Hi, everyone.

Welcome back to another episode of the ADHD Women's Wellbeing Wisdom.

It's your Sunday episode, and today I'm sharing with you a snippet of a conversation with Tony Russo.

Now, Tony is a specialist nurse with 20 years of practicing obesity management.

So Tony was diagnosed a couple of years ago, and now she's really passionate about creating more awareness around ADHD and obesity, binge eating, overeating, and understanding where that comes from, a neurological perspective.

So you'll hear in today's snippet us talk about this unknown fact.

And now, thankfully, people are understanding more and more that there is a link between compulsive and addictive tendencies and obesity and eating.

And if there was the opportunity for more screening involved, there would be more understanding about where this compulsion for eating comes from and understanding how we can be kinder and more helpful with regards to compulsive eating.

So I think many of you will find this helpful.

Now, obviously, we know now that Ozempic and there's lots of medical information coming out, some good, some bad, but we are understanding more that compulsive eating, addictive behaviors are something that we can't just override and that there's a neurological reason for it.

And I think this conversation really helps break that down and offer compassion and kindness to people who are really suffering.

So I hope this conversation is helpful for you, but also share it, send it to people who you think that might need to listen to it.

And here it is.

Here's my conversation with Tony Russo.

So you obviously, you know, academically, you found it challenging, but you've obviously gone on and you've had a very successful career doing what you do in a field that sounds complex for lots of different levels.

And, you know, obviously this conversation today, I want to talk about this correlation between ADHD and obesity.

What are you noticing now that you have this ADHD lens that I guess you didn't have throughout most of your career.

And what do you sort of see now that you have this.

This extra layer of understanding with regards to obesity and adhd, I see a.

Lot of the self recrimination.

So particularly, I mean, when somebody typically comes along for weight loss surgery, for example, and regardless of what the government rules are about qualifying for weight loss surgery in most areas, you can't really get through the door unless you've got a body mass index of 50 or above.

So you've got to be pretty heavy to qualify for weight loss surgery.

And at that stage, the majority of those patients are women.

And they all feel very guilty.

How have I allowed myself to get to this stage?

It's disgraceful.

And then if anything happens to me, what's going to happen to my children, you know, and if they can't work, I'm a burden on the state.

I can't work the influence it's having on my kids.

And what we used to do in weight loss surgery was do like a little psychological appraisal.

And it was usually for binge eating disorder.

And that didn't really show up that many because a lot of people don't typically have binge eating disorder.

But what a lot of people do have, what I now do, if I see anybody now, I do the screening test for ADHD at the first appointment, which takes 10 minutes max.

And some people, you know, straight away they're not.

But some people, you can see the threads.

And I usually raise the subject with them and say, had you thought of this?

And sometimes, particularly because of the recent TV program, they go, no, everybody's on the bandwagon now.

You know, everybody's got a bit of adhd, which they haven't.

But some people said this might be an issue, it might be worth considering.

So if perhaps somebody's serious, then I will go through and I'll even download the right to choose letters for them, fill them in for them.

But I think the difficulty you get with ADHD is the compulsion.

And you know, sometimes, you know, you shouldn't do something, but you just can't help.

You know, when you're desperate to go out and you've got a time, but you're still playing Candy Crush.

So just one more game, just one more game and you know you're going to be late.

And I think for me, I was very, I got into obesity because I was very living with obesity.

So I got to nearly 22 stone.

So I had weight loss surgery, gosh, 20 something years ago and I lost the bulk of my weight and then I had revision surgery.

But I always stayed at about a stone more than I am now.

And I didn't want to get obsessed with weighing.

So I'd wait until my clothes got a little bit tight.

But it was always still a struggle and I knew I was never going to be able to get this out of my head.

And I kind of quite compulsive.

There are certain foods I just wouldn't have in the house because I can't moderate.

I can't have one or two biscuits, I want the whole packet.

And then when I started my ADHD medication, my Appetite went.

And before I knew I dropped a stone and I suddenly thought, what's going on here?

And at that point I thought, you know what?

Why are we doing these operations on people when there are other alternatives?

