ADHD and Binge Eating: Are They Inextricably Linked?
In medical school, we were repeatedly advised that there is both a science and an art to the practice of medicine. In these days of “doc-in-a-box” on-line consultations for obesity, it is tempting to think there is a one-size-fits-all purely scientific approach called Ozempic. Yet, for every nine patients who lose weight seemingly effortlessly on this class of medication, there is always one whose body stubbornly refuses to submit.
Adam is a 58-year-old male who came to me last month for difficulty losing weight. He had been steadily gaining weight for the past 20 years and is now technically morbidly obese (a term which should arguably be obsolete). His weight gain is complicated by high blood pressure, high cholesterol, and obstructive sleep apnea. His sleep apnea has caused such profound exhaustion that he no longer has the energy to work out. He also has significant attention deficit hyperactivity disorder (ADHD) which has been left untreated due to his ability to white-knuckle it through his many daily meetings and calls. He is a successful portfolio manager at a high-yield bond fund and is a married father of three. Adam tends to eat minimally during the day, thereby baffling his colleagues with the stark contrast between his minimal caloric intake and his large belly. However, when he returns from work late at night (kids already safely tucked into bed), the floodgates open. He reports polishing off pints of ice cream, scarfing down bags of cookies, inhaling trays of brownies. No carbohydrate is off limits to him once he steps off the Metro North train and crosses the threshold from work to home.
Does Adam simply lack the desire or common-sense willpower to make the necessary changes in his lifestyle or is there something more complicated at play?
I would argue that Adam’s ADHD triggered a binge eating disorder (BED) that festered unchecked over the past twenty years. Patients with BED typically eat massive quantities of food over short periods of time- often when they are not even hungry! Adam admitted that he would generally continue to eat well after feeling stuffed to the brim. It is well known that ADHD is a leading cause of binge eating tendencies. So, what is the link between these two seemingly unrelated disorders?
The answer likely lies with dopamine. Dopamine is a neurotransmitter produced in the reward centers of the brain which regulates how people experience pleasure and control impulses. We believe that people with ADHD have low levels of dopamine (it’s actually a bit more complicated, but this is the general idea). These low levels of dopamine lead people to self-medicate with sugars, salt and fats to raise up dopamine levels. Vyvanse is an FDA approved treatment option for both ADHD and binge eating. Vyvanse raises the levels of dopamine (as well as norepinephrine) in the brain’s reward center. Often the strong urge to binge subsides rapidly once the ADHD is properly treated.
Rather than start Adam on Ozempic or a similar agent, I opted to start him on Vyvanse. When I spoke to him a week later, he confided that the world suddenly shifted into focus, and he was able to plan his meals throughout the day and resist the urge to binge late at night. While I may eventually add on an Ozempic-like medication if his weight loss plateaus, for now I will focus on raising his dopamine levels to tackle the underlying cause of his weight gain.
