ADHD Associated With Lower Weight at Birth, but Obesity in Childhood

Children with attention-deficit/hyperactivity disorder (ADHD) weighed less at birth but were significantly more likely to have obesity after age five compared with those without ADHD, according to a study issued by the Journal of the American Academy of Child & Adolescent Psychiatry. However, elevated ADHD symptoms were not predictive of increased obesity risk until age 7 in females and age 11 in males.

“The relationship between ADHD and body weight, despite being largely investigated, is still unclear,” wrote Claire Reed, M.Sc., of the University of Southampton, and colleagues. “Children with increased ADHD symptoms are typically lighter at birth than their peers but are later more likely to have obesity. Research into the ‘when and why’ regarding this turning point is scarce.”

Reed and colleagues used data from the Millennium Cohort Study, which included 7,908 children born between 2000 and 2002. Families provided data when children were 9 months old and again at ages 3, 5, 7, 11, 14, and 17. The 442 children with ADHD were identified either when they received a diagnosis or by the results of the Strengths and Difficulties Questionnaire (SDQ) hyperactivity/inattention subscale. Parents completed the SDQ during each data collection wave between the ages of 3 and 17. Children who scored high or very high on the subscale during at least five of the six waves were considered to have ADHD. The control group included 5,398 children without an ADHD diagnosis who never scored high on the hyperactivity/inattention subscale.

All children were weighed during each wave of data collection, and parents reported birth weights at the first wave.

Though children in the ADHD group weighed less on average at birth compared with the control group, the difference in weight between the two groups was not significant at 9 months or 3 years. However, those in the ADHD group were significantly more likely to have obesity from age 5 onwards, after excluding children taking stimulants. Further, higher ADHD symptoms as measured on the SDQ scale at ages 7, 11, and 14 were significantly associated with higher body mass index (BMI) scores at the next data wave among girls. This association was only seen in boys at ages 11 and 14.

The findings suggest that there may be a sensitive period between the ages of 3 and 5 during which higher ADHD symptoms become associated with obesity, the authors wrote. Additionally, the later association between higher ADHD symptoms and higher BMI scores may relate to increasing independence regarding food choices as children age, the authors posited. “Those with higher levels of impulsivity may be less likely to make healthier choices,” they wrote.

(Image: Getty Images/iStock/XiXinXing)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on X!

Follow Psychiatric News on LinkedIn!

Mobile Intervention as Effective as Group Intervention for Promoting Weight Loss in Young People With SMI

Young adults with serious mental illness (SMI) who are overweight or obese experienced similar weight loss and cardiorespiratory fitness improvements after participating in a 12-month group intervention as those who received one-on-one mobile health (mHealth) coaching for 12 months, a report in Psychiatric Services in Advance has found.

The findings suggest that “mHealth coaching may be a more scalable approach for addressing modifiable cardiometabolic risk factors among young adults with serious mental illness,” wrote Stephen J. Bartels, M.D., M.S., of Massachusetts General Hospital and colleagues.

The study involved 150 adults with SMI aged 18 to 35 years with a body mass index ≥25 kg/m2 who were receiving services at four community mental health centers in the northeastern United States. The participants were randomly assigned to one of two groups:

• PeerFIT: Participants in the PeerFIT group were invited to twice-weekly one-hour group meetings in person for six months followed by weekly exercise sessions for six months. They also received wearable activity trackers (Fitbits) and were encouraged to participate in a private Facebook group, where they could access information about healthy lifestyles and interact with others in the group. PeerFIT participants received weekly text messages (three to five texts per week) from the coach, encouraging healthy behaviors and monitoring of weight and physical activity.
• BEAT: Participants in the BEAT mHealth group attended an in-person orientation during which they received a scale and Fitbit and were taught to weigh and track their daily step count regularly. A coach subsequently delivered five monthly 30-minute telephone calls, during which participants were reminded to monitor weight and daily step counts, detect changes in weight and physical activity, identify and reduce barriers to achieving healthy changes, and recognize and celebrate their success. BEAT participants received three to five text messages per week with reminders and encouragement about monitoring weight and physical activity.

All participants were assessed at the start of the study as well as six and 12 months later. (Participants received $50 for completing each assessment.) The primary outcome was the proportion of participants who achieved cardiovascular disease risk reduction—defined as either weight loss of 5% from baseline or an increase of >50 m on the six-minute walk test, an objective measure of functional exercise capacity—from baseline to 6 and 12 months.

