Adult ADHD: evaluation and treatment in family medicine. Am Fam Physician 2000, 62:2077-86.
• [14]Biederman J, Mick E, Faraone SV: Age-dependent decline of symptoms of attention deficity/hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry 2000, 157:816-818.
• [15]Faraone SV, Biederman J, Spencer T, et al.: Attention-deficit/hyperactivity disorder in adults: an overview. Biol Psychiatry 2000, 48:9-20.
• [16]Levin FR, Evans SM: Diagnostic and treatment issues in comorbid substance abuse and adult attention-deficit hyperactivity disorder. Psychiatric Ann 2001, 31:303-312.
• [17]Parham PS: Compulsive eating: applying a medical addiction model. In Obesity: new directions in assessment and management.. Edited by VanItallie TB, Simopoulos AP. Philadelphia, The Charles Press; 1995.
• [18]Black DW, Goldstein RB, Mason EE: Prevalence of mental disorder in 88 morbidly obese bariatric clinic patients. Am J Psychiatry 1992, 149:227-234.
• [19]Blum K, Braverman ER, Wood RC, et al.: Increased prevalence of the Taq I A1 allele of the dopamine receptor gene (DRD2) in obesity with comorbid substances use disorder: a preliminary report. Pharmacogenetics 1996, 6:297-305.
• [20]Cugini P, Cilli M, Salandri A, et al.: Anxiety, depression, and body composition: III. Their relationships in obese patients. Eat Weight Disord 1999, 4:115-120.
• [21]Jensen PS, Hinshaw SP, Kraener HC, et al.: ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry 2001, 40:147-158.
• [22]Murphy K, Barkley RA: Attention deficit hyperactivity disorder adults: comorbidities and adaptive impairments. Compr Psychiatry 1996, 37:393-401.
• [23]McCann BS, Roy-Byrne P: Attention-deficit/hyperactivity disorder and learning disabilities in adults. Semin Clin Neuropsychiatry 2000, 5:191-197.
• [24]Pine DS, Cohen P, Brook J, Coplan JD: Psychiatric symptoms in adolescence as predictors of obesity in early adulthood: a longitudinal study. Am J Public Health 1997, 87:1303-1310.
• [25]Murphy P, Schachar R: Use of self-ratings in the assessment of symptoms of attention deficit hyperactivity disorder in adults. Am J Psychiatry 2000, 157:1156-1159.
• [26]Wender PH: Attention-deficit hyperactivity disorder in adults. New York, Oxford University Press. 1995, 45-47.
• [27]Barkley RA, Biederman J: Toward a broader definition of the age-of-onset criterion for attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 1997, 36:1204-10.
• [28]Otto MW, Tuby KS, Gould RA, McLean RY, Pollack MH: An effect-size analysis ofthe relative efficacy and tolerability of serotonin selective reuptake inhibitors for panic disorder. Am J Psychiatry 2001, 158:1989-1992.
• [29]Swanson J, Oosterlaan J, Murias M, et al.: Attention deficit/ hyperactivity disorder children with a 7-repeat allele of the dopamine receptor D4 gene have extreme behavior but normal performance on critical neurospychological tests of attention. Proc Natl Acad Sci 2000, 97:4754-4759.
• [30]Noble EP: The DRD2 gene in psychiatric and neurological disorders and its phenotypes. Pharmacogenomics 2000, 1:309-33.
• [31]Poston WS 2nd, Ericsson M, Linder J, et al.: D4 dopamine receptor gene exon III polymorphism and obesity risk. Eat Weight Disord 1998, 3:71-77.
• [32]Sunohara GA, Roberts W, Malone M, et al.: Linkage of the dopamine D4 receptor gene and attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2000, 39:1537-42.
• [33]Muglia P, Jain U, Macciardi F, Kennedy JL: Adult attention deficit hyperactivity disorder and the dopamine D4 receptor. Am J Med Genet 2000, 96:273-277.
• [34]Comings DE, Blum K: Reward deficiency syndrome: genetic aspects of behavioral disorders. Prog Brain Res 2000, 126:325-341.
• [35]Wang GJ, Volkow ND, Logan J, et al.: Brain dopamine and obesity. Lancet 2001, 357:354-357.
• [36]Cincotta AH, Meier AH, Cincotta Jr: Bromocriptine improves glycaemic control and serum lipid profile in obese Type 2 diabetic subjects: a new approach in the treatment of diabetes. Expert Opin Investig Drugs 1999, 8:1683-1707.
• [37]Schulingkamp RJ, Pagano TC, Hung D, Raffa RB: Insulin receptors and insulin action in the brain: review and clinical implications. Neurosci Biobehav Rev 2000, 24:855-872.
• [38]Murphy K, Barkley RA: Prevalence of DSM-IV symptoms of attention deficit hyperactivity disorder in adult licensed drivers. J Attention Disorders 1996, 1:146-161.
• [39]Levin FR, Evans SM, Kleber HD: Prevalence of adult attention-deficit hyperactivity disorder among cocaine abusers seeking treatment. Drug Alcohol Depend 1998, 52:15-25.
• [40]Mancini C, Van Ameringen M, Oakman JM, Figueiredo D: Childhood attention deficit/hyperactivity disorder in adults with anxiety disorders. Psychol Med 1999, 29:515-525.
• [41]Fones CS, Pollack MH, Susswein L, Otto M: History of childhood attention deficit hyperactivity disorder (ADHD) features among adults with panic disorder. J Affect Disord 2000, 58:99-106.
• [42]Schubiner H, Tzelepis A, Milberger S, et al.: Prevalence of attention-deficit/hyperactivity disorder and conduct disorder among substance abusers. J Clin Psychiatry 2000, 61:244-251.
• [43]Weiler MD, Bellinger DK, Simmons EK, et al.: Reliability and validity of a DSM-IV based ADHD screener. Neuropsychol Dev Cogn Sect C Child Neuropsychol 2000, 6:3-23.
• [44]Schreiber HE, Javorsky DJ, Robinson JE, Stern RA: Rey-Osterrieth Complex Figure performance in adults with attention deficit hyperactivity disorder: a validation study of the Boston Qualitative Scoring System. Clin Neuropsychol 1999, 13:509-520.