And I'm not saying for one second that weight loss surgery is wrong or there isn't a place for it, but I do actually wonder if a lot of people now have undiagnosed adhd.

And particularly the warning bounds will be those that have maybe had a history of drug misuse or alcohol misuse in the past.

Because you often get this transference, don't you, where if you give up alcohol, you turn to smoking, you go out smoking, you turn to something else.

We very seldom just give up a habit, we tend to want to replace it.

Yeah, anything else.

And so that for me was a link.

So I tried to do some research and there were a few inferences, but not too much.

And I presented at a conference and I thought nobody was going to be interested and was really shocked that people were going, you know what?

There might be something in this.

And so I kind of really got this bug.

It's a great ADHD habit, isn't it?

Because now I've got this obsession with investigating this and I kind of almost want to go out like a.

What's the word?

A missionary?

Is it a missionary?

I want to go out and say to people, this is great, the service you're offering is fantastic.

But you know, people are having to wait two years for surgery anyway, so we're not wasting any time.

Why don't we sort of sort these people out first?

The ones that have ADHD we can treat and it'll either work with the medication and if it doesn't, it may make them more able to follow the instructions.

Yeah.

Nobody puts themselves through an operation meaning to cheat.

Nobody willfully cheats, nobody wants to regain that weight again.

But we know that 60% of people at five years have regained a significant amount of the weight that they lost, regardless of which operation they had, who did it and in what country.

So our body are fighting constantly against us to make us regain that weight again, which is nothing to do with adhd.

But if we can remove the compulsion to eat, that's an enormous release to people.

And now I don't really think about food.

I eat when I want it and I don't eat when I don't want it.

You know, like when you're.

I'm literally sort of just like listening, just thinking.

It's like a no brainer, isn't it really because like you're explaining the ADHD brain, this sort of dopamine stimulating, seeking part of our brain that you're right, there's a compulsion and when people sort of say, I've got, haven't got any willpower, I'm so weak and I've got an addictive personality and all these different things and there's so much shame there, but actually when they understand that's a part of their brain that is predisposed to this and like you say, the, the addiction or the addictive part is going to just transfer to something else.

So unless we actually sort it at its root, and like you say with ADHD medication, very often that sort of self medicating part, that self soothing, the, the seeking, the stimulation seeking is dissipated using the medication, which feels a much more cost effective and much healthier way of treating patients.

And you know, here in the uk, the obesity is probably one of the biggest health crises that we've got going on.

You know, diabetes, I don't even know how much it's costing the nhs, but I know it's billions.

So it's almost feels like, why, why is this only just being spoken about, like, why are professionals that have been working in this industry for so long not targeting the brain with medication as opposed to sort of just thinking, right, let's just, let's go in for sort of this weight loss surgery.

So when you did this presentation, which sounds, you know, fascinating, how did people react who had never really considered this, who maybe don't understand neurodivergence, don't understand ADHD and maybe don't even understand the interplay between that and binge eating, obesity, you know, food compulsion.

Well, I think, I think what happened?

Well, first of all, I said at the beginning, not because I didn't want people to be mean to me, because I don't mind if people argue with me, but I said I did this because I've been diagnosed.

I wanted them to see someone that they perceived as normal and not naughty, that they might, they might listen.

But when I started to say, how can we relate this to our own personal practice?

And I wasn't saying don't operate because that's not the right thing to say to surgeons.

I think they realized that this could actually, our outcomes could be better, we could be more successful and get better outcomes.

I mean, for me, for example, I had a road traffic accident six, seven years ago and I fractured my femur.

I came from motorbike and a year later I was still taking OxyContin, you know, which is one of the most addictive drugs on earth.

And I suddenly realized I couldn't stop taking it.

And I was the tiniest dose.

It wasn't giving me a high.

Part of it was probably fear.

And I actually had to pay a psychiatrist to supervise me coming off.

But clearly there is the.

What we used to call I've got an addictive personality may actually now be us being more astute and going, actually, maybe they've got adhd.

Correct.

And maybe that's what we need to look at.

And I see so many people with ADHD with struggling with alcohol.

Yeah, we had an amazing woman on a few months ago talking about alcohol dependence and addiction and ADHD.

