More Than a Full Plate
One common, under-addressed symptom of attention deficit-hyperactivity disorder (ADHD) is its impact on eating. A new study in the Western Journal of Nursing Research suggests the possibility of screening anyone with a chronic weight issue for ADHD since one in five adults who were obese turned out to have multiple symptoms of it, compared with around one in thirty in the general adult population. Previous studies have also found that children and adults with ADHD are significantly more likely to be overweight. With so many millions of people affected by ADHD, any risk of increased obesity influences the health of huge numbers of people. Is the connection with ADHD affecting you or someone you care about?
The link between ADHD and poor eating habits isn't surprising when you consider that it is a disorder of executive function, a set of cognitive skills which act as our brain manager. Executive function impacts almost every aspect of living, encompassing our ability to self-regulate, organize, plan, prioritize, and anticipate the future. Eating is only one of many facets of ordinary life influenced by ADHD, yet typically flies under the radar.
The Makings of Self-Control
Executive function deficits get in the way of everything from noticing when we are full to making healthy food choices in the midst of a stressful day. For kids and adults, impulsivity leads well-intentioned diets out the window in a moment, making it that much harder to walk past a MacDonald's or avoid the pile of donuts left by the coffee machine. Executive function affects the ability to judge time, perhaps to see that today's 'exception' is part of a larger pattern. It's not a rare splurge, it's the same as four times this week already for ourselves or for our children.
Studies looking at eating habits in general, not specific to ADHD, have shown that distracted eating - eating while watching television, playing games, or simply daydreaming - increases calorie intake. Stress and anxiety, especially when amplified by ADHD, can push anybody of any age to reach for food. And then when a new diet or lifestyle is needed for a teen or young adult, executive function skills are required to develop and stick with the plan.
Guiding children with ADHD becomes even more important than it does for other kids, from behavioral patterns around food to the choices and the brands they encounter at home, and learn to prefer. ADHD causes some children, unless taught otherwise, to unknowingly overeat at every sitting or always grab an extra cookie from the pile. They may be less tolerant of hunger, quicker to raid the cabinet, melt down near the cash register candy, or experience any of a host of related moments that add up to a longer-term problem. Recognizing all the myriad ways executive function influences eating allows for a deeper perspective and suggests new possibilities for change.
A Hidden Ingredient
As a starting point, we must look for and identify the influence of ADHD in the first place. When children with ADHD overeat or begin to gain weight, we can dig deeper into their ADHD, looking for ways to manage it better. If an undiagnosed child struggles chronically around food, we should consider the possibility of ADHD, looking for symptoms in other areas of life. Other studies of obese adults have showed more than in four to be affected, and the rate in children could prove even higher as more kids have ADHD than grown-ups.
Many parents of children with ADHD have symptoms of the diagnosis as well. With adult ADHD it becomes that much harder to maintain long-term plans and healthier lifestyles, so the whole family may need outside support. Often these parents battle their own difficulties with self-regulation around nutrition, from how they manage the family pantry to their own eating style. Unaddressed, parental issues increase the risk that their kids will struggle with the same.
Parents are concerned about weight loss as a side effect to ADHD medication and rightfully so, although in practice most kids do fine. In fact, medical treatment of ADHD can lead to healthier eating habits through a decrease in impulsivity and distractibility and all the rest. Kids who start out overweight sometimes seem to lose weight only until reaching a more appropriate one for their height, and then resume typical growth. In some situations improved eating habits, not the potential medication side effect of appetite suppression, may explain their initial weight loss.
Recipe for Success
It's not only about what we serve or when we serve it, it's about the example we set. We can choose to model only eating when eating, instead of staying half-engaged in other activities, such as reading the newspaper, watching television, working, or daydreaming. When at the dinner table we can leave our food alone while in conversation, pausing instead of mechanically lifting our fork again and again. We can practice putting our utensils on the plate between bites, serving ourselves on smaller plates, or never eating directly from the bag. Our children watch, and learn.
We might even notice how we habitually shop. Maybe decide not to keep challenging foods in the house at all, or only to buy them when consciously deciding it's time for a treat. If a child raids the pantry, constantly debates about having more junk food, or refuses healthy snacks for the chips they know are available ... don't have the overly enticing items on the shelf. We do the shopping, we can choose not to have them around.
The practice of routinely having family dinner has been linked to healthier habits, as well as fostering various emotional and behavioral benefits, but keep in mind that having the television on during dinner reverses much of that. In the midst of a hectic afternoon or butting up against larger behavioral issues elsewhere in life, we may give in to complaining about food, or use food to calm irritated children. Or conversely, we might stick to a different routine: Two cookies after dinner and no junk the rest of the day, dessert only on Saturday, or whatever else best fits our lifestyle. Establishing these healthy habits early often heads off troubles before they start.
The Whole Enchilada
So often, we compartmentalize troubles related to ADHD: My daughter has a hard time focusing and is more reactive than I like, and overeats and misplaces her homework all the time. Maybe you wrestle with a similar set of difficulties as a parent. We often judge our kids or ourselves for being 'bad' or to be failing in some way: How come this looks so easy for all his classmates, and is so hard for my son? We scramble to address ADHD through hodgepodge solutions targeting each bump in the road (or mountain) separately. Yet in reality these all reflect the same condition, the same executive function deficits.
Plenty more may be going on around food for any individual, rarely is it a simple relationship. Beyond the range of struggles typical for many of us, anyone may experience an eating disorder, mental health concern, or a difficult family situation that affects their relationship with food. And this entire article is written from the perspective of a country where famine is rare, where most of us have options; when food is truly scarce, everything must change.
While there may be layers and layers of emotional and behavioral habit contributing, observing eating through the lens of ADHD allows for a deeper exploration, instead of chasing only the end point - eat less and exercise more. That's an answer, but executive function lets it happen. For anyone with ADHD it may seem weight control and five or ten different things are going 'wrong' at once, yet executive function ties them all together. While not a miracle cure, all will be easier managed when we acknowledge this often overlooked element in the recipe of life.
Published on August 1, 2011 by Mark Bertin, M.D. in The Family ADHD Solution
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