ADHD in obesity clinics: common, often missed, highly treatable

Editor – we welcome Dandgey and Patten's article¹ on psychological considerations in the Issue of Clinical Medicine devoted to obesity. We were disappointed that the article does not mention attention deficit hyperactivity disorder (ADHD).

A meta-analysis² of 42 studies showed that ADHD, particularly untreated, is strongly associated with obesity in children and adults. A more recent meta-analysis³ of five studies of 492 patients referred for bariatric surgery found 20.9% had ADHD. Another study⁴ showed 27.4% of 215 patients being treated for obesity had ADHD and this rose to 42.6% for those with BMI >40.

Untreated ADHD is a major cause of poor impulse control and bingeing. Difficulty with executive function makes it harder for patients to follow a diet or exercise programme. Interestingly the ADHD stimulant lisdexamfetamine has a licence for binge eating disorder in the USA. ADHD can also contribute to financial and social problems which correlate with obesity. Indeed, nearly all the psychosocial problems mentioned by Dandgey and Patten could be directly or indirectly related to ADHD. The symptoms are often seen as part of depression or anxiety or as part of various psychosocial disadvantages, without probing for an underlying cause, which may be ADHD. ADHD remains largely undiagnosed, despite recent publicity. Yet ADHD symptoms respond extremely well to treatment, and stimulants have the added potential for controlling appetite. It may not be proven that treating ADHD alone will control obesity, but it is likely to improve overall quality of life and concordance with other treatment and follow up. A diagnosis of ADHD could make a dramatic difference to patients with clinical obesity.

Yes, it is important for multidisciplinary teams to gain a holistic understanding of the patient's psychosocial factors but surely this should include screening for a highly treatable condition that is common, relevant to their obesity, but often unrecognised. It is easy to screen for ADHD using a simple six question scoring tool, available free of charge, as recommended by the WHO: the ASRS.⁵

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