The Dopamine Deficiency That’s Sabotaging Your Diet

Weight management is difficult for everyone. Like many other tasks, it’s an even bigger challenge for adults with ADHD. Symptoms like impulsivity make us more prone to give in to cravings for high-fat, high-sugar foods. And the dopamine rush we get from carbohydrates and sweets becomes addictive; it feels as if our brain needs that grilled cheese sandwich.

But don’t despair! Armed with information about the ADHD-obesity link, you can understand why shedding pounds has been difficult in the past, and take the right steps to lose them once and for all.

A study by Dr. John Fleming and Dr. Lance Levy found that more than 25% of people struggling with obesity at a specific clinic had a history of ADHD symptoms — much higher than the 4-6% found in the general population.

Additionally, studies have found that candidates for gastric bypass surgery — who have a body mass index above the 90th percentile — have a very high rate of undiagnosed ADHD. After surgery, those people with ADHD are prone to losing less weight and gaining more back.

ADHD creates problems with self-regulation — of attention, short-term memory, and emotion—that extend to food intake. Trouble with impulse control keeps people with ADHD from thinking, “I won’t eat that because it’s not healthy, and I will regret it later.” Instead, we grab an unhealthy snack without considering if it’s a good idea or not.

The ADHD brain has low levels of two neurotransmitters: dopamine (responsible for feelings of reward) and GABA (responsible for inhibition). We crave sugar to stimulate dopamine production. This, paired with a lack of inhibitions, can set the stage for weight gain.

[Free Download: The ADHD-Friendly Diet]

Diets don’t work for adults with ADHD because they are considered a short term fix to lose weight before returning to a manageable "normal." But ADHD bodies are often sending the wrong signals about what “feels right,” so relying on our natural tendencies can lead to overeating.

The same difficulty with impulse control that leads you to interrupt in conversations also makes it harder to resist a tasty snack when it’s calling your name. The same feelings of being overwhelmed that stop you from cleaning a room can keep you from adding a detailed new diet plan to your life.

Restrictive, calorie-counting diets require organizational skills, long-term planning skills, and self discipline — executive function skills that many with  ADHD lack. Tracking food intake with a journal or app can be difficult to sustain it when it becomes too complicated or boring.

Weight Watchers or Overeaters Anonymous offer a supportive environment and lessons about impulse control, craving, and steering away from refined foods. These programs can work for adults with ADHD, but only if they view the programs as a lifetime commitment, not a short-term fix.

When you are starting a weight-loss plan, know that it will take time (and some mistakes along the way) to find the combination of exercise and healthy eating that works for you. If that’s your expectation from the get-go, you’re more likely to stick to it, even when things get tough.

Anything that promises a quick, easy fix won’t work in the long term. Set a clear goal for yourself of losing one pound a week, or cutting refined sugar out of your diet. Weigh yourself just once a week; it's just enough to track your progress, but not obsess over small fluctuations.

Adults with ADHD who take medication are more likely to lose weight and keep it off than are those who do not. A study found that people who were effectively treated for ADHD symptoms lost 12% of their body weight and sustained the loss for at least a year, while people who were not taking medication gained 3% of their body weight in the same period. Medication can help control symptoms like impulsivity, restlessness, inattentiveness, and sleeplessness that can lead to weight gain.

[Your ADHD Weight-Loss Guide]

Adults with ADHD often have trouble sleeping, and this can sabotage weight loss in three ways. Your body responds to fatigue the same way it responds to extreme hunger — by looking for fast energy sources like simple carbohydrates, and slowing your metabolism to hang on to calories. Lack of sleep throws off the hormones ghrelin and leptin that regulate cravings and feelings of fullness. Finally, you are not as cognitively clear without sleep, which makes it more difficult to manage your time to fit in healthy meals and exercise. Before dealing with weight loss, try to resolve your sleep issues.

