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April 2, 2014
Pediatric Study Finds Links Between ADHD Stimulants,
Later Obesity Baltimore—The earlier attention-deficit hyperactivity disorder (ADHD) stimulants are initiated and the longer they are used, the more likely that users will have slower body mass index (BMI) growth in earlier childhood but a BMI rebound in late adolescence, according to new research. The Johns Hopkins University study pointed out that weight gain especially was a risk when medication was discontinued as the user approached adulthood. The research, published recently in the journal Pediatrics, involved analysis of electronic health records of more than 150,000 children. “Our findings should motivate greater attention to the possibility that longer-term stimulant use plays a role in the development of obesity in children,” said lead author Brian S. Schwartz, MD, MS. “Given the dramatic rise in ADHD diagnosis and stimulant treatment for it in recent decades, this is an interesting avenue of research regarding the childhood obesity epidemic, because the rises in each of these roughly parallel one another.” Growth deficits and possibly delays were identified in previous research on stimulant use to treat ADHD, but this study also found associations of ADHD with obesity in both childhood and adulthood. The study also found limited longitudinal evidence that unmedicated ADHD is associated with higher BMIs. For the study, researchers analyzed the electronic health records of 163,820 children, ages 3 to 18, in the Geisinger Health System, a Pennsylvania-based integrated health services organization. Of the records reviewed—involving an equal number of boys and girls—6.8% had an order for stimulants, with 8.4% receiving a diagnosis of ADHD. With median age at drug initiation of 8.5 years, median use was 183 days, with 50% of children taking stimulants for less than 6 months and 50% of children for more than 6 months. The BMI trends of those who had never had a diagnosis or prescription were compared to three groups: those with a diagnosis but no stimulant prescription; those with orders for stimulants without an ADHD diagnosis; and those with both an ADHD diagnosis and stimulant orders. Results indicate that those in the third group—both a diagnosis and stimulant use—had slower rates of BMI growth in early childhood, with more rapid rates during adolescence that eventually exceeded those of the controls. Those with a diagnosis of ADHD but no stimulant orders had more rapid BMI growth after age 10 versus the controls, but the effects were small. “The study provides the first longitudinal evidence that ADHD during childhood not treated with stimulants was associated with higher childhood BMIs,” the authors conclude. “In contrast, ADHD treated with stimulants was associated with slower early BMI growth but a rebound later in adolescence to levels above children without a history of ADHD or stimulant use. The findings have important clinical and neurobiological implications.” “Stimulant use was strongly implicated,” Schwartz added. “The earlier stimulants were started and the longer they were used, the stronger was their influence on the degree of both the delayed BMI growth in early childhood and the rebound BMI growth in late adolescence. This is an important unintended consequence of stimulant use in childhood.”
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