0:02

Hi everyone, welcome back to another episode

0:04

of the ADHD Women's Wellbeing Wisdom. It's

0:07

your Sunday episode. And today

0:09

I'm sharing with you a snippet of

0:11

conversation with Tony Russo. Now Tony

0:13

is a specialist nurse with 20

0:15

years of practice in obesity management.

0:17

So Tony was diagnosed a couple

0:20

of years ago and now she's

0:22

really passionate about creating more awareness

0:24

around ADHD and obesity, binge eating,

0:26

overeating and understanding where that comes

0:28

from a neurological perspective. So

0:30

you'll hear in today's snippet us

0:33

talk about this unknown fact. And

0:35

now thankfully people are understanding more

0:37

and more that there is a

0:39

link between compulsive and addictive tendencies

0:41

and obesity and eating. And

0:44

if there was the opportunity for

0:46

more screening involved, there would be

0:48

more understanding about where this compulsion

0:51

for eating comes from and understanding how we

0:53

can be kinder

0:56

and more helpful with regards to compulsive

0:59

eating. So I think many

1:01

of you will find this helpful. Now,

1:04

obviously we know now that as empic

1:06

and there's lots of medical information

1:08

coming out, some goods and bad, but

1:11

we are understanding more that

1:14

compulsive eating addictive behaviors are something

1:16

that we can't just override and

1:19

that there's a neurological reason for it.

1:21

And I think this conversation really helps

1:23

break that down and offer

1:26

compassion and kindness to people

1:28

who are really suffering. So I hope this

1:30

conversation is helpful for you, but also share

1:32

it, send it to people who you think

1:34

that might need to listen to it. And

1:37

here it is, here's my conversation with Tony Russo. So

1:41

you obviously, you know, academically, you

1:43

found it challenging, but you've obviously

1:45

gone on and you've had a

1:47

very successful career doing what you

1:49

do in a field that

1:52

sounds complex for lots of different

1:54

levels. And, you know,

1:56

obviously this conversation today, I want to

1:58

talk about this correlation between ADHD and

2:00

obesity. What are you noticing

2:03

now that you have this ADHD lens

2:05

that I guess you didn't have throughout

2:08

most of your career? And what do

2:10

you sort of see now that you have

2:12

this this extra layer of understanding with regards

2:14

to obesity and ADHD? I

2:16

see a lot of the self-incrimination. So

2:19

particularly when somebody typically comes

2:21

along for weight loss

2:23

surgery, if it was harmful, and regardless

2:26

of what the government rules

2:28

are about qualifying for weight loss surgery, in most

2:31

areas you can't really get through the door unless

2:33

you've got a body mass index of 50 or

2:35

above. So you've got to be pretty heavy to

2:37

qualify for weight loss surgery. And at that stage,

2:39

the majority of those patients are women and they

2:41

all feel very guilty. How have I allowed myself

2:44

to get to this stage? It's

2:46

disgraceful. And then if anything

2:48

happens to me, what's going to happen to my

2:50

children? And if they

2:52

can't work on a burden on the state, I can't

2:54

work, the influence is having on my kids. And

2:57

what we used to do in weight

2:59

loss surgery was do like a psychological

3:01

appraisal. And it was usually for binge

3:03

eating disorder. And that didn't really show up that

3:05

many because a lot of people don't typically have

3:07

binge eating disorder. But what a

3:09

lot of people do have what I

3:11

now do, if I see anybody now,

3:14

I do the screening test for ADHD

3:16

at the first appointment, which takes 10 minutes

3:19

max. And some people you know

3:21

straight away, they're not but some people you can see

3:23

the threads. And I usually raise a

3:25

subject with them and say how do you thought of

3:27

this and sometimes, particularly because of the recent TV programme,

3:29

they go to everybody's on the bandwagon now, you know,

3:31

everybody's got a bit of ADHD, at which

3:34

they haven't. But some people said this might

3:36

be an issue it might be worth considering. So

3:38

if somebody's serious, then I

3:41

will go through and I'll even download the

3:43

right to choose letters for them, fill them

3:45

in for them. But I think the difficulty

3:47

you get with ADHD is the compulsion. And

3:51

you know, sometimes you know, you shouldn't do something

3:53

that you just can't have, you know, when

3:55

you're desperate to go out and you've got a

3:57

time, but you're still playing Candy Crush. just

4:00

one more game, just one more game, and you know

4:02

you're going to be late. And I

4:04

think, for me, I was very, I got into

4:06

obesity because I was very living

4:08

with obesity, so I got to nearly

4:11

22 stone. So I

4:13

had weight loss surgery, gosh, 20 something years

4:15

ago, and I lost the bulk

4:17

of my weight, and then I had revision surgery.

