Did you know that ADHD is more common in the bariatric community? In today’s episode, we’re going to explore how ADHD and neurodivergence shape our relationship with food, how this affects the bariatric community and discover strategies to thrive. 

We are happy to introduce a clinical psychologist with 20 years of experience working in bariatric medicine, who brings personal insight as a bariatric patient managing ADHD and weight regain. Dr. Karen Stewart shares practical approaches like meal prepping and mindfulness, while addressing how perimenopause and hormone replacement influence emotional regulation and decision making in the bariatric community. By exploring executive functioning, dopamine, and self-compassion, we’ll uncover tools to support the bariatric community in overcoming obesity and weight regain.

Tune in, and don’t forget to join the BariNation Community to attend community meetups, watch exclusive bonus content and support the podcast for as little as $5 per month!  You can also contribute to BariNation and become a Drive To Thrive Supporter with a one-time or recurring donation.

IN THIS EPISODE:

• (00:00) Introduction
• (02:30) Dr.  Stewart shares her area of expertise and journey with ADHD and weight regain
• (08:00) ADHD neurodivergence may lead to obesity due to disordered eating patterns
• (14:30) Connection between ADHD, multitasking, and mindfulness 
• (20:15) Defining ADHD, neurodivergence, executive functioning, and weight regain
• (29:47) Effects of perimenopause and hormone replacement on ADHD Symptoms and emotional regulation
• (34:40)  Practical strategies for bariatric patients with ADHD, focusing on dopamine, executive functioning, and self-compassion
• (39:13) Lowering the expectation on the food front

KEY TAKEAWAYS:

• ADHD and Neurodivergence are more prevalent in the Bariatric Community, contributing to obesity through disordered eating patterns driven by Dopamine-seeking behaviors and Executive Functioning challenges.
• Task switching, cognitive flexibility, and decision making tax the brain, especially in ADHD, necessitating strategies like meal prepping to conserve mental energy.
• For neurodivergent individuals, food often serves as a quick Dopamine hit. However, healthy eating alternatives and non-food activities, such as walks, can help replace unhealthy habits.

RESOURCES:

• BariNation Website
• Tune in, and don’t forget to join the BariNation Community to attend community meetups, watch exclusive bonus content and support the podcast for as little as $5 per month! You can also contribute to BariNation and become a Drive To Thrive Supporter with a one-time or recurring donation.
• BariNation - Email
• BariNation’s How to Find an Obesity Specialist Guide
• Karen Stewart - Instagram
• Karen Stewart - Facebook
• Dr. Karen Stewart - Website

GUEST BIOGRAPHY:

Dr. Karen Stewart is a clinical psychologist who’s spent 20 years supporting bariatric patients—and she’s been through the process herself. She brings both personal and professional insight to her work, with a special focus on how ADHD affects eating habits, self-care, and long-term health. Karen helps people understand what’s driving their patterns and find practical, sustainable ways to feel better in their bodies.

ABOUT:

If the BariNation podcast helps power your bariatric journey, become a monthly podcast supporter and help us produce the show! Visit www.barinationpodcast.com and help us support people treating the disease of obesity with humor, humility, and honesty.

April Williams: You've just tuned into a podcast that welcomes you into a community, a resource center, and a safe place that powers your [00:00:15] journey towards personal wellness.

Natalie Tierney: Our goal is you leave us today feeling hopeful, inspired, and ready to live your best bariatric life.

An exclusive $29 a month membership for Bari Nation. So it's around about a dollar a day, and that gives you access to all of the support groups, the classes, and the [00:01:00] meetups that we offer in this community. So if you're interested in that, just open up the show notes and click the link that you see down there.

So you're [00:01:30] gonna hear how a DHD, neurodivergency and executive function can kind of slow us down. Especially as we're trying to fight the disease of obesity, and Dr. Stewart offers some amazing things to try. We know it's one thing to like know it, but it's [00:01:45] another thing to actually practice and do it. In the variation membership community, you can do exactly that in our support groups, classes, and meetups.

So join us today, head to [00:02:15] Bari nation dotn.co, and become a member of our amazing community. All right, my friends. Let's jump right into this awesome conversation. Hi friends. Welcome back to the Bari Nation Podcast. Today we have the [00:02:30] honor of introducing you to an expert that we have not yet had the chance to talk with.

Dr. Karen Stewart: Sure. Thanks for having me.

And, um, I also had ruin y gastric bypass in 2018 myself. Um, and currently main, uh, well sort of maintain with Zep Bound is what I'm taking now. Um. And [00:03:30] needed that. 'cause I did have some weight regain, especially during those COVID times. Right. Um, mm-hmm. I, you know, uh, anyway, so, um, I have known for about 20 some years that I have a DHD.

