Deneen Fanelli tried many diets over the years and had a good deal of success losing a lot of weight over a short period. The problem is she could never stick to a program for long and invariably packed the pounds back on -- and then some.
"I would be hyper-focused for a while but I couldn't stay focused on the diet, so I gained all the weight back," the Toronto woman said.
Yo-yo dieting is a common problem but Ms. Fanelli's extreme weight gain and the health problems that ensued meant she was referred to a specialized weight-management clinic.
Her weight had ballooned to more than 230 pounds (104 kilograms); measuring a shade over five feet, she was morbidly obese.
At the clinic, Ms. Fanelli was treated for depression and made some progress, but soon lost her focus again, and the doctor suspected something else.
She was referred to a psychologist, who diagnosed her with attention deficit hyperactivity disorder.
According to new Canadian research, almost 27 per cent of chronically obese people -- those who have repeatedly attempted and failed to lose weight -- suffer from ADHD. In the general population, about 4 per cent of people have symptoms suggestive of ADHD.
"We're not sure if having ADHD predisposes you to obesity," said Dr. Lance Levy, director of the Nutritional and Eating Disorders Clinic in Toronto.
"What we do know is that problems with attentiveness, distractivity and other symptoms related to ADHD hamstrings weight loss efforts and leads to chronic failure."
The research, published in the medical journal Eating Weight Disorders, focused on 75 morbidly obese women who were referred to the clinic over a 14-month period. The women had, on average, more than 43 per cent of their body weight as fat, and despite a strong desire to lose weight they had failed repeatedly.
While the study was done exclusively on women, who make up more than 85 per cent of the clientele of obesity clinics, Dr. Levy said the findings apply equally to men. Men, in fact, are more likely to be obese than women, but far less likely to diet and seek help.
Earlier research had shown a link between ADHD and childhood obesity, but the new study looked at adults.
"We kept seeing these patients who were intelligent, had good jobs, families and they were highly motivated to get healthy but they became unhinged after a couple of weeks of a simple weight-management plan," Dr. Levy said. "We were looking for an explanation."
In many cases, it turned out the problem was an inability to focus and follow through, a hallmark of ADHD.
Ms. Fanelli, 41, said that describes her situation perfectly.
She was referred to a psychologist, Dr. John Fleming. He diagnosed ADHD and prescribed the drug methylphenidate HC (sold under the brand name Concerta).
"It was like a light came on for me," Ms. Fanelli said. She was better able to concentrate and control her impulses, particularly the impulse to eat sweets continually.
"The sweets, the sugar, was almost a medication for me," she said. "Now, the sweets don't matter. I don't miss them."
Ms. Fanelli follows a healthy eating plan and exercises almost daily, and has been able to stick to the program for more than a year. In the process, her weight has dropped to 174 pounds (79 kg), and she is looking to shed 20 more pounds by the end of the summer.
An added benefit of her treatment is the newfound concentration has been a great help in her professional life. "Sure I'm thinner, but I'm also more alert. I'm getting things done, not just jumping from one project to another," Ms Fanelli said.
Dr. Fleming, co-author of the new research, said many obese patients treated for their underlying ADHD have had similar success. But he cautioned that treatment was only one small part of their weight-management plan.
"Is it a miracle in terms of a magic bullet that makes you immediately lose weight? No, not at all. What it does is give patients a level playing field to work from," he said.
Dr. Levy agreed, saying the causes of obesity are complex, and so are the treatments.
He said it is well established that there are several medical conditions that make it more likely a person will end up obese, including depression, sleep disorders, chronic pain and gastrointestinal problems and the new research "suggests we should be adding ADHD to the list."
About half of Canadian adults are overweight, including 15 per cent who are obese, according to Statistics Canada.