4:20

But I always stayed at about

4:22

a stone more than I am now, and

4:25

I didn't want to get obsessed with weighing, so

4:28

I'd wait until my clothes got a little bit tight. But it was

4:30

always still a struggle, and I knew I was never going to be

4:32

able to get this out of my head. And I

4:34

kind of quite compulsive. There are certain foods I just

4:36

wouldn't have in the house because I can't moderate. I

4:39

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

4:41

packet. And then when I started

4:43

my ADHD medication, my appetite went,

4:45

and before I knew it, I dropped a

4:47

stone. And I suddenly thought, what's going

4:49

on here? And at that

4:51

point, I thought, you know what? Why are

4:53

we doing these operations on people when

4:56

there are other alternatives? And I'm not saying for

4:58

one second that weight loss surgery is wrong or

5:00

there isn't a place for it, but

5:02

I do actually wonder if a lot

5:04

of people now have undiagnosed

5:06

ADHD, and particularly the warning bells will

5:08

be those that have maybe had a

5:10

history of drug misuse or alcohol

5:13

misuse in the past, because you

5:15

often get this transference, don't you, where if you

5:17

give up alcohol, you turn to smoking, you go

5:19

out smoking, you turn to something else. We very

5:21

seldom just give up a habit.

5:23

We tend to want to replace it.

5:26

Yeah. Everything else. And so

5:28

that for me was a link. So I tried

5:30

to do some research and there were a few

5:32

inferences, but not too much. And

5:34

I presented at a conference and I thought nobody was

5:37

gonna be interested. And it was really shocked that people

5:39

were going, you know what, there might be something in

5:41

this. And so I kind

5:43

of really got this bug. It's a great ADHD

5:45

habit, isn't it? Because now I've got this recession

5:47

with investigating this. And I kind

5:49

of almost want to go out like a, what's

5:52

the word, a missionary, is it a missionary? I want

5:54

to go out and say to people, this

5:56

is great. The service you're offering is fantastic,

5:58

but, you know, to wait two years

6:00

for surgery anyway, so we're not wasting any time. Why

6:03

don't we sort of sort these people

6:05

out first? The ones that

6:07

have ADHD we can treat and

6:10

it'll either work with a medication, if it

6:12

doesn't it may make them more able to

6:15

follow the instructions. Yeah. Nobody puts

6:17

them south through an operation meaning

6:19

to cheat. Nobody willfully

6:21

cheats, nobody wants to regain

6:23

that weight again. But we know

6:25

that 60% of people at

6:28

five years have regained a significant amount of the

6:30

weight that they lost regardless of which operation they

6:32

had, who did it and in what country. So

6:35

our body are fighting constantly against us

6:37

to make us regain that weight again,

6:39

which is not just to be ADHD.

6:41

But if we can remove the compulsion

6:44

to eat, that's an enormous

6:46

release to people. And now I don't really think about

6:48

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

6:50

eat when I don't want it. You

6:52

know, like when you're literally sort of

6:55

just like listening to thinking it's like

6:57

a no-brainer, isn't it really? Because like

6:59

you're explaining the ADHD brain, this sort

7:01

of dopamine stimulating seeking part of our

7:04

brain, that you write this a

7:06

compulsion. And when people sort of say, I've

7:08

got haven't got any willpower, I'm so weak,

7:10

and I've got an addictive personality and all

7:12

these different things. And it's so much shame

7:14

there. But actually, when they understand that it's

7:17

a part of their brain that is predisposed

7:19

to this, and like you say, the addiction

7:22

or the addictive part is going to just

7:24

transfer to something else. So

7:26

unless we actually sort it at

7:28

its root, and like you say,

7:30

with ADHD medication, very often that

7:32

sort of self-medicating part, that self-soothing,

7:35

the seeking, the stimulation

7:37

seeking is dissipated using

7:39

the medication, which feels a much more

7:42

cost effective, and much

7:44

healthier way of treating patients. And, you

7:46

know, here in the UK, the

7:49

obesity is probably one of the biggest health

7:51

crises that we've got going on, you know,

7:54

diabetes, I don't even know how much it's

7:56

costing the NHS, but I know it's billions.