Um, we talked about it in our testing courses, so that's like. [00:04:15] Doing psychological testing to get diagnosed with something, but it never ever came up in any of our treatment courses or in of our considering, you know, I'm a specialist in health psychology and so you know, a lot of talk about depression, anxiety, and how those affect our [00:04:30] health.

And not a lot of flexibility. [00:05:00] Um, and actually this is actually a characteristic of a DH ADHD as well, is that cognitive flexibility can be challenging. Um, things like switching tasks is hard, unexpected deviations to your scheduled or your routine can be really dysregulating and difficult. [00:05:15] Um, so in any case, um.

Um, and, um, we screen for it, um, in our practice. And really it allows me to, you know, uh, it's not enough to. Give a [00:05:45] diagnosis during that meeting. But it allows me to give them some really personalized feedback on like, here are some strategies that might be beneficial for you. Wow. And you know, it's really just such a very, uh, as someone with a [00:06:00] DHD, it's just been such a gratifying experience to be able to share with someone, you know, here's what your might, what might be going on with you.

Pieces. Every, every like adult decision you make is basically tapping that resource. And, uh, it's a lot. And so, um, you know, I, I just really feel like that's an area that anyone can benefit [00:07:00] from the conversation around. Like how do you protect that resource? How do you build it up? Um, and what are some ways to just make life a little easier?

And, um, how to be a little kinder to yourself with the whole process.

Yeah. One conversation is, is not gonna be enough. I can, I can already tell that I'm here for it. Yeah. Awesome. I'm nerd. Let's talk, let's. Do it Well, and maybe that is actually just a really great place to [00:07:45] start. You mentioned that A DHD Neurodivergency is more prevalent in the bariatric community. Yeah.

Why is that?

Right. Um, and [00:08:15] so even from a pretty young age, some of the, the A DHD, um, is more associated with obesity in general.

Now it's like, well, yes, you [00:08:45] have the disease of obesity, but maybe it's the A DHD that's driving some of those actions and behaviors, not necessarily the disease.

Um, I think people assume that we're obsessed with food and that we're like always eating all the time. Right? Like I think we have all been exposed to that stereotype, unfortunately. Mm-hmm. [00:09:15] Um, often. People are forgetting to eat. They are skipping meals. Um, and then they are ravenously hungry, um, and desperate without a plan and grabbing whatever is convenient and quick.

Mentioned, you know, not everyone has every symptom, right? So I'm kind of speaking just generally here, but, um, planning an organization, especially when it comes [00:10:00] to food, um, I think are prevalent. And I think that's because you wanna also think about a DHD as, um, it's a brain that's wired for interest. And so food is actually a fairly low priority for a lot of a [00:10:15] DH ADHD years because there's just so many more interesting things happening in their brains and in their world.

And, sorry that sounded really clinical, but basically like it can be overwhelming. It's multitask basically, and you're losing a lot of efficiency by switching back and forth. And yet you have a brain that keeps trying to switch you back and forth and it gets very frustrating. Mm-hmm. Um. [00:11:00] So, yeah, so I think that meal skipping, um, either due to, you know, not being terribly focused on it, um, also sensory low sensory awareness can be contributing to that.

Natalie Tierney: Yeah, I, [00:11:30] I relate to, uh, pretty much everything that you just said.

Mm-hmm. Or, um, you know, skipping meals until you're so hungry. Like there were all of these things and I just remember feeling really validated, um, after almost 30 years of, of. [00:12:15] Struggling to figure out why even with bariatric surgery, why I just couldn't, um, get over quote unquote this hurdle. And, um, everything you said just [00:12:30] hits the nail right on the head.

I don't always want to eat.

Dr. Karen Stewart: Mm-hmm.

'cause I will just. Keep going until I'm too hungry. And then, like you said, I just make those poor food [00:13:00] decisions And um, I was lamenting about that this morning and a very nation support group on my way to work. Just why can't I make the right decision in the moment? And part of it is definitely my A DHD, my neurodivergence.[00:13:15]

April Williams: I'm kind of putting all of these things together in one and I'm just, this is kind of learner. I am. So I'm just gonna summarize what I think you said to make sure that I'm understanding this and then kind of apply what we've been learning. So we're recording this episode in May [00:14:00] of 2025 and in May we're focusing on mindfulness.

It is, it is taking your focus to all kinds of different places.

Dr. Karen Stewart: Mm-hmm.