And again, she was in her late 40s, she'd been struggling in and out of rehab.

And it was only, you know, much further down the line did she know.

And she's now been able to take medication and she's not been drinking.

But, you know, for that her to have been in and out of different rehab facilities and no one mentioned adhd.

It's kind of like, why is the mental health industry, why are the professionals not seeing this as almost like a first line, like you say, the screening takes 10 minutes and you know, again, we'll talk about Sarah Templeton, is that she is spearheading campaign of anyone that goes through the criminal justice system gets that screening 10 minutes.

Again, it's not a formal diagnosis, but it's understanding and it's a recognition of, okay, this is the playing field that we're working with.

And, you know, how can we help them?

Can we get them fast track them through to get them help and medication.

And it should be the same in your profession.

It should be the same with anything to do with drugs and alcohol.

And I hope that things are changing.

I really do.

And there's a lot more conversation going on now.

And awareness, I guess when you sort of do that initial screening with your patients and they get almost that penny dropping moment, how do they react?

And have you had moments where they're just like, I can't believe that this is what it's been.

I had one woman who just burst into tears and cried for five minutes and then I thought, oh my God, what have I done?

I've opened a real Pandora's box here.

And she was just for somebody to tell me that I'm not just a stupid person that can't control their willpower.

What you do have to do is manage people's expectations because first of all, they've got to get past the GP.

And GPs aren't mean, GPs aren't there to stop you being well.

But the thing is, people do get an idea in their head sometimes about an illness which they may not have.

And I think you have to manage people's expectations because a lot of people think, well, I'll get an ADHD diagnosis, I'll get drugs and the whole world's going to be different, I'm going to be clever and everybody's going to like me.

And, you know, medication works differently for different people and it's a long, drawn out period of time and sometimes medication may not suit you at all and some people don't want to take meds and that's absolutely fine.

But I do think that it can be quite powerful just to know, then you can work with it.

And of course, there are other advantages.

If you've got an ADHD diagnosis, you can claim access to work from the government, which is a benefit that can really make your life easier.

And it's not like, oh, it's another benefit you're paying out to people.

It's serious practical stuff like coaching, noise canceling, headsets, stuff to make.

Enable you to work as well.

It's like if somebody's got a leg missing, it's like giving them a prosthesis.

You're not giving them money, but you're helping them to have the same advantages as somebody that has two legs.

You know, it's more like you're getting a level playing field.

So there are various advantages to knowing.

I agree with you.

And I think, you know, again, if they don't know it's there and you're then offering them this sort of, this new way of looking at the world and helping themselves and asking for the accommodations, I always think it's worth it.

Yes, the.

The reaction may be emotional or there may be sort of disbelief or cynicism there.

I mean, I can understand, you know, like you said, that there's, oh, everyone's jumping on this bandwagon.

And even this morning I, you know, I turned on my phone and there was a thing from the Daily Mail, another one of those horrendous articles of ADHD diagnoses have hit the roof.

And is this due to celebrities speaking out?

It was just horrendous.

It was just another sort of gaslighting article of making people believe that they're just jumping on a celebrity bandwagon, when actually what's happening is that it's a much more common, you know, condition than people believe.

And it shows up quite differently in different people.

But it's not a bandwagon because, you know, if you think about the amount of people that suffer with obesity, they suffer with disordered eating, addiction issues, emotional dysregulation, anxiety, depression.

If you think about that, it's quite.

You know, we.

Within my group of friends, it's probably one in five, one in seven, and I do.

And those are pretty much the stats that we're thinking.

You know, we're talking about maybe we.

Exactly, exactly.

Yeah.

That's the thing is, when one of us gets diagnosed in a friendship group, very often it's sort of like a bit of a domino's effect as well, isn't it?

Because we're more likely to be friendly with other neurodivergent people as well, or be married to them or whatever.

I saw a lady the other day who in the past had been very, very overweight, and then in her 20s, she'd moved to London, she'd got a cocaine habit, lost a load of weight, come off the cocaine and turned to alcohol and still remained quite small.

And she'd come off the alcohol and has been sober for a year, which is magnificent.