7:59

So it It almost feels like why

8:01

is this only just being

8:03

spoken about? Why are professionals that have

8:05

been working in this industry for so

8:07

long not targeting the brain

8:09

with medication as opposed to just

8:12

thinking, right, let's go in for

8:14

this weight loss surgery? So

8:16

when you did this presentation,

8:18

which sounds fascinating, how

8:21

did people react who had never really considered

8:23

this, who maybe don't understand neurodivergence,

8:25

don't understand ADHD and maybe don't

8:27

even understand the interplay between that

8:29

and binge eating, obesity, you know,

8:32

food compulsion? Well I think, I

8:34

think what happened, well first of all I said at

8:36

the beginning, not because

8:38

I didn't want people to be mean to me, because I

8:40

don't mind if people argue with me, but I said I

8:43

did this because I've been diagnosed. I

8:45

wanted them to see someone that they perceived

8:47

as normal and not naughty, that

8:49

they might listen. But

8:52

when I started to say how can we relate

8:55

this to our own personal practice, and I wasn't

8:57

saying don't operate because that's not the right thing

8:59

to say to surgeons, I think they realised that

9:01

this could actually, our outcomes could be better. We

9:05

could be more successful and get better

9:07

outcomes. I mean after me for example,

9:09

I had a road traffic accident six,

9:11

seven years ago, I fractured my femur, I came

9:14

for motorbike, and a year

9:16

later I was still taking OxyContin, you know, which

9:18

is one of the most addictive drugs on earth,

9:21

and I suddenly realised I couldn't stop taking

9:23

it, and I was not, it's the tiniest

9:25

dose. It wasn't giving me a

9:27

high, part of it was probably fear, and I

9:29

actually had to pay a psychiatrist

9:33

to supervise me coming off. But

9:36

clearly there is the, what we used to

9:38

call, I've got an addictive personality, may actually

9:40

now be us being more a student going

9:42

actually maybe they've got ADHD. Correct.

9:46

And maybe that's what we need to look at, and

9:48

I see so many people with ADHD with

9:50

struggling with alcohol. Yeah.

9:53

We had an amazing woman on a

9:55

few months ago talking about alcohol dependence

9:58

and addiction, and ADHD. And

10:00

again, she was in her late 40s. She'd

10:03

been struggling in and out of rehab.

10:05

And it was only, you know, much further

10:07

down the line did she know, and she's

10:10

now been able to take

10:12

medication and she's not been

10:14

drinking. But, you know,

10:16

for her to have been in and out

10:18

of different rehab facilities and no one mentioned

10:20

ADHD, it's kind of

10:23

like, why is the mental health industry,

10:25

why are the professionals not seeing this

10:27

as almost like a first line? You

10:29

say the screening takes 10 minutes. And,

10:32

you know, again, we'll talk about Sarah Templeton is

10:34

that she is spearheading campaign

10:36

of anyone that goes through the

10:38

criminal justice system gets that screening

10:40

10 minutes. Again, it's not a formal diagnosis,

10:43

but it's understanding and it's a recognition of,

10:45

okay, this is the playing field that we're

10:47

working with. And, you know,

10:49

how can we help them? Can we get them

10:51

fast track them through to get them help and

10:54

medication? And it should be the same in your

10:56

profession. It should be the same with anything to

10:58

do with drugs and alcohol.