Mm-hmm. And it's hard to make those decisions that are aligned to our bariatric goals. Mm-hmm.

Being able to intentionally control and direct your attention. Um, and so, you know, you are trying to focus on this super tedious [00:15:45] task of like the, you know, filling in the dots on your documentation for your job or whatever, you know, filling in a spreadsheet or something really boring. Meanwhile, in the back of your brain, you're thinking about what you're doing later today or.

April Williams: And in a world where. Like we're, we're walking around with right things, or we're holding things that are literally giving us these hits of dopamine that even complicates it even further.

Dr. Karen Stewart: Mm-hmm.

And I just, I was craving the dopamine hit all the time. Mm-hmm. I had bags of [00:16:45] candy and chips and anything I could like. Like to like eat, to like get that dopamine hit mm-hmm. Was just at my fingertips because I just needed it so badly. Mm-hmm. Um, and I think that's part of what. [00:17:00] Alerted me when I, when I read that article at first, oh, this makes a lot of sense.

Dr. Karen Stewart: mm-hmm.

Natalie Tierney: Would be, would literally send me, I would rather not eat dinner, then have to make it. Mm-hmm.

Right? Like, I'm just gonna repeat. That decision. It's a, it's a strategy for protecting yet that resource that you didn't even realize you were doing. And so I think sometimes when you hear something like that, it makes you realize [00:18:15] this is a behavior that I was using to protect myself and I don't need to beat myself up over that.

April Williams: There are so [00:18:45] many people who are listening to this. We often talk about this in the variation community as bariatric patients of people who've been obese. We wanna beat ourselves up, right? For, for us getting to this point in our life. But what we really stress in our [00:19:00] community is that. Right. Our bodies and our minds were doing the things that it needed to do to keep us alive, right?

Dr. Karen Stewart: Mm-hmm. And what

April Williams: I hear, what we heard you just say is really the same thing.

Yeah. Mm-hmm. Wow. Okay. So you've said a couple words, and I think I just almost wanna take a step back here. We've talked about [00:20:00] A DHD, we've talked about neuro neurodivergency, and you've talked about executive functioning. Mm-hmm. So can we maybe define what these are and then talk about how they are all related to one another?

Like the obesity epidemic isn't like. It's not, it's not a genetic change. Right. Um, the reason we're seeing more is because we're looking for it more is one thing, right? Like, as I [00:20:45] mentioned, we've basically considered a DHD to be a childhood only disorder, um, for a long time. Right. Um, and I would say it's still a tr uh, uh, it's still a struggle to get, you know, people [00:21:00] recognizing the impact of adult A DHD.

Um, one of my goals is to start creating continuing ed courses for other therapists and [00:21:30] healthcare providers around, you know, this is impacting your, your, um, your patient's health. Um, it's a serious, uh, problem for adults that is affecting their health. It's affecting their quality of life, relationships.

Um, uh, and then also there's a third concept in the neurodivergence. Space of giftedness, um, that [00:22:15] is, um, talked about as another form of neurodivergence. Um, and so, um, there's uh, something in the kind of the, um, school, like in the educational space of like mm-hmm. It could be like two E, which was, is like usually [00:22:30] they gifted and A DHD gifted and autistic, you know, um, they have like a dual diver neurodivergence.

If you're having [00:23:00] executive function difficulties, it's not as important to me if you meet all the criteria to have a DHD as it is that I help you with those problems. Um, the challenge there for diagnosis is that executive functioning difficulties are an [00:23:15] aspect of A DHD autism, um, and nearly every other psychiatric disorder as well.

So. No, people weren't getting a DHD, but our brains were really being, you know, overwhelmed with like, just the heaviness of the world, the isolation and Oh yeah, the stress of that time. Mm-hmm. I think is, [00:24:00] is what that is. And big transitions. Like suddenly I have a work from home job and, you know, uh, is a lot, you know?

April Williams: Well, and for all the reasons that we've already discussed, right. When, when we're asking ourselves to live in a different environment, to, to just to, to be totally different from [00:24:45] what we've ever known. Yes. Stress levels go through the roof and you're spending time with people that you usually don't spend that much time with, even though you live with them.

It was a lot. It was a lot. And I don't think we give ourselves enough credit for just how [00:25:15] challenging those moments were. Some people were, I think, brave and bold enough to talk about it, but every. Anybody else just kind of suffered through it and it was like, it is what it is. Yeah, sure, it is what it is, but how do we move through this in a way that's beneficial for us and not [00:25:30] detrimental right.

To our overall health. That was kind of the big question there.

Dr. Karen Stewart: Yeah.

