Sex and racial/ethnic differences in the association between childhood attention‐deficit/hyperactivity disorder symptom subtypes and body mass index in the transition from adolescence to adulthood in the United States

Inoue, Yosuke; Howard, Annie Green; Stickley, Andrew; Yazawa, Aki; Gordon‐Larsen, Penny

doi:10.1111/ijpo.12498

Cited by 8 publications

(6 citation statements)

References 33 publications

(40 reference statements)

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“…In addition, this study confirms that alpha‐2‐agonists cause weight gain as well, as supported by several preliminary studies 9,11 . With recent research suggesting the association between subtypes of ADHD and BMI may vary by sex and race/ethnicity, 5 future research examining race/ethnicity and ADHD subtypes by medication type is also warranted.…”

Section: Discussionsupporting

confidence: 83%

“…8,22 In addition, this study confirms that alpha-2-agonists cause weight gain as well, as supported by several preliminary studies. 9,11 With recent research suggesting the association between subtypes of ADHD and BMI may vary by sex and race/ ethnicity, 5 future research examining race/ethnicity and ADHD subtypes by medication type is also warranted. Given changes to the diagnostic and statistical manual of mental disorders that occurred during the range of this study, misclassification of ADHD (and our sample) may be a concern.…”

Section: Discussionmentioning

confidence: 99%

“…There is growing evidence that attention deficit hyperactivity disorder (ADHD), the most common neurobehavioral disorder, 1 is associated with obesity 2‐5 and obesity‐related eating behaviors 6 . In addition, studies show that the medications used to treat ADHD can also impact children's weight 7 .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…However, they both agree that the relationship between ADHD and obesity is stronger in adults compared to children/adolescents. Interestingly, sex and ADHD presentation effects have been found in an additional study published after these two meta-analyses [5]. Drawing on data from the National Longitudinal Survey of Adolescent to Adult Health, Waves II to IV (including 13,332 participants, aged 12–34 years), Inoue et al reported that, compared with individuals without ADHD, both males and females with ADHD hyperactive impulsive presentation (as per DSM-5 terminology) had significantly higher BMI, whereas the ADHD inattentive presentation was associated with higher BMI in females only.…”

Section: What Is the Evidence Supporting A Significant Associationmentioning

confidence: 99%

The Association between ADHD and Obesity: Intriguing, Progressively More Investigated, but Still Puzzling

Cortese

2019

Brain Sciences

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This narrative review is aimed at presenting the most recent evidence on the association between attention-deficit/hyperactivity disorder (ADHD) and obesity. The review is informed by previous relevant systematic reviews and a search in Pubmed and PsycINFO up to 1 August 2019. Although the association between ADHD and obesity would seem, at first, paradoxical, in the past two decades there has been an increasing number of studies on this topic. The present review shows that there is meta-analytic evidence supporting a significant association between these two conditions, at least in adults. Growing evidence is also being published on the genetic and environmental factors underlying the association. However, the cause–effects paths, as well as the exact mechanisms explaining the association, remain unclear. Additionally, empirical evidence guiding the management/treatment of patients with the two conditions is still limited. Therefore, after almost 20 years from the first report of a link between ADHD and obesity, this association continues to be puzzling.

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“…Preliminary evidence suggests that the comorbidity between ADHD and obesity varies by race such that ADHD was associated with higher body mass index (BMI) among White youth, but not Black youth. 10 There are many potential explanations for the association between ADHD and obesity. ADHD-related deficits in executive functioning, impulsivity, and emotion regulation have been shown to relate to BMI, 11,12 although other studies found no relationship between executive functioning and obesity.…”

mentioning

confidence: 99%

Prevalence and Correlates of Attention-Deficit Hyperactivity Disorder in a Diverse, Treatment-Seeking Pediatric Overweight/Obesity Sample

Merrill

Morrow

Sarver

et al. 2021

J Dev Behav Pediatr

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Objective: Attention-deficit hyperactivity disorder (ADHD) and obesity are highly prevalent, impairing, and costly conditions, affecting about 10% of children each. Research indicates heightened prevalence of childhood obesity among youth with ADHD. However, more research is needed, examining comorbid ADHD among youth with overweight/obesity (OV/OB) from diverse demographic backgrounds and effects on medically relevant behaviors. The aim of the current study was to examine the prevalence of ADHD in a racially diverse sample of youth in a weight management clinic. Furthermore, we examined the effects of race, rurality, and ADHD on weight status and health behaviors in this under-researched population. Method: Participants included 1003 patients (M age 5 12.55; 58% female; 67% Black/African American; M BMI Z-Score 5 2.54; 98.6% with obesity) in a pediatric weight management clinic serving a rural and urban/suburban area in the southern United States. Parent-reported demographics, ADHD diagnosis, and child health behaviors were recorded. Result: In total, 17.6% (n 5 177) of the sample had an ADHD diagnosis. ADHD status interacted with race to predict standardized body mass index (BMIz), and rurality predicted higher BMIz. Children with comorbid ADHD had significantly more meals per day and fewer active days compared with children with OV/OB without ADHD. Conclusion: ADHD prevalence was higher in this diverse sample of children seeking obesity treatment (17.6%) compared with the prevalence nationally (9%-10%) and in other obesity samples. Comorbid ADHD was related to higher weight status among racial minority youth and increased engagement in unhealthy lifestyle behaviors often targeted in weight management treatment. It is critical to screen for ADHD in pediatric specialty clinics and assess healthy lifestyle behaviors.

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Sex and racial/ethnic differences in the association between childhood attention‐deficit/hyperactivity disorder symptom subtypes and body mass index in the transition from adolescence to adulthood in the United States

Cited by 8 publications

References 33 publications

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

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

The Association between ADHD and Obesity: Intriguing, Progressively More Investigated, but Still Puzzling

Prevalence and Correlates of Attention-Deficit Hyperactivity Disorder in a Diverse, Treatment-Seeking Pediatric Overweight/Obesity Sample

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