11:00

And I hope that things are changing. I really

11:02

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

11:05

now and awareness. I guess when

11:07

you sort of do that initial screening with

11:09

your patients and they get almost that penny

11:11

dropping moment, how do they react? And

11:13

have you had moments where they're just like, I can't

11:15

believe that this is what it's been. I had one

11:17

woman who just burst into tears and cried for five

11:19

minutes. And then I thought, oh my God, what have

11:22

I done? I've opened a real Pandora's box here. And

11:24

she was just for somebody

11:27

to tell me that I'm not just

11:29

a stupid person that can't control their

11:31

willpower. What you

11:33

do have to do is manage people's expectations. Because first

11:35

of all, they've got to get past the GP. And

11:38

GPs aren't mean. GPs aren't there to stop

11:41

you being well. But the thing is

11:43

people do get an idea in their head sometimes about

11:45

an illness, which they may not have. And

11:47

I think you have to manage people's expectations because

11:50

a lot of people think, well, I'll get an

11:52

ADHD diagnosis, I'll get drugs, and the whole world's

11:54

gonna be different. I'm gonna be clever and everybody's

11:56

gonna like me. And you

11:58

know, medication works differently. for different people

12:01

and it's a long drawn-out period of

12:03

time and sometimes medication

12:05

may not suit you at all and some

12:07

people don't want to take meds and that's

12:09

absolutely fine but I do think that it

12:11

can be quite powerful just to know then

12:14

you can work with it and of course

12:16

there are other advantages if you've got an

12:18

ADHD diagnosis you can claim access to work

12:20

from the government which is a benefit that

12:22

can really make your life easier and it's

12:24

not like oh it's another benefit you're paying

12:26

out to people it's serious practical stuff like

12:28

coaching, noise cancelling

12:30

headsets, stuff to make enable you

12:32

to work as well it's

12:34

like if somebody's got a leg missing it's

12:36

like giving them a prosthesis you're not giving

12:39

them money but you're helping them to have

12:41

the same advantages

12:43

as somebody that has two legs you know

12:45

it's more like you're getting a level playing

12:47

field so there are various advantages to knowing.

12:50

I agree with you

12:52

and I think you know again if they don't know

12:54

it's there and you're then offering them this sort of

12:57

this new way of looking at the world

12:59

and helping themselves and asking for the accommodations

13:02

I always think it's worth it yes the reaction

13:04

may be emotional or there may be sort of

13:07

disbelief or cynicism there I mean I can

13:09

understand you know like you said that this

13:11

oh everyone's jumping on this bandwagon and even

13:14

this morning I you know I turned on

13:16

my phone and there was a thing from

13:18

the Daily Mail another one

13:20

of those horrendous articles of ADHD diagnoses

13:23

have hit the roof and is this

13:25

due to celebrities speaking out it was

13:27

just horrendous it was just another sort

13:30

of gas lighting article of

13:32

making people believe that they're just jumping

13:34

on a celebrity bandwagon when actually

13:37

what's happening is that it's a much

13:39

more common you know

13:41

condition than people believe and it shows

13:43

up quite differently in different people but

13:45

it's not a bandwagon because you know

13:47

if you think about the amount of

13:49

people that suffer with obesity they suffer

13:51

with disordered eating

13:54

addiction issues emotional

13:56

dysregulation anxiety depression if

13:58

you think about that. It's quite, you know,

14:01

we within my group of friends, it's probably

14:03

one in five, one in seven. And I

14:05

do and they're pretty much the stats that

14:07

we're thinking, you know, we're talking about. Exactly.

14:14

Exactly. Yeah, that's the thing is when one

14:17

of us gets diagnosed in a friendship group,

14:19

very often, it's sort of like a bit

14:21

of a dominoes effect as well, isn't it?

14:23

Because we're more likely to be friendly with

14:25

other neurodivergent people as well, or be married

14:27

to them or whatever. I saw

14:29

a lady the other day who in the

14:31

past had been very, very overweight. And then

14:33

in her 20s, she'd moved to London, she'd

14:36

got a cocaine habit, lost the load of

14:38

weight, come off the cocaine and turn

14:41

to alcohol and still remain quite small. And

14:43

she'd come off the alcohol and has been

14:45

sober for a year, which

14:47

is magnificent. She did the testing and

14:50

she looks quite high for ADHD, went

14:52

to her GP with the results. And

14:54

his words to her, you've got an

14:56

addictive personality. Do you think

14:58

it's on your family, talk about guilt tripping,

15:00

that you're going to maybe get diagnosed for

15:02

a condition that's going to give you speed?