April Williams: So when, when you talk about executive functioning, what, what is that? Oh,

It's basically kind of, um, exerting control over all the functions of your brain and helping, um, kind of organize and coordinate [00:26:00] those different activities and intentions in your brain. Um. And so as I mentioned that, you know, I think one thing that is often overlooked, um, in A DHD, and it's not mentioned in the diagnostic criteria at all, is the effect on emotion [00:26:15] regulation.

And like, I'm like, I'm supposed to be starting that chart review right now. What am I supposed to do instead? I can't get in. What am I supposed to do? And it, it took some recovery time to get back into, and then it's like, well now I still have the appointment at the same time, but I have less time to review [00:27:00] the chart.

Yeah, a little mini meltdown. Mostly. Mostly internally, but,

Executive functioning, don't wanna do it. It's tedious. [00:27:30] If I stray from it, it's just not gonna get done. So if I have, you know, a four hour time trunk, I can just get it done.

Dr. Karen Stewart: Yeah.

Dr. Karen Stewart: And

Dr. Karen Stewart: And

Natalie Tierney: it

Dr. Karen Stewart: feels so outsized, right? Yes. Of like, you know, I mean, I, I was just, just saying the other day I was like, I can climb a mountain, but put a mole hill in front of me and I melt.

Yes. You know?

And I was probably like, why? Like, you're getting worked up outta nothing. And I remember she just, she turned to me and she's like, it's just a big deal to me and I can't explain why. Yeah. There's, right. And it was kind of what you just

It interrupting me three times in a row. Make me wanna punch you in the throat. Uh, it really does.

Right. Um, and also just kind of. [00:29:15] Getting okay with I am the way I am and I need things to be the way they are. And I actually caught myself apologizing to a colleague, um, because I said, I'm sorry for being rigid about my schedule. And then I thought, and I [00:29:30] texted back and I said. I'm gonna take that back.

Uhhuh. [00:30:00] So, um, and it turns out that estrogen is actually a facilitator of dopamine. And so if you are middle aged going through perimenopause or wherever you are in your journey with that, and you feel like maybe I do have a little a DHD, maybe it's a little [00:30:15] perimenopause. You are not imagining that that is, that is a thing.

So. Yeah, so it's like I, I, oh, sorry. Things that used to be mildly annoying are rage inducing now, basically, right? Yeah. That's what happened.

I was like, something is really wrong here. Something is. This is just not, not good and went in realized, oh, I'm actually postmenopausal. Whole different story on that. But I have since started hormone replacement therapy [00:31:00] under, you know, strict guidance of, of my doctors, and I cannot believe the change that it has made up here.

Dr. Karen Stewart: Mm-hmm.

That connection to [00:31:30] estrogen and hormone replacement and the, the, the things that I've noticed going on up here has really been monumental and it's helped me let go of some of that guilt and shame and blame that I was feeling towards myself.

Dr. Karen Stewart: Yeah.

It's helping me, I guess, [00:32:00] have more appreciation just for how I'm built, because now that I know how I'm built, I can apply different strategies and techniques and tools that helps me maximize, right? This wonderful way that, that I've been put together instead of trying to [00:32:15] push it away or shove it down.

Dr. Karen Stewart: I love it. And um, one of my favorite conversations was being able to, you know, speak with an older patient who had never.

It's very creative. It's, uh, usually, you know, pretty good at like, if, if you're good at something, you are good at it. Like you really, um, that hyper focus is like that really. Mm-hmm. [00:33:15] Purpose. Um, usually a lot of empathy, a lot of compassion, um, and, and a lot of positives, I think, to that brain that, you know, aren't always a fit for, um, our traditional workspace in America where we, we kind of [00:33:30] prioritize things like being interruptible.

You know, there's, there's some elements where that kind of looks, um, a certain kind of way in the workplace, especially for female, but probably males as well, so, mm-hmm.

Um, knowing that A DHD right, this neurodivergent brain interacts with the disease of obesity a little bit different. Are there areas in which [00:34:30] this. Can impact our eating as bariatric patients, and are there things that we can do to kind of work around those, those impacts?

Kind of guideposts about what is the crux of going, what's going on with A DHD, and how to navigate that, right? In terms of your eating. So one is [00:35:00] the dopamine, right, of like food is serving that role of, you know, giving a quick. Um, constantly available and very effective. Dopamine hit. Right? Um, the second is this executive functioning as a limited [00:35:15] resource and things you can do to protect that resource.

