Contributors:  Heba E. Essawy MD *,. Ahmed A. Abdelgawad MD *,. Marwa E. Khamis MD *,. Alaa Zakaria MB.BCh. **

Published in Middle East Current Psychiatry  in March 2020

ABSTRACT

Background: There is growing evidence that aberrant eating behaviors, including emotional eating, and obesity co-occur with attention-deficit/ hyperactivity disorder (ADHD) in children. The present study aims to investigate the association between ADHD symptoms, eating behaviors and obesity in ADHD children. Aim of the study: This study aimed to assess the relation between ADHD and overweight/obesity. Also, to identify different eating behaviors and abnormal emotional eating in children with ADHD and detect the relation between ADHD symptoms profile and disturbed eating behaviors in children. Patients and Methods: We included 50 ADHD children diagnosed by Conners scale. They completed the Emotional Eating scale adapted for children (ESS-C) to assess eating in response to emotions. Parents completed the Children’s Eating Behavior Questionnaire (CEBQ) to assess children’s eating behavior. Multivariable linear regression analysis was used to detect the most independent risk factor for higher Body mass Index (BMI) z-scores. Results: Higher percentage of overweight/obesity was detected among ADHD children than normal population studies. Also, higher Conners global index was associated with higher BMI z-scores. Both Inattentive and combined types were associated with higher BMI, while hyperactive type with lower BMI. Regarding eating behaviors, a positive association between food approach and BMI z-scores, while a negative association between food avoidant and BMI z-scores found. Similarly, there was a significant positive association between emotional overeating and BMI z-scores. 68% of ADHD children were high emotional eaters, mainly inattentive and combined. Others were low emotional eaters, mainly hyperactive. Only ESS-C total score was independent risk factor for higher BMI z-scores. Conclusion: Our findings provide evidence that emotional overeating and food approach eating behaviors such are more common among ADHD children with higher BMI z-scores among them. Future studies better understand this overlap will enhance potential interventions.

INTRODUCTION

Attention-deficit/hyperactivity disorder (ADHD) is a disorder of inattention, impulsivity, and hyperactivity that affects 5% to 8% of children worldwide [1]. Neurobehavioral studies have demonstrated an association between inattention/impulsivity and pediatric obesity [2]. One hypothesized factor that could link ADHD and obesity may be disinhibited eating behavior, such as binge eating, which has been found to partially mediate the association between ADHD and obesity among adults [3, 4]. Today, Data from studies of adults and youth in both clinical and population-based settings suggest that individuals with ADHD may have an elevated risk for obesity [4, 5]. However, when looking at younger age in children, the comorbidity between ADHD and obesity has not been examined sufficiently, especially with the lack of data based on population. A study based on a small sample of clinical data confirmed that ADHD would increase the risk of obesity in boy ADHD patients [6]. Several studies have pointed out the potential contributing role of disturbed eating behaviors, such as overeating, binge eating (overeating with loss of control)  and bulimic behaviors to the association between obesity and ADHD [7,8]. In addition, emotional eating has been defined as eating in response to a range of negative emotions such as anxiety, depression, and loneliness to cope with negative affect [9, 10]. Emotional eating is highly associated with other eating disorders, like Bulimia Nervosa symptoms, since both of them are related to emotion-focused coping, maladaptive coping strategies, and a strong aversion to negative feelings and stimuli [11, 12]. Although difficult to fully decipher the direction of the association between ADHD, eating patterns and obesity, in-depth understanding of this association can not only help preventative efforts for weight gain and obesity, but can also help us understand the risk mechanisms. We hypothesized that disturbed eating behaviors in children diagnosed with ADHD are related to ADHD symptom profile and severity. READ FULL ARTICLE.

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