“Participants in both groups achieved clinically significant weight loss, [cardiorespiratory fitness] improvements, and [cardiovascular disease] risk reduction from baseline to 6 and 12 months,” Bartels and colleagues wrote. “At 6 months, more than half of the participants in both groups were at or below their baseline weight: 52% of PeerFIT participants and 58% of BEAT participants. Similar rates of weight-gain prevention were found at the 12-month follow-up: 50% of PeerFIT participants compared with 54% of BEAT participants were at or below their baseline weight.”

For related information, see the Psychiatric Services article “Participant Experiences With a Peer-Led Healthy Lifestyle Intervention for People With Serious Mental Illness.”

(Image: iStock/ferrantraite)

Effects of Sertraline-Olanzapine on Weight, Cholesterol May Differ According to Patient Age

Older adults with psychotic depression may experience less weight gain and increases in total cholesterol than younger adults when taking a combination of sertraline and olanzapine over an extended period, suggests a study in the American Journal of Geriatric Psychiatry.

The findings are from the Study Pharmacotherapy of Psychotic Depression II (STOP-PD II). The original STOP-PD trial established that a combination therapy of the antidepressant sertraline plus the antipsychotic olanzapine was more likely to lead to remission of psychotic depression than olanzapine alone over 12 weeks of therapy. STOP-PD II examined the risks and benefits of patients continuing to take sertraline and olanzapine to prevent a relapse of the symptoms. (Eli Lilly provided olanzapine and matching placebo pills and Pfizer provided sertraline; neither company provided funding for this study.)

“Older adults are more likely to experience psychotic features during a major depressive episode than younger adults,” wrote Alastair J. Flint, M.B., of the Department of Psychiatry at the University of Toronto and colleagues. Metabolic disorders, such as diabetes and hyperlipidemia, also increase later in life. “It is therefore important to determine whether there are age-related differences in anthropometric and metabolic outcomes associated with the treatment of psychotic depression with antipsychotic medication,” Flint and colleagues wrote.

They analyzed data from 269 adults aged 18 to 85 years with psychotic depression who were treated with open-label sertraline plus olanzapine for up to 12 weeks (acute phase). A total of 126 participants who remained in remission for eight weeks (stabilization phase) on the sertraline-olanzapine combination were then randomly divided into two groups: one group continued taking the sertraline-olanzapine combination, and the other group was transitioned to a sertraline-placebo combination; the randomized phase was for 36 weeks. The researchers evaluated changes in participants’ weight, waist circumference, plasma lipids, glucose, hemoglobin A1c, and insulin over the course of the study, comparing participants aged 18 to 59 (younger) with those 60 to 85 (older).

While both younger and older participants experienced weight gain and an increase in total cholesterol levels when treated with sertraline-olanzapine versus sertraline-placebo, “the increase in these measures was less in the older group,” Flint and colleagues reported.

“At the acute-stabilization termination visit, mean weight in older participants remained below their mean premorbid weight, whereas it was approximately 18 lb. higher than premorbid weight in younger participants,” they continued. “These findings suggest that the weight gained during the acute and stabilization treatment of psychotic depression was partial restoration of lost weight in older patients [during depressive episodes] but clinically significant excess weight in younger patients.” There were no clinically significant differences between younger and older participants in glycemic measures.

For related information, see the Psychiatric News article “Maintenance Antipsychotic Lowers Risk of Psychotic Depression Relapse.”

(Image: iStock/FatCamera)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Patient’s Weight May Affect Response to Antidepressants

A patient’s body mass index (BMI) may play a role in the effectiveness of treatment with certain antidepressants for major depressive disorder, suggests a study published Thursday in the Journal of Affective Disorders.

Le Xiao, M.D., Ph.D., of Capital Medical University in Beijing and colleagues analyzed data collected in a clinical trial that included 202 adults with major depressive disorder at five hospitals from 2011 to 2016. Patients were 18 to 60 years and had scores of at least 20 on the 17-item Hamilton Rating Scale for Depression (HAMD-17) upon enrollment. All patients initially received paroxetine, and those whose symptoms did not begin to improve after two weeks were randomized to continue paroxetine, switch to mirtazapine, or take both paroxetine with mirtazapine for six weeks. BMI analysis revealed that 55% of patients had normal body weight, 35.1% were overweight or obese, and 9.9% were underweight.

The researchers found that patients who were normal weight or underweight were twice as likely to experience remission of their depression by the end of the eighth week, as defined by HAMD-17 scores of 7 or lower.

