Illustration by Cathryn Virginia
When Spencer Jardine was 15, she was diagnosed with attention-deficit/hyperactivity disorder (ADHD) and prescribed treatment in the form of Adderall. Within days, Jardine began experiencing the drug’s effects: greater focus and less impulsivity, as promised—but also a dry mouth and a drastically lower appetite. Jardine lost 20 lbs. off her 5’3” frame, growing so thin that she covered herself in bulky sweatshirts to disguise her body and drank the kids’ nutritional supplement PediaSure to try to gain weight.
How to wrap your head around the finer points of prescription drugs.
Jardine, who is now 28 and a stay-at-home parent in Truckee, California, recalled that, at one point, her high school guidance counselor asked her if she had an eating disorder. “I was like, ‘I take meds that make it very hard for me to eat,’ but she didn’t believe it,” Jardine said. While not every person on ADHD medications experience decreased appetite, many do; according to recent research, at least half of children and possibly an even greater number of adults “experience some [...] appetite reduction from being on the medication,” said Russell A. Barkley, a clinical professor of psychiatry at Virginia Commonwealth University School of Medicine. When stimulants such as Adderall and Vyvanse (the most commonly prescribed ADHD medication for adults), along with others like Focalin and Concerta, raise the brain’s levels of the chemical dopamine to heighten concentration and combat restlessness and hyperactivity, they can also decrease appetite. While a lack of hunger is typically most extreme immediately after starting treatment, it can last as long as the drugs are used—which means that, for many people with ADHD, keeping a close eye on their daily food intake each day can be as essential as remembering to take the medication itself.For those with a history of eating disorders and/or negative feelings about their bodies, monitoring food and weight is a double-edged sword. And even for people who don’t have that history, our culture’s obsession with thinness is so prevalent that it can be easy to fall into destructive thinking and unhealthy eating habits. Experts often say that being closely in touch with hunger is key for maintaining a healthy food intake, but if thinking more frequently than usual about your consumption is causing you to focus obsessively on it or view taking in fewer calories as a goal, it can do more harm than good. It also can make dealing with your ADHD more difficult, as it requires focusing intently on two complicated parts of your mental state—your attention, and your relationship with food.
“I have certainly seen [ADHD medication] being a contributing factor to the development of an eating disorder,” said Anna M. Lutz, a nutritionist and dietician specializing in eating disorders. Part of it, she noted, has to do with diet culture; when decreased eating leads to weight loss, and weight loss leads to compliments from others, “All of that can be... a trigger” for body-related disorders, said Lutz. Treating ADHD through medication without allowing the side effects to negatively affect their eating habits can be a challenge—but there are ways to cope. Below, experts provide advice on managing both the disorder and its side effect.
Whether you have a history of disordered eating or are just starting to deal with that issue, consider writing down your biggest fears and worries about how your ADHD medication could affect your eating habits. Seeing your concerns on paper—“What if I lose too much weight?” “What if I like weight loss, even though I don’t need it?”—can make them seem less overwhelming, and easier to deal with. You can bring that list to your doctor or therapist and get their advice on how to approach each question—and think through any others that might come up along the way.
Write down your biggest concerns.
If you have or had an eating disorder, or are worried that taking ADHD medication is leading you into worrying thoughts about your body, it’s crucial to be open about your concerns with your doctors at the beginning of your treatment plan. Lutz said that when she meets with patients who have both eating issues and ADHD, they work together on a nutrition plan that allows for both conditions to be addressed. “Oftentimes, I’d be talking to my patient about, ‘What is recovery going to look like for you? What is nourishing your body going to look like for you, given that you’re taking this medication? And can you recover from your eating disorder if you’re taking this medication, if it’s kind of triggering those feelings?’” said Lutz. Depending on their answers, a nutritionist might suggest their patient talk to their doctor about switching to a non-appetite suppressing ADHD medication, or encourage the intake of foods that are both nutritional and easy to consume.
Talk to your doctor about your body- and food-related concerns.
Discussing your relationship with your body and food with medical professionals can be uncomfortable. But it can also be necessary, especially if you’re already eating less and losing weight due to your medication. “If there’s an eating disorder coexisting with ADHD, you have to treat both—no different than if you have ADHD and co-existing depression, for example, or ADHD and coexisting anxiety,” said Peter Jaksa, a clinical psychologist at ADHD Center Chicago.
