Attention deficit hyperactivity disorder medications and BMI trajectories: The role of medication type, sex and age

Abstract

Summary Objectives Attention deficit hyperactivity disorder (ADHD) and the medications used to treat it are associated with obesity. Stimulants lead to weight loss, while antipsychotics and antidepressants lead to weight gain. Little is known, however, how alpha‐2‐agonists impact weight, or the independent effect on BMI of these four classes of medications, which are often prescribed concurrently. We aimed to estimate the proximal change in BMI associated with start of medication and to assess whether medication‐specific departures in BMI varied by age and sex. Study Design We analysed longitudinal electronic health records from children (4‐19 years) with an ADHD diagnosis seen at one healthcare system (2011‐2018). Their BMI z‐scores were fit as a cubic function of age via a mixed model, separately by sex and adjusting for race/ethnicity. From this model, we estimated annual changes in BMI‐z after medication, allowing changes to vary by age and sex. Results Among the 22 714 children with ADHD (mean initial age = 10.0), 4335 (19.1%) were never prescribed ADHD medication. The others (80.9%) experienced departures in BMI‐z after start of all four medication classes, which varied across age and sex (interaction P‐values < .01). All medications had larger impacts at younger ages. As expected, decreased BMI‐z was observed with stimulants, while antidepressants and antipsychotics led to BMI‐z increases; alpha‐agonists also were associated with BMI‐z increases. Conclusions This longitudinal study revealed that ADHD medications are independently associated with proximal changes in BMI‐z after initiation, significantly varying by sex and age. Future research should study further the interactions of these medications on long‐term impacts on obesity.

Brain structural changes and the development of interference control in children with ADHD: The predictive value of physical activity and body mass index

“…As ADHD has been considered as both a cause and consequence of weight gain ( Cortese and Tessari, 2017 ), the association of GWMR abnormalities and cognitive function underlines the need to monitor the patients’ BMI. This is further supported by the observation that some pharmacological treatments applied in ADHD elicit further increases of the BMI ( Gurka et al, 2021 ). While physical activity has the potential to influence executive function by normalizing the BMI ( Chang et al, 2017 ), it was independently associated with interference control in children with ADHD and neurotypical peers.…”

Patient, supporter and primary healthcare professional perspectives on health risks in over 16s with attention deficit hyperactivity disorder (ADHD) in England: a national survey study

“…Weight management (both being underweight and overweight) also was a commonly identified health risk, mentioned by around 4-6% of people with ADHD and healthcare professionals. In the wider literature, difficulties with weight management in relation to ADHD have been observed both in genetic studies and epidemiological studies [7,[64][65][66][67]. This raises the question of whether weight management needs to be highlighted more explicitly to people with ADHD, supporters, and healthcare professionals in respect to ADHD.…”

“…However, weight management does not currently appear in UK ADHD guidance, possibly due to the lack of evidencebased interventions in this field. While there is research around the impact of medication on BMI, very few studies explore the potential of ADHD specific weight interventions, beyond one small pilot study (Bjork et al, 2020) [38,64].…”

Somatic burden of attention‐deficit/hyperactivity disorder across the lifecourse

“…Frequently co‐occurring substance abuse or (head) injuries may also facilitate cognitive decline 39,40 . Moreover, it is important to consider that use of ADHD medication may influence the risk of somatic comorbidities, which may be both beneficial 41 and detrimental 42,43 . Further, ADHD is associated with other mental disorders, for example depression, 6,7 which in itself may increase the chance for somatic diseases such as cardiovascular disorders or dementia 44,45 .…”