Establishing new routines by yourself is hard, particularly when you feel like you barely have enough time in the day to fit in another task — let alone work out. Instead of trying to get to the gym a few times a week, make 20 to 30 minutes of physical activity part of your daily routine. Plan to walk to work, or get off the bus a stop early to walk the rest of the way. It’s not willpower; it’s being strategic. Or, make working out easy and fun by choosing sports you enjoy, and team up with a buddy who can help keep you on track. Create a mantra like, “I’ve never regretted being active,” that will prompt you to head off the couch and out the door even when you don’t feel like it.

30 minutes of activity a day won’t erase unhealthy diet choices. In additional to exercise, you'll need to eat healthier.

Avoid simple carbohydrates and anything sweetened with corn syrup. Replace these with fruit and high-protein food rich in omega-3 fatty acids, like tuna and olive oil. The more protein you eat, the more sustained you will feel. It’s OK to eat healthy fat because it will help you feel full for longer. Instead of completely cutting out certain foods, let yourself have one Oreo. Sometimes feeling deprived can make you crave that food even more.

Eating three meals a day, plus healthy snacks, is essential for appetite control. Waiting until your stomach is growling to eat often means consuming extra calories. Have a reserve of easy recipes or some healthy frozen meals.

Create a meal schedule; for example, Sundays are food prep for the week, Mondays are meatloaf, Tuesdays are salad, etc. Avoid triggers like restaurants with buffets. If you are going to a barbecue, eat something healthy right before you go. Chew gum to keep yourself occupied. Or set up a code word like "beach" with friends or loved ones so they can gently prompt you not to overeat.

Adults with ADHD often have trouble perceiving when they are satisfied or hungry. Time your meals — set an alarm to remind you to sit down and have a healthy meal — and then notice how you eat. Eliminate distractions. Don’t sit in front of the TV with a full bag of chips. Portion out a plate, and focus on enjoying it.

Think about how many times you chew your food. Are you taking deep breaths before and while you eat? Do you put your fork down in between bites? Your brain time needs time to send word that your stomach is full. Eat as if you’ll need to describe each part of the meal to someone else when you’re finished. It can help you connect with what’s on your plate.

Become aware of negative thoughts around food, and self-judgment, then seek to minimize those feelings when eating. Self-blame just gets in the way of healthy eating. Many people eat when they are emotional or upset. Adults with ADHD have heightened emotions — stress, anxiety, and even happiness. Start to notice if you are turning to food to fill an emotional need.

A therapist can help you notice how you react when you’ve eaten badly — do you condemn yourself? Do you consider yourself a complete failure? — and instead be compassionate with yourself. Cognitive behavioral therapy can also help you use ADHD-specific strategies to achieve your weight loss goals. Thinking about habits and actively working toward different patterns can help keep you from falling back into old ruts.

Many people want to sit and watch TV to relax when they are done with their tasks for the day. But adults with ADHD often aren’t entertained enough and feel restless. They reach for a bag of chips to give them something else to do. Instead, try doing crossword puzzles, knitting, or playing a game on your phone to stay more engaged. If you realize that you use food as a fidget while you’re doing something boring, try substituting a healthy snack like baby carrots.

Whenever possible, relax with activities that offer a higher stimulation level, like reading, which can satisfy you in itself rather than leaving you looking for something else to add on. Be careful if you’re a night owl. When everyone else is asleep and you’re bored, food can give the instant gratification you crave.

Our culture discriminates against people who are overweight. It ignores the fact that there is a problem with dieting, and blames the individuals who already often blame themselves.

Remember that your ultimate weight-loss goal should be forging a new lifestyle that will make you feel better, rather than achieving some short-term extreme to shave off a few pounds. Don’t beat yourself up when you slip up. That never leads to anything good. Understand that you shouldn’t feel ashamed. You’re biologically wired to have issues with food, and you're on the path to overcome them.

[“My Amazing ADHD Weight Loss Story”]

Roberto Olivardia, Ph.D., is a member of the ADDitude ADHD Specialist Panel.