Before taking your medication each morning, have breakfast. “Make sure you eat first,” said Jaksa. That way, even if you eat lightly for the rest of the day, you’ve ensured you’ve gotten some nutrition. Encourage yourself to eat later in the day by setting reminders. ADHD medication is typically “at peak therapeutic levels” around midday, or 2–3 hours after it’s ingested, Barkley noted, meaning people taking the drugs often experience the most appetite loss right when others would be having lunch. As a result, you might forget about mealtime completely—so making reminders for when it’s time to eat can be useful in order to avoid skipping out. Lutz said “eating by the clock”—whether that’s a few times a day at regular mealtimes, or at shorter intervals if you prefer snacking—will help keep things on track and should occur each day, “regardless of how hungry you are.”
Set reminders for mealtimes—and stick to them.
Because forgetting or not feeling it’s urgent to eat is normal for those on ADHD medication, some people gravitate towards foods that are simple to make and to eat—think sandwiches over salads; soups over big spreads. Although these aren’t always the most nutritious options, they do the job, and according to Lutz, giving up some health value in order to ensure you eat enough can be perfectly fine. Try to remember that you still are getting some nutrition and, just as important, are feeding yourself on a regular basis.
Don’t criticize yourself for not consuming the “right” foods.
Managing the effects of ADHD can be challenging enough, but when you add in having to constantly monitor your food intake and relationship with eating, it can become an exhausting mental burden. You don’t have to carry it alone—reach out to family and friends to let them know if you’re struggling and tell them how they can support you best. Maybe your partner could check in on you during the day to remind you to eat, or perhaps your people have tips about pre-made foods that require little effort to eat. Even if you don’t need help in those capacities, it can be a relief just to talk to someone about what you’re going through.
Keep your loved ones in the loop.
Just because your stomach isn’t rumbling doesn’t mean you’re not hungry. If your focus is waning and your mood is worsening despite the ADHD medication, that might be signs your blood sugar is too low, said Jaksa, and you need to eat. By skipping out on meals, Jaksa said, you’re actually “contradicting the effect of the medication,” so it’s even more important to get some food ASAP. Additionally, keep an eye on your eating habits when the drugs aren’t in your system. Catalano said that her lowered food intake during the day led to overeating once the medication wore off. “When I crashed at night or took the weekend off from meds, I found myself craving really high-calorie foods to make up for the deficit I was in all week,” she said.
Pay attention to your body’s warning signs.
“I would consider my relationship with my body and food to be a forever work in progress,” said Erica Zenn, a Los Angeles–based 28-year-old in Diversity and Inclusion who’s taken ADHD medication for 13 years. “Slipping back into old patterns of thinking and behaving is so easy, especially when my relationship with my body and food is so intertwined with my self-worth.”Sravya Attaluri, a 26-year-old creative director in London, said she struggles with body dysmorphia, and while she’s worked hard to not let her ADHD diagnosis worsen her dysmorphia, she also knows it’ll be a lifelong project. “I've accepted that I may need ADHD medication for a long time, and, if that's the case, I need to put extra effort into taking care of myself and developing my willpower and self control so that I do not become a prisoner of my disordered eating,” she said.
Remember that readjusting your relationship to eating and your body can take time.
Although stimulants like Adderall and Vyvanse are considered the most effective ADHD treatments currently available, they’re not the only choices. Medications in the methylphenidate family, such as Ritalin and Focalin, are less potent stimulants, and non-stimulants such as Strattera, Clonidine, and Guanfacine also treat ADHD while targeting the condition in a way that doesn’t typically lead to extreme appetite loss. That said, each of these alternative medications do “come with their own side effects,” said Barkley, such as nausea or insomnia, and anyone considering taking a non-stimulant or methylphenidate should weigh the cost-benefit analysis first. If your ADHD symptoms are severe and you feel you can safely handle the appetite loss, a stimulant might be the best bet, but if your condition is more manageable, and you’re concerned about eating less, talk to your doctor about other possibilities. When it comes down to it, said Barkley, “It’s just a matter of the tradeoff.”If you or someone you know is dealing with an eating disorder, you can contact the helpline of the National Eating Disorders Association (NEDA) at 1-800-931-2237, or visit their site. You can also live chat with a volunteer via Facebook Messenger, and text 'NED!' to 741741 for crisis support 24/7.Follow Rachel Simon on Twitter.