Psychosocial risk factors underlie the link between attention deficit hyperactivity symptoms and overweight at school entry

Abstract

The link between symptoms of attention deficit hyperactivity disorder (ADHD) and increased body weight is well established, while the underlying mechanisms are not yet clear. Since increased body weight and ADHD symptoms have been found to be associated with psychosocial risk factors in childhood, we analyzed whether the psychosocial risks explain the association between the two conditions. The sample consisted of 360 children (age range 6-7 years, 173 boys) attending the obligatory medical health exam before school entry. The childrens' height and weight were measured during the examination. ADHD symptoms were ascertained by parent-report questionnaires. Psychosocial risks were ascertained by a structured interview. The link between ADHD symptoms and body weight could be completely explained by cumulative psychosocial risks while controlling for gender, symptoms of depression/anxiety and oppositional defiant disorder of the child, maternal smoking during pregnancy, parental body mass index, and potential diagnosis of ADHD in the parents. In current models pertaining to the etiology of overweight/obesity and ADHD, chronic stress caused by psychosocial adversity is assumed to act as a trigger for these conditions. Psychosocial risks experienced during childhood may activate processes that specifically lead to the combined ADHD-overweight phenotype.

Overweight in family members of probands with ADHD

“…The results are in line with another study suggesting the association between ADHD and overweight was completely explained by cumulative psychosocial risks [19]. Prime candidate environmental factors that increase the risk for both ADHD and overweight and that are shared by family members include inadequate health behaviors, foremost poor nutritional habits and lack of physical activity [48–51] as well as chronic stress [19]. Poor nutritional habits, lack of physical activity, and chronic stress tend to cluster with each other and within families [19], particularly in families with disadvantaged backgrounds [52].…”

“…This is not in line with a recent review on ADHD and overweight [24], hypothesizing that the association between ADHD and overweight may be primarily linked to deficits in hot executive functions, characterized by impulsivity and difficulties in postponing gratification. The results are in line with another study suggesting the association between ADHD and overweight was completely explained by cumulative psychosocial risks [19]. Prime candidate environmental factors that increase the risk for both ADHD and overweight and that are shared by family members include inadequate health behaviors, foremost poor nutritional habits and lack of physical activity [48–51] as well as chronic stress [19].…”

“…In addition, a large-scale genetic correlation between both phenotypes was reported based on genome-wide association studies of common genetic variants, but potential sex moderating effects were not reported [18]. Apart from a shared genetic background, both phenotypes also show very similar relationships with adverse environmental factors such as low socio-economic status, parental psychopathology, and poor nutritional and exercise habits [19–23]. A recent report even argued that the link between ADHD symptoms and increased body weight could be completely explained by cumulative psychosocial risks, and highlighted the importance of chronic stress as a trigger for both conditions [19].…”

“…Apart from a shared genetic background, both phenotypes also show very similar relationships with adverse environmental factors such as low socio-economic status, parental psychopathology, and poor nutritional and exercise habits [19–23]. A recent report even argued that the link between ADHD symptoms and increased body weight could be completely explained by cumulative psychosocial risks, and highlighted the importance of chronic stress as a trigger for both conditions [19]. In a recent comprehensive review on potential mechanism explaining the association between ADHD and overweight [24], including genetic factors, fetal programming, executive dysfunctions, psychosocial stress, factors directly related to energy balance, and sleep patterns alterations, it was concluded that physical activity and eating patterns as possible and most direct causes of weight gain do not seem to fully explain the link and need to be integrated in a broader biopsychosocial model.…”

Excessive Weight Gain and Dental Caries Experience among Children Affected by ADHD

“…It can be assumed that unspecified intermediaries have a role in the observed incidence of obesity in children with ADHD. The ADHD-obesity relationship can be explained by genes [ 9 , 12 ], neurobiological features [ 37 ], deficits in executive functions [ 39 ], fetal programming [ 36 ], sleep disorders (circadian rhythm) and incorrect eating habits [ 23 ], high-fat diet [ 22 ], reduced physical activity [ 20 , 21 ], and stress [ 40 ], as well as a sedentary lifestyle. It is also suggested that the association of ADHD with obesity may be a side effect of adaptation to a poor food environment [ 41 ], but few studies have tested this hypothesis and the results are inconclusive [ 1 ].…”