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On the link between attention deficit/hyperactivity disorder and obesity: do comorbid oppositional defiant and conduct disorder matter?

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Abstract

The link between attention deficit/hyperactivity disorder (ADHD) and elevated body weight/obesity can be regarded as well established. Because oppositional defiant disorder (ODD)/conduct disorder (CD) has also been found to be associated with these characteristics and ADHD and ODD/CD often occur comorbidly, we investigated whether ODD/CD and ADHD are independently linked with body weight and obesity. The clinical records of 360 children, 257 (6–12 years) with diagnoses of ADHD, ODD/CD, or comorbid ADHD and ODD/CD and 103 children with adjustment disorder (as a control group) constituted the database. All children were seen for the first time in two outpatient psychiatric clinics. Associations of the psychiatric diagnoses (ADHD present vs. not present; ODD/CD present vs. not present) with the standard deviation scores (according to German reference data) of the child’s body mass index (BMI-SDS) and presence of obesity were analyzed by ANCOVA and hierarchical logistic regression analysis, respectively. Children with ODD/CD showed higher BMI-SDS (F = 7.67, p < 0.006) and rate of obesity (Wald = 4.12, p < 0.05, OR = 2.43) while controlling for ADHD comorbidity. While adjusting for ODD/CD comorbidity, the links between ADHD and BMI-SDS or obesity did not reach statistical significance. Given a cross validation of these findings, future (preferably prospective longitudinal) research should analyze the mediating mechanism between the psychiatric conditions and obesity. This knowledge could be helpful for preventive interventions.

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Notes

  1. This ICD-10 F90.0 diagnosis corresponds to the ADHD combined type diagnosis 314.01 of the DSM-IV.

  2. For this diagnosis, the criteria for hyperkinetic disorder (F90) and a conduct disorder (F91.-) must be met. In ICD-10, ODD constitutes a subcategory of CD. Equivalent to DSM-IV, in ICD-10 ODD (F91.3) is defined by less severe symptoms that usually occur in younger children [25, 31]. Therefore this group is named “comorbid ADHD + ODD/CD”.

  3. ICD-10 and DSM-IV contain equivalent diagnostic criteria and symptom lists for CD and ODD. CD diagnosis is completely equivalent, and all children who receive an ODD diagnosis by use of DSM-IV also receive this diagnosis on basis of ICD-10. The small subgroup of children who fulfill the ICD-10 but not the DSM-IV criteria is very similar to those who meet the criteria with respect to comorbidity, development and impairment [25]. Therefore the group is named ODD/CD.

  4. F91.0: n = 6, F91.1: n = 11, F91.2: n = 10, F91.3: n = 20, F91.8: n = 3.

  5. F43.20: n = 11, F43.21: n = 5, F43.22: n = 11, F43.23: n = 58, F43.25: n = 17, F43.28: n = 1.

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Acknowledgments

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Conflicts of interest

Ursula Pauli-Pott, John Neidhardt, Monika Heinzel-Gutenbrunner: none to declare. Katja Becker: is/has been involved in research/clinical trials with Eli Lilly and Shire, is on the Advisory Board of Eli Lilly/Germany, and was paid for public speaking by Eli Lilly and Shire.

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  1. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University Marburg, Hans-Sachs-Str. 6, 35039, Marburg, Germany

    Ursula Pauli-Pott, John Neidhard, Monika Heinzel-Gutenbrunner & Katja Becker

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  1. Ursula Pauli-Pott
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Correspondence to Ursula Pauli-Pott.

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Pauli-Pott, U., Neidhard, J., Heinzel-Gutenbrunner, M. et al. On the link between attention deficit/hyperactivity disorder and obesity: do comorbid oppositional defiant and conduct disorder matter?. Eur Child Adolesc Psychiatry 23, 531–537 (2014). https://doi.org/10.1007/s00787-013-0489-4

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