Diet and Weight Management Strategies for Adults with ADD
(ADHD)
Kathleen G. Nadeau, Ph.D.
Although obesity is a high-profile national concern, very
little attention has been focused on adults with ADD (ADHD)
and whether they have an increased vulnerability to obesity,
weight management problems, or eating disorders.
Carbyhydrates and ADD (ADHD) - Self-medication?
Several years ago, ADDvance Magazine, co-published and co-edited
by the author and Patricia Quinn, M.D., sent readers an informal
survey asking about problems of over-eating and eating disorders.
The women who responded did not report a high incidence of
eating disorders such as anorexia or bulemia, but did report
problems with compulsive over-eating. Many women described
a pattern of eating carbohydrates (sweets and starchy snacks)
in the evening, not only as a means of reward, but also as
a means self-calming or "self-medication."
ADD (ADHD) and Impulsive Eating Patterns
The tendencies of people with ADD (ADHD) not to plan, to
grab food on the run, is, unfortunately, a perfect match for
the fast food and snack food industries. As Dr. Michael Lyon
(2000) writes, "ADD (ADHD)-affected people tend to be
too busy to take the time to plan menus or prepare proper
meals." It would be interesting to conduct a study of
the eating habits of adults (and children) with ADD (ADHD)
compared to the general population. While it is clear that
most Americans need to make major changes in their eating
habits, it would seem very likely that those with ADD (ADHD)
have an even higher tendency to eat fast-food meals and snack
on "junk food" including sodas, chips, cookies,
and crackers. Dr. Lyons goes on to describe compulsive eating
patterns among those with ADD (ADHD) - an intense craving
for junk food, wheat and dairy products. Additionally, he
reports that adults with ADD (ADHD) often develop compulsive
cravings for caffeine containing food items such as chocolate
and coffee.
ADD (ADHD) and Obesity - is there a link?
John Fleming (2002) is one of the few who has conducted
preliminary research regarding ADD (ADHD) and eating disorders.
In an unpublished pilot study, Dr. Fleming describes an investigation
that he conducted at the Nutritional Disorders Clinic in Toronto,
Ontario. While many clients who were self-referred to the
clinic benefited from the weight reduction treatment program,
there was a significant group that improved in some areas
such as mood and energy level, but who could not lose weight
easily and could not sustain dietary or lifestyle changes
for longer than a few weeks.
Dr. Fleming studied a group of 50 clients who fell into
this category. They did not meet the criteria for either anorexia
or bulimia, but "clearly had disturbed eating habits,
with typically no regularly planned meals or snacks, and an
inability to follow dietary plans for any useful length of
time." (p. 412). As these clients were more carefully
evaluated, it became clear that the incidence of undiagnosed
ADD (ADHD) was very high. In fact, Dr. Fleming reported that
approximately one third of the clients at their clinic met
clinical criteria for a diagnosis of ADD (ADHD). Dr. Fleming
is careful to note that this statistic does not imply that
most people with ADD (ADHD) have disordered eating, but rather
that there is a "sub-population of individuals with disordered
eating plays a major role in the etiology and maintenance
of the disorder."
ADD (ADHD) and Disordered Eating
The ADD (ADHD)/disordered eating connection is not difficult
to understand. Healthy dietary regulation requires organization
and planning - two areas of cognitive functioning that are
typically difficult for those with ADD (ADHD). Good eating
habits also require self-awareness - awareness of when one
is hungry, awareness of when one is full. Many individuals
with ADD (ADHD) report that they skip meals because they were
busy and distracted; these same individuals often report that
later their hunger becomes so intense that they swing in the
opposite direction, overeating well beyond the point of reasonable
intake because they don't know when to stop until they feel
"stuffed." And individuals eat for many reasons
besides hunger - including boredom, self-stimulation, anger,
sadness, reward, simple food availability, and stress relief.
It is easy to understand how consistent self-regulation, which
is a well-documented difficulty for those with ADD (ADHD),
can lead to patterns of chronic over-eating.
Why most diet plans don't work for those with ADHD
Many diet plans are very ADD-unfriendly. They require detailed
record-keeping, weighing of food, or unrealistically severe
food restrictions are difficult for those without ADD (ADHD)
and impossible for those with ADD (ADHD). Other weight loss
programs involve pre-selected, pre-packaged foods that may
work well in the short-run, but that do not help the individual
with ADD (ADHD) to learn to make consistently good choices
in real-world food environments.
Stimulant medication
Dr. Fleming writes that the use of stimulant medication
alone has not been shown to be effective in achieving and
maintaining weight loss and improved daily eating patterns.
Although appetite suppression is a common side effect of stimulant
medication during the initial phase of treatment, this side
effect wears off. He emphasizes that stimulants should never
be prescribed for their side effect of appetite suppression,
but notes that stimulant medication can be a very useful part
of an overall weight-loss treatment program for those with
ADD (ADHD).
The primary benefit of stimulant medication in healthy dietary
management is its enhancement of the executive functions of
the brain. In other words, stimulants can help individuals
with ADHD to become better self-observers; to become more
consistent in their ability to self-regulate and resist eating
impulses; and to more easily engage in the planning and follow-through
necessary for the maintenance of healthy eating habits.
Don't go on a "diet."
Many with ADD (ADHD) want "instant results" and
are drawn to the most strict and radical diet plan promising
a weight loss of several pounds per week. Statistics show
that such plans are doomed to failure for the general population,
and are even less likely to result in long-term success for
those with ADD (ADHD).