She did the testing and she looks quite high for adhd.

Went to her GP with the results, results and his words to her, you've got an addictive personality.

Do you think it's fair on your family, talk about guilt tripping, that you're going to maybe get diagnosed for a condition that's going to give you speed?

Oh, my God.

Oh, my God.

I'm just.

I just can't.

Because that just.

It makes my blood boil.

Because they are the gatekeepers and like you say, you know, listen, gps are doing the best they can and I know a lot of gps listen to this and it's incredible because they are listening because they are struggling with resources themselves, or they're listening because they want to help their patients, or there's quite a lot of GPs out there with ADHD themselves and they're struggling with the paperwork, the admin, they're struggling with sort of the day to day, sort of just sitting in an office and they are kind of, you know, they're all.

They're burning out, they, you know, really are.

This is what I'm hearing.

But with regards to the gps that are not willing to open their eyes and they're not willing to sort of start thinking outside of the box a little bit, that really upsets me because what happens is people come to me and build up this confidence, but Also courage to go into their gp.

You know, they may have been sitting on information and little articles and podcasts and all this and they finally, you know, drop me a message and say, you know, I think I've got adhd.

What do I do now?

And I say, go and speak, make an appointment, speak to your gp, but advocate for yourself, make sure you have done an online, you know, assessment form, make sure you have maybe like listed some things, kept a little bit of a journal.

Because unfortunately, if we don't go armed with a little bit of evidence or something to back up our claim, it can often just be dismissed.

And I wish, how's the GP determine?

Because at the end of the day, remember, if it's adhd, it will have started in childhood.

Exactly.

If you've just been like this for the last year or two, that could be something else.

And of course a lot of people get misdiagnosed with bipolar, but it could go the other way as well, couldn't it?

Because if you've got bipolar and you've got the ADHD symptoms, they might apply to you.

So, you know, the gps do know this and I think that, you know, you do have to manage people's expectations because if you take right to choose out of the equation in my area, if I went to my GP tomorrow, I mean, I have a great gp, but if I went to my GP surgery and they referred me on the nhs, I'd be looking at a three year wait.

And they do have to manage that for people and say, do you realize it?

You know, it's going to be a tricky road, they just need to understand that.

So someone who's listening now and they are really relating to maybe your sort of type of patient where, you know, obesity for them has been a lifelong struggle and they've maybe seen it in their family, maybe weight loss surgery has been a consideration for them.

What, where would you direct people?

Like, what would be your, your channel for them to go through?

Now they have also got that ADHD awareness.

Would you say, get that diagnosis?

I get on the, on the list for adhd.

Because you don't know, even with, you know, right to choose.

They say six months, it's getting longer because these people can't cope with the service.

You not wasting any time, use the time you're waiting.

So you wait for ADHD and you also wait for obesity treatments.

There is a middle ground at the moment that if people are living with a BMI of greater than 30, they may well qualify for medical treatment with sort of GLP1 drugs, which are the drugs like Ozempic.

Now, they are fantastic drugs that have been used extensively for obesity, sorry for diabetes, and we now know they work well for obesity at higher doses.

And one of them, which is the Ozempic, is the lower dose and there's a higher dose called Weigavy, which is going to be given to people living with obesity.

However, again, managing expectations, they can't produce enough.

There is a worldwide shortage.

So regardless of what people see in ads, it's probably going to be at least six months before these drugs become widely available in the uk.

But for a lot of people, they are transforming and that may well be the answer for some people.

So I would say get referred for everything and see what comes first, because none of them are mutually exclusive.

Nobody says to you with ADHD you're on the pathway for weight loss surgery, so we're not going to treat you.

And you may well find as you're going along that you think actually this is more of an ADHD thing and that's fine, but I would say take all the help you can get.

So I hope you enjoyed listening to this shorter episode of the ADHD Women's Wellbeing podcast.

I've called it the ADHD Women's Wellbeing Wisdom because I believe there's so much wisdom in the guests that I have on and their insights.

So sometimes we just need that little bit of a reminder and I hope that has helped you today and look forward to seeing you back on the brand new episode on Thursday.

Have a good rest of your week.

Weekend.