A Battle for Balance

BMI & Weight

When I was 19, I was desperately looking for an explanation for the reason why I was forgetful, inattentive, and seeking stimulation 24/7, often in the form of snacks. Instead of an answer, I was told I was overweight.

While seeking an Attention-Deficit/ Hyperactivity Disorder (ADHD) diagnosis, I had to go to the doctor's office to register my basic physiological measurements (heart rate, blood pressure, weight, height, and so on), so if or when the time came I could be fitted for medication faster.

The next thing that happened deterred me from ever going to the doctor again.

Shortly after my measurements were taken by machines (due to COVID-19 precautions), having had no conversations with a real doctor or nurse, I got a text from my medical service. I was hoping for a progress update towards getting tested. Instead, the text told me what my BMI (body mass index, the ratio between one's height and weight) was, referred me to the “healthy eating” National Health Service (United Kingdom) webpage, and recommended a consultation with my general practitioner.

What this system did not take into account was that I knew just about everything there is to know about “healthy eating”, and I was perfectly aware of my BMI, too. I had been battling my weight since puberty, and had gone through countless ups and downs in the realm of body image, dieting, sports, and weight.

I sought a diagnosis because of academic struggles, but the confirmation that I really do have ADHD sent me down a rabbit hole of everything else it might have been affecting this whole time. Before my diagnosis, I had no idea that my ADHD had just about everything to do with my eating patterns and weight cycling, too, not just my bad concentration and constant scrambling to make up for silly mistakes.

And I'm far from being the only one: there is growing evidence that there is a heightened likelihood of the prevalence of eating disorders (or disordered eating behaviours) in people with ADHD, and vice versa. However, despite the clear tendency for the comorbitity of these health challenges, they are rarely considered in tandem in healthcare - as I have had to realize myself.

Health goals have to be addressed differently for people with ADHD - our brains work differently, so everything related to weight and food is also different.

Hunger & Fullness

Labelled a picky eater by her parents, Lena* was in the unique situation of being accommodated and restricted by her parents simultaneously. Sensory overload due to textures and tastes is a common neurodivergent trait. However, Lena's parents never accommodated her properly.

"My mom was kind enough to make me food separately," she explains. "But there was also a point where she would give me a glass of full fat milk three times a day, because that's all that I was willing to eat."

Lena was diagnosed with ADHD as a teenager, so her pre-teen years were filled with daily food battles - and they never really went away. "[My parents would] essentially force me to try everything at least once," she says. In retrospect, she appreciates their efforts to help her get over her distastes, but without an acknowledgement of her ADHD, they fell short.

Her irregular eating habits, perpetuated by her family, developed into a cycle of overeating and undereating, and of gaining and losing weight. "When I was young, up till the age of seven, I was really scrawny, all bones," she says. "When I was nine, I was very fat. When I was around fifteen, I got extremely fat. I think I was borderline obese."

Patterns of overeating or binge eating are extremely common among people with ADHD, says Karine Stephan, a Registered Nutritional Therapy & Lifestyle Medicine Practitioner who specializes in nutrition for hormone health and ADHD. "ADHD-ers often have impulsive eating behaviours such as binge eating or grazing throughout the day without proper meal structure," she tells me. "Issues with dopamine regulation can also cause people with ADHD to seek out rewarding behaviours, such as eating highly palatable foods."

Gaining weight due to these patterns and irregularities is an experience many share on their social media feeds. Tarah Elizabeth, a creator who frequently shares her ADHD struggles with a positive spin, recently opened up about gaining weight due to a period when her ADHD symptoms became too difficult to manage. She is focusing on getting back on track now, working with professionals who take her ADHD into account.

On the other side of the spectrum is severe undereating. Since her mother felt responsible for Lena's eating habits, she also felt responsible for her body, which meant commenting on it relentlessly. "I was like, Mom, you made me fat. Like, she would give me milk three times a day. What do you think happens?" she explains. "And the problem is, she still does that." The constant comments were the last straw that led to her body image issues.

"It still affects me during my worst moments. If I think too hard about it, I'm like, why would she say that? But then, when I do end up skipping a meal, not because I want to but it just happened that way, because I had a meeting during lunch hour or something, my Mom's voice is in my head saying 'I guess I'll lose some weight because of that'."

Despite all of it, she's aware of her hypocrisy when it comes to judging other people not eating enough. "I have a friend who was fasting, by which he meant eating one meal a day. And I told him I thought that was a bad idea, but then I realized I'm a hypocrite. Because this week, I had a total of seven meals."

She tells me that, despite understanding that people who don't have ADHD also might struggle with-eating related issues, she firmly believes ADHD plays a part in her behaviours. "I think it releates to my ADHD because I forget easily. And also, I don't feel pain like normal people do," she tells me with an easy laugh. "If I'm feeling hunger, I can choose to stop feeling it. [...] I'm just going to forget it, because pain is inconvenience. And sometimes so is hunger."

Sports & Movement

"I know I have to eat, but I don't know how to push myself," Anastasiia tells me. "I just can't!" Just like Lena, throughout her teenage years, she struggled with two very different types of eating disorders: overeating and undereating.

Now, she is trying to cultivate a healthy relationship with food, but it is taking all of her precious effort. "For me, eating is kind of like I'm on a rollercoaster," she says. "I need to survive somehow with food, because I can't not eat. [...] But eating is stressful, and not eating is even more stressful."

For Anastasiia, the hardest part of it all is focusing on one task at a time, which is perpetuated by her undereating. "When I haven't been eating properly for a long time, my body reacts so weirdly that I cannot even focus, or just survive and do regular stuff," she explains, distraught. "Even basic things like walking my dogs; I cannot go and walk with them regularly every day. It’s so hard for me."