The researchers noted that one possible reason why people with a high BMI or excessive body fat may have a lower response to antidepressants compared with people with a lower BMI is that the drug must travel through more tissue and fluid in their bodies than in the bodies of people who are normal weight or underweight.

“The other potential mechanisms underlying the association between body weight and antidepressant response could be attributed to brain insulin resistance, inflammatory dysregulation, oxidative and nitrosative stress which is caused by obesity,” the researchers wrote. “Finally, decreased physical activity and obesity stigma can also contribute to poor response to antidepressants in patients with excess weight.”

(Image: iStock\LumiNola)

---

APA Urges You to Join in Next Town Hall on Racism

Join APA leaders Monday, November 16, at 8 p.m. ET, as they examine how the persistent stress of experiencing racial discrimination has an impact across generations and the degree to which the health consequences of racism and bigotry can be passed down from one generation to the next.

Learn More and Register

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Clinicians Develop New Rating Scale for Perimenopausal Depression

Key differences in depressive symptoms that arise during perimenopause (the period immediately before menopause) suggest that perimenopausal depression may be a distinct subtype of depression, but scales to measure or monitor symptoms of perimenopausal depression are lacking. A report published yesterday in Translational Psychiatry describes the development and validation of a questionnaire that clinicians or patients can use to rate the severity of perimenopausal depression symptoms.

“Having a reliable tool to aid in the diagnosis of perimenopausal depression is very important in research of this relatively neglected area of women’s health,” wrote Jayashiri Kulkarni, M.D., and colleagues at Monash University in Melbourne, Australia. “Clinically, it is very important to accurately detect and diagnose perimenopausal depression as early as possible to enable more specific treatments, such as hormone treatment strategies.”

Kulkarni and colleagues conducted an extensive literature review and relied on clinical observation and focus groups (including perimenopausal women and clinicians) to identify key perimenopausal depression symptom areas. From this research, they created a 12-item questionnaire, called the Meno-D, which asked patients to rate the severity of the following symptoms on a scale of 0 to 4: anxiety, concentration, energy, irritability, isolation, memory, paranoia, self-esteem, sexual interest, sleep, somatic symptoms, and weight changes.

The Meno-D was then administered to 93 women experiencing symptoms of perimenopausal depression, 82 of whom completed the questionnaire. While the women varied significantly in their total Meno-D scores, despite all having perimenopausal depression, they generally had above average scores related to somatic (somatic symptoms and weight), cognitive (memory and concentration), self (self-esteem, paranoia, isolation, and anxiety), sleep (sleep disturbances and irritability), and/or sexual (sexual interest and energy) symptoms.

“Previous studies have reported that women experiencing perimenopausal depression complain about physical symptoms more than cognitive ones, which are not typically included in previous scales assessing for major depressive disorder,” Kulkarni and colleagues wrote. “This may explain why perimenopausal depression is often overlooked or left undiagnosed.”

They concluded, “The Meno-D will support a growing research field, interfacing both psychiatry and endocrinology, which indicates that perimenopausal depression is a unique subtype of depression requiring a different management approach.”

To read more about this topic, see the Psychiatric News article “Discontinuing Hormone Therapy May Increase Risk of Depression in Some Women.”

(Image: iStock/monkeybusinessimages)

Follow Psychiatric News on Twitter!

Parents' Discussion of Weight With Their Children Can Raise Eating-Disorder Risk, Study Finds

When parents discuss weight issues with their adolescents, it may encourage them to develop eating disorders, a large community-based study reported in JAMA Pediatrics suggests. The study found, for example, that youngsters were more likely to engage in unhealthy eating behaviors such as extreme dieting, laxative use, and binge eating when their parents talked about weight than when they talked about eating healthy foods. This was the case for overweight youth as well as for those who were not overweight. In addition, binge eating was found to be more prevalent among adolescents whose mothers discussed weight than among adolescents whose mothers didn't.

"I think these are important findings," Michael Devlin, M.D., co-director of eating disorders research at the New York State Psychiatric Institute, told Psychiatric News. "They support the idea that, despite our concerns about obesity and its comorbidities, the most useful health promotion messages relate to lifestyle and not weight, and that weight-related messaging, particularly messages that evoke shame or contribute to stigma, can be counterproductive."

Body dissatisfaction is another major factor that has been linked with the development of eating disorders in young people. Read more about that issue in Psychiatric News here, and read about research on binge-eating disorder here. To learn more about eating disorders, see Developing an Evidence-Based Classification of Eating Disorders: Scientific Finding for DSM-5, from American Psychiatric Publishing.

(image: serg64/Shutterstock.com)