Develop an ADD-friendly Eating Plan
A plan is more likely to succeed for people with ADD (ADHD)
if it does not require careful daily planning and packing
of food. An adult with ADD (ADHD) often begins a new eating
plan with determination, carefully preparing a bag lunch to
take to work each day. Such a plan, however, is nearly doomed
to fail. As soon as stress levels rise, or the individual
wakes up late, the day's lunch isn't packed and an immediate
reversion to fast food or junk food occurs.
An eating plan that doesn't require 100% success
is more likely to succeed. An ADD (ADHD)-friendly plan makes
allowances for common ADD (ADHD) patterns such as forgetfulness
or lateness with a "Plan B." Plan B involves keeping
foods with a longer shelf-live in stock at the office for
days of lateness, forgetfulness or high stress. These staples
should not be sweets or tempting salty snacks, but rather
things such as protein bars, sunflower seeds, dried fruit,
yogurt (which can last for weeks when refrigerated), unsalted
nuts, and refrigerated fresh fruit - a bag of apples or oranges.
If you are fortunate enough to have a freezer available at
the office, your Plan B could also involve containers of frozen
left-overs from home that you can pop in the microwave or
frozen protein drinks that can be thawed. These foods can
be restocked every couple of weeks so that there's no need
to revert to your old high-calorie lunch habits on days you
don't pack a lunch.
Don't feel you must "go along with the crowd"
in your eating habits - remember, "the crowd" used
to smoke!
Unhealthy eating patterns are only now beginning to be seen
as a significant public health problem that affects those
around you as well as yourself. Twenty or more years ago,
people quietly suffered while others smoked cigarettes during
meetings and at meals. Today, many people who are working
hard to develop healthy eating patterns don't feel as comfortable
asking people not to share brownies, although they would feel
very comfortable asking them not to share second-hand smoke.
A person with ADD (ADHD)-related impulsivity shouldn't expect
himself to maintain self-control while sitting in front of
tempting, but unhealthy food. Instead, we need the confidence
to speak up and request that we are not required to expose
ourselves to unwanted temptation through the "good intentions"
of coworkers.
Often, our bad eating patterns are related to our particular
environment. To make changes in your own eating patterns,
you may need to make changes in the environment - both at
home and at work.
Coworkers with bad eating habits
One woman with ADD (ADHD) reported that she worked in a
group that was very food-oriented. Many of her co-workers
were obese and often brought delicious, fattening food to
work to share with the group - platters of brownies, homemade
cookies, or bagels and cream cheese picked up on the way to
work. While she wasn't successful in changing the eating habits
of her group of co-workers, she was able to change her habit
of eating in the staff lounge on days when such foods were
on display. She was successful in her request that
such food not be on display at meetings that she was required
to attend.
Work environments with no healthy food choices.
A young man with ADD (ADHD) reported that he survived on
junk food during the day at work. Although he worked for an
organization that stressed healthful living and outdoor activities,
ironically the only food or drink available in vending machines
was sugar-laden sodas, and vending-machine junk-food snacks.
His disorganization and lack of planning, along with the junk-food
availability on the job were a dangerous combination.
Most likely the contradiction between his company's philosophy
and the vending machine products available to employees had
never been noticed. After speaking to his ADD (ADHD) counselor,
he decided to be pro-active. He asked for healthy snacks and
drinks such as apple juice, V-8, and bottled water; low-sugar
protein bars, nuts, and dried fruits to be made available
in the vending machines in the staff lounge. To his pleasure
and surprise, several co-workers thanked him for initiating
the change.
Family members who insist on tempting, unhealthy food
Some people with ADD (ADHD) who try to improve their eating
patterns feel sabotaged by family members who insist upon
keeping desserts and snack foods in the house. While you can't
insist that the entire family live according to your new eating
plans, it's important to talk about your needs with your partner
and children. Everyone will benefit from a healthier diet
with fewer processed snack foods and less sugar. Try making
gradual changes - for example having only one or two sweets
or snacks in the house. And try to problem-solve by purchasing
snacks or desserts that are not your favorites but
still appeal to the snackers in your family. It's also reasonable
to request that tempting foods be kept in places where you're
not likely to see them each time you open the refrigerator
or pantry.
Assess your own daily eating patterns. Most likely you will
identify one, two, or three likely places and circumstances
in which you are more likely to overeat or to eat food items
you would rather avoid. Once these circumstances are identified,
then you can begin to problem-solve.
No "good-for-you" food around
This calls for some problem-solving. Make a list of foods
that you want to include in your new, healthier eating plan
- choose those that can be kept in the freezer or that have
a long shelf-life in the pantry. That way, there's always
something healthy to eat and to need to grab the chips.
Too hungry to wait
Many people with ADD (ADHD) don't pay enough attention to
their hunger levels. They may become busy during the day,
eating very little, and then discover that they're ravenous
- resorting to fast food or high-calorie snacks because it's
too hard to wait and eating something healthy.
Skip meals, then binge
Fasting and binging is another common ADD (ADHD) pattern
- sort of an all or nothing approach to food. Many people
mistakenly believe that it's good to skip a meal, not realizing
that they are setting themselves up to overeat at the next
meal.
Look for strategies that make it easy to succeed and harder
to fail -
Weight management resources for adults with ADHD:
Fleming, John (2002) Eating disorders in women with ADHD.
In P.Quinn & K. Nadeau, Gender Issues and ADHD,
pp. 411-426. Silver Spring: Advantage Books.
Lyon, Michael (2000) Healing the hyperactive brain.
Calgary, AB, Canada: Focused Publishing.
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