Her issues with eating make her issues with movement worse, which was already a struggle for her as a kid, before she started developing disordered eating habits. "I’ve always, since my childhood, had trouble with focusing on one thing… I was always, even right now, when I’m talking, my hands are fidgeting and I can’t just sit without fidgeting," she says with a laugh while raising her hands so I can see them on the Zoom screen.

"I had trouble focusing even on some sports because I was getting tired of them after the first or second practice," she continues.

"I thought this was something normal, that i was trying to find a branch of sport that I enjoyed, but in reality, these activities were enough for me to try just once or twice, and then I got distracted by new things I wanted to try that I was seeing my friends do. So I was in a rush going from sport to sport, trying out all of the things, and not sticking with any of them."

Research suggest that exercise is good for improving the executive function of children and adolescents with ADHD, but struggles with executive function make sporting habits difficult to maintain.

"It's not a knowledge deficit, it's a performance deficit," clinical psychologist and mental performance coach Dr. Joseph Case explains in the video below, talking about time blindness in ADHD sportspeople. What he means is, essentially, people with ADHD struggle to execute the plans they have made for themselves - the problem is not with the planning or the desire to execute the plan. Anastasiia's relationship to sport is a perfect example of this.

"ADHD really causes problems, because you cannot focus, but you really want to. You just want to find a focus for your life, to be good at just one sport, one hobby." She says she has found refuge in music and singing, which helps while cooking, but can't get her to the gym. "This is the way I can focus, or to relax a bit. But even with [studying] music, focusing is a big problem."

Her habit of hopping from sport to sport remains to this day. "I love working out. I’m in love with sport, I’m in love with fitness,” she tells me. But with everything she tries, she gets really into it, does it for maybe a month, and then it all falls apart. “Suddenly I just couldn’t find my motivation or something,” she said, referring to a fitness routine she tried a couple months ago. “I just couldn’t focus on it, I couldn’t push myself to go and do it, like, deep in my mind."

"I understand that I need to do it for myself, and that no one pushed me to go there, no one came with me to the gym and told me I need to [work out]. It was my idea, and it just didn’t work. I’m still paying monthly for nothing.”

Routines & Diets

David* is a motivated, courageous person who does not shy away from a challenge - but keeping up with a consistent routine and putting in the same amount of effort all the time is a hurdle even he struggles to cross. Much like Anastasiia, he has dipped his toes in and out of multiple different sports and gym routines, supplemented by diets and lifestyle changes with varying success.

Although not officially diagnosed with ADHD, he relates to all the symptoms in the diagnostic criteria, and even more so to the online content he found about ADHD struggles - like this moving compilation of testimonies by the channel How to ADHD by Jessica McCabe.

After spending months looking at videos and posts on social media by people who have ADHD, "trying to see if I could identify with the smaller aspects of how it reflected in their lives," David says he's confident he has the condition.

"One of the things that I was really surprised to realize was that most of them had tendencies to fidget, snack and and overspend," he explains. "Because for me personally, that was what led to my weight gain.”

David's struggles really came to light during the COVID-19 pandemic, when his usual routines were overturned. Although he says he has always been "a little overweight", the running around at college to go to classes and other activities helped him keep a balance, despite never having a fixed schedule. During lockdown, however, he completely stopped working out, and started putting on weight immediately.

"My diet was still basically the same [as before the pandemic], but I drastically started putting on weight the minute I stopped working out. So even when I was working out and when I had lost weight, it was not because my diet was on point."

He says he quickly made the connection between his ADHD-like behaviours and his diet, with the snacking and lack of movement under a spotlight thanks to the new circumstances he was in.

"I realized don't eat something because I'm hungry, necessarily, but just for the sake of eating itself. I don't even mind the taste, to be honest - I don't mind the taste that much. So even if it's food I don't like, sometimes I just start nibbling on it. For example, I hate raisins, but if I have a raisin in front of me, I may nibble for the stimulation of it."

After the lockdowns eased, he noticed that his struggles with working out were still exacerbated by ADHD. "I always had to mentally push myself, force myself to adhere to a workout regime. And because of that, even though the back of my mind, I always had this instinctive gut feeling that it was something that I couldn't help."

David now understands, better than ever, the effects ADHD have on his efforts - on his performance deficit, as Dr. Case put it. "I used to think it was a discipline issue, a small thing, with things like fidgeting, being extremely distracted, missing out extremely obvious - but crucial - details, snacking and eating a lot, not being able to focus on one particular area of interest. But it's not about discipline at all."

Another ADHD content creator whose content David found very relatable, Olivia Lutfallah, talks about this frequently. "[People see] the struggles associated with ADHD [...] as personal failings. And that is ablism," she says in a video.

David is now working on accepting he may be different, while also looking at it as a need for adjustment, not a hindrance. All he truly wants to achieve is to be consistent, and this is where traditional advice simply does not do the trick.

The number one thing that has helped him is thinking long-term. "Maintaining a diet, as in counting calories or segregating foods, making meal plans - that's never worked out for me. I've tried for the last five, six years, and it's never worked out."

'It has to be a lifestyle change, not a temporary one.' While you might be familiar with this phrase from falsely advertised diets and impossible to follow workout regimes, it might take on a new meaning for ADHD-ers.

"What I'm doing today is something that I can continue to do for the next couple years, and that's good," David explains. "So when I do have a long term goal, when I do have long term security, it puts me at ease."

*Names have been changed to protect the privacy of individuals.