In Case You Missed It: ADHD and Bariatric Surgery, presented by Michelle Frank, Psy.D.

Thursday, July 23, 2015 Support Group MeetingPresented by Michelle Frank Psy.D., clinical psychologist specializing in ADHD; Sari Solden and Associates, LLC in Ann Arbor, Michigan

Most of us have either met someone with Attention Deficit Disorder (ADD) (also known as Attention Deficit Hyperactivity Disorder (ADHD)-these terms are used interchangeably), are close to a good friend or relative with ADD, or are coping with it themselves. It is a very common condition that has an interestingly strong tie to bariatric patients, and those battling weight issues in general. Clinical psychologist, Michelle Frank, Psy.D., dives into the the topic by given some great insight into what the disorder actually is and why certain behavioral patterns are seen with ADD. She also offers great tips on how to cope with this condition throughout the weight loss process!

A lot of things come to mind when we hear the term “ADD “or “ADHD” such as: hyperactivity, non-compliance, easily distracted, or a slew of ADD medications come to mind. But what is ADD exactly? According to Michelle Frank, it is a brain-based, lifelong condition in which the frontal lobe of the brain, which is in charge of executive functioning, is not working properly, ultimately disrupting the normal “flow” of your day. Think of the frontal lobe as the part of your brain that acts as the CEO or the President of your brain’s final decisions. It organizes information and ultimately integrates your thoughts and implements them into action.

There are different domains under executive control that are impaired to some degree in ADD patients. These include:Activation- getting yourself motivated when you do not feel like it or even something as simple as starting on a project (procrastination can be a common issue with those who have ADD). Focus- sustaining attention on one task or even shifting focus to another task can be difficult for an individual with ADD to do.Effort-this includes staying on task for a sustained period of time and finishing something that you have started. Emotion- managing frustration; ADD patients can become flooded with emotion, which could result in outbursts and ultimately regret afterwards.Memory- prospective memory or working memory. ADD patients may find it hard to hold something in their memory, use it to solve the problem, and then let it go.Action- hyperactivity and impulsiveness. Putting the “breaks” on and self-regulating one’s actions.

Patients with ADD may not have issues or symptoms in all of these areas described; ADD can present itself in different ways. For example, some people with ADD do not

show signs of hyperactivity. Also, it is suggested that 30 percent of those diagnosed with ADD outgrow the disorder, while 60 percent do not. It is acknowledged that a lot of individuals with ADD have good intentions and know what they should be doing, but have trouble applying their skills.

So what does ADHD have to do with bariatric patients? It has been found that those with ADD, are 1.5 times more likely to become obese. In other words, there is an increased incidence of ADHD in bariatric patients. This is due to genetic and neurochemical reasons, as well as because of the impulsive behavior that is classically seen with this disorder. For instance, there has been found to be increased incidence of eating disorders within the ADHD population. But besides behavioral reasons, there are physiological etiologies of ADD that may be driving them towards an obese state. For example, dopamine, the neurotransmitter associated with pleasure and reward, is not “flowing” or communicating the way that it should be, which leaves ADD patients craving high intensity situations for that quick reward and neural stimulation (ie speeding, smoking, drug use, etc).

Also, 80% of ADD patients have trouble sleeping. Some individuals describe themselves as restless or that their brain “wakes up” in the middle of the night. This break in the normal circadian rhythm can have an impact on the hunger hormones, Leptin and Ghrelin, (they are the signals letting us know when to start eating and when we are full) to ultimately lead the body to hoard carbohydrates because it is sensing that something is not right. In addition to this, lack of sleep has been shown to increase cortisol levels (our main stress hormone) which drives an increase in appetite and storage of fat.

Behaviorally, it has been found that untreated ADHD patients who have undergone bariatric surgery have had more attempts at weight loss overall, have less follow-up to the clinic after surgery, less compliance to the bariatric diet, and have taken longer to achieve their weight loss goals. ADHD patients who are treated and regulate their ADD (includes attending support groups) tend to do better, feel better and hit their goal weight loss.

So, with these various factors contributing to weight gain, what can an individual with ADD do to manage their weight throughout the bariatric process?

Well, fortunately, it is very manageable, but the first step would be for the individual to acknowledge the fact that they have ADD, or “own it,” and address their strengths and weaknesses. Once that is on the table, they are one step closer to managing their ADHD throughout the bariatric process. It is recommended that each patient either speak with a therapist or medical professional and have them collaborate with the bariatric team to create an individualized treatment plan. The reason for this individualized plan is truly because everyone is different! Everyone has their own stressors or “emotional roadblocks” which should be addressed. Also, keep in mind that medications and cognitive therapies are the first-line in treating and regulating ADD, as well.

Typical challenges that ADD-bariatric patients have may revolve more around details such as remembering to prepare meals and bring them to work, planning out time in their schedule to exercise and pack lunches, recording everything they eat in food logs, keeping track of the medically supervised weight loss documentation, and more. But it has been found that ADD patients are very successful when an external structure and routine are put in place.

Here are suggestions for staying on top of the bariatric routine by implementing structure:

Set a realistic health goal – write it down and post it someplace you will visually see it everyday

Create a vision board! Write down your successes! Set alarms or download reminder apps on your smart phone …Or put post-it notes everywhere Make sure you have a GREAT support group person…or group of people! Record what DOES work for you- what do your “good” days look like and

what do your “bad” days look like? What is happening on those days that are different and how can you make more “good” days happen?

Exercise daily- this can lead to natural dopamine boost while simultaneously dropping cortisol levels!

Remember that every meal is a new opportunity to make a healthy choice; don’t have an “all-or-nothing” approach and do not discourage yourself from getting back on the horse!

Find unique and immediate rewards that present right after the action/behavior (ie feeling great right after exercise)

Written by: Molly MacDonald, UM Dietetic Intern Summer 2015

References:

This paper is a summary of Michelle Frank’s Presentation on July 23, 2015. The information in this paper consists of Michelle Frank’s original material.

Support Group Meeting on July 23, 2015 by Michelle Frank, Psy.D of Sari Solden and Associates, LLC Ann Arbor, Michigan

Executive: Describing 6 Aspects of a Complex Syndrome. Dr. Thomas E. Brown, PhD. February 2008. http://www.drthomasebrown.com/pdfs/Executive_Functions_by_Thomas_Brown.pdf