And so that, that kind of like. Narrative that's there of like really healing. That narrative is a big part of it too. Um, so, um, to focus more on the dopamine part, right? Um, [00:36:00] so it's very natural to need dopamine, you know, through the day. Right? Of course. You know. We're not even talking about medications and treatments, like that's an option for things, right?

Um, build in things [00:36:30] that are, um, you know, maybe you do need a healthy snack at that time. And if you have that. Snack readily available. Um, and it's easier to get than the unhealthy snack. Mm-hmm. Especially with that hyper focus. You're gonna not go out of your way to [00:36:45] go get chips if the apple is right there.

Um, you know, lots of things. Um, and I sometimes encourage people actually to keep a list on hand. [00:37:15] Readily accessible, easy activities that you can do in a moment like that because going back to what I was mentioning earlier about my doctoral research, um, when we're in a, a moment of not feeling great, our flexibility is low.

And that link between this is the only thing that works and these substitutes are gonna feel not as satisfying, at least in the early [00:38:00] stages, but the more that you build up other things. You have to make them readily available. That's one of things. You know, you can't take a break and go watch a whole movie during the workday.

Mm-hmm. So that's some thoughts on dopamine. Um. The executive functioning, you know, I think the cognitive efficiency we were talking about of like meal prepping, [00:38:45] making it simple. I'm a big fan of things like rotisserie chicken and then just put three different sauces on it, three different nights, the dinner.

April Williams: Food was, had protein, protein, heavy food was had. Yeah. Even better.

Yeah, yeah,

'cause like, I mean, this might mean do you need a career change? You know, I mean, like, are you [00:39:45] in the wrong profession? Um, and actually I, I'm looking into getting involved in, um, some. Um, agencies in my area that are, you know, helping out with young ladies in their education and they do some personality assessment and I, I, I have to express some [00:40:00] interest, I might be able to kind of help with, like, I have a strong, I have kids and I'm like, I'm really interested in helping them figure out what's gonna work for you CareerWise, like, you know, and choosing something that's gonna be a good home for you [00:40:15] as your brain works, right.

And like providing that mentorship that I don't think anyone knew to give me those. Mm-hmm.

And you were doing it just because you figured out this is gonna work for me. Mm-hmm.

Or don't try to get ahold of me, like I'm very rigid because I have to be. Mm-hmm. Um, [00:41:15] and that is the same way with food. I mean, talk, the hyper fixation meal thing is, I'm still stuck on that because I eat the same. I like have rotations of like. These are the things that I like [00:41:30] to eat, and I don't stray from them because I don't have to decide.

Sounds [00:42:00] good. You know, because I, mm-hmm. There, there are moments where I just do not have that extra reserve, or I know we're about to do something that's gonna take a lot more out of me, so I, I can kind of reserve that. [00:42:15] The spoon theory that people talk about with chronic illness. Right. It's very similar in terms of like brain power and cognitive.

April Williams: Yep. Well, and I've seen you too, not like with your, with your new job, you are walking throughout the day. Mm-hmm. I know. Every now and then you're like, oh, I just heard this song. Right. That that's something that, that's dopamine [00:42:45] hit.

But I've just seen you. Do so many things and make so many of these small changes, but they've added up to big things when you travel, how you pack, what you choose to pack, when you're packing, why you're doing it. It's really setting you up for success. And I never [00:43:15] connected it with Neurodivergency until this conversation, but the changes and the things that you've implemented in your life have really been a game changer for you.

Dr. Karen Stewart: I mean, and it sounds like you've done the deep dive on that and you've really analyzed, you know, what's going on and so, and given yourself the space to do the problem solving and figure it out.

Them. It's always April and I traveling together to get to them. There were a couple times where I was like, Ooh, this is not, [00:44:00] this is not how I do things. How am I going? You know? So then I have to just say, I'm following you. I can't make a decision. Just do do what you gotta do and I will follow suit, um, because this is not my routine [00:44:15] at an airport or, you know, anything like that.

Mm-hmm. Um, but yeah, it's been really eyeopening and the topic has kind of exploded within Bari Nation too, so.

Dr. Karen Stewart: Mm-hmm.

April Williams: Yeah. Oh my gosh. Yeah. Yeah.

Send us a dm. All of this information will be in the [00:45:00] show notes because we know that there. This topic almost has limitless possibilities when it comes to understanding it more and on a deeper level. So you are about to unleash a wealth of knowledge, not only to the bariatric community, but just to the universe.

It's great to see you both. Awesome. Bye friends. Hi guys.

Natalie Tierney: Join us at Barination.mn.co

jason smith: And just remember at the end of the day, you've got this. We've got you. And we'll see you next time. Bye [00:46:15] everybody.