15:04

Oh my God. Oh my

15:07

God. I just

15:11

can't because that

15:13

just makes my bird boil. Because

15:15

they are the gatekeepers. And like you say,

15:17

no, listen, GPs are doing the best they

15:19

can. And I know a lot of GPs

15:21

listen to this. And it's incredible because they

15:23

are listening because they are struggling with resources

15:25

themselves, or they're listening because they

15:27

want to help their patients. Or there's quite a

15:30

lot of GPs out there with ADHD themselves. And

15:32

they're struggling with the paperwork, the admin, they're struggling

15:34

with the day to day, sort of just sitting

15:36

in an office. And they are

15:38

kind of, you know, they're all they're burning out. They,

15:40

you know, really are this is what I'm hearing. But

15:43

with regards to the GPs that are

15:45

not willing to open their eyes, and

15:48

they're not willing to sort of start

15:50

thinking outside of the box a little

15:52

bit. That really upsets me because what

15:54

happens is people come to me and

15:56

build up this confidence

15:58

but also courage. to go

16:01

into their GP. They may

16:03

have been sitting on information and little articles and

16:05

podcasts and all this, and they finally drop me

16:07

a message and say, I think I've got ADHD,

16:09

what do I do now? And

16:11

I say, go and make an appointment, speak

16:14

to your GP, but advocate for yourself. Make

16:16

sure you have done an online assessment

16:19

form. Make sure you have maybe listed

16:21

some things, kept a little bit of

16:23

a journal, because unfortunately, if

16:26

we don't go armed with a little

16:28

bit of evidence or something to back

16:30

up our claim, it can often

16:32

just be dismissed. And I wish- I've got GP, a

16:35

house of GP determined, because at the end of the

16:37

day, I remember if it's ADHD, it will have started

16:39

in childhood. Exactly. If you've just been like this for

16:41

the last year or two, that could be something else.

16:43

And of course, a lot of people get misdiagnosed with

16:46

bipolar, but it could go the other way as well,

16:48

couldn't it? Because if you've got bipolar

16:50

and you've got the ADHD symptoms, they might apply

16:52

to you. So, you know, the GPs

16:54

do know this. And I think that, you know,

16:57

you do have to manage people's expectations, because if

16:59

you take right

17:01

to choose out of the equation, in my area, if

17:03

I went to my GP tomorrow, I mean, I have

17:05

a great GP, but if I went to

17:07

my GP surgery and they referred me on the NHS, I'd

17:09

be looking at a three year wait. And

17:12

they do have to manage that for people and say,

17:14

do you realize it, you know, it's gonna be a

17:16

tricky road? They just need to

17:18

understand that. So,

17:20

someone who's listening now, and they are

17:22

really relating to maybe your sort of

17:24

type of patient where, you know, obesity

17:27

for them has been a lifelong struggle

17:29

and they've maybe seen it in their

17:31

family. Maybe weight loss surgery has

17:33

been a consideration for them. What,

17:35

where would you direct people? Like, what

17:37

would be your channel for

17:39

them to go through? Now they have

17:42

also got that ADHD awareness. Would you

17:44

say, get that diagnosis? I'll

17:46

get on the list for ADHD, because you

17:48

don't know, even with, you know, right

17:50

to choose, they say six months, it's getting longer because

17:52

these people can't cope with the service. You're

17:55

not wasting any time. Use the time you're

17:57

waiting. So you wait for ADHD and you

17:59

also wait. for obesity treatments. There

18:01

is a middle ground at the moment that if

18:03

people are living

18:06

with a BMI of greater than 30, they

18:08

may well qualify for medical treatment

18:10

with some GLP1 drugs, which are the

18:13

drugs like Azmpic. Now, they are fantastic

18:15

drugs that have been used extensively for

18:17

obesity, sorry, for diabetes. And

18:20

we now know they work well for

18:22

obesity at higher doses. And one of

18:24

them, which is the Azmpic is the

18:26

lower dose, and there's a

18:28

higher dose called Wigaby, which is

18:30

going to be given to people living

18:33

with obesity. However, again, managing expectations, they

18:36

can't produce enough, there is a worldwide shortage.

18:38

So regardless of what people see in

18:40

ads, it's probably going to be

18:43

at least six months before these drugs

18:45

become widely available in the UK. But

18:47

for a lot of people, they are

18:50

transforming. And that may well

18:52

be the answer for some people. So I would say, get

18:54

referred to everything and

18:56

see what comes first, because none of them are

18:59

music exclusive. Nobody says to you with ADHD, you're

19:01

on the pathway for weight loss surgery, so we're

19:03

not going to treat you. And you may well

19:05

find as you're going along that you think, actually,

19:07

this is more of an ADHD thing, and that's

19:09

fine. But I would say, take

19:11

all the help you can get. So

19:17

I hope you enjoyed listening to this

19:19

shorter episode of the ADHD

19:21

Women's Wellbeing podcast. I've called it the

19:24

ADHD Women's Wellbeing Wisdom because I believe

19:26

there's so much wisdom in

19:28

the guests that I have on and their

19:30

insights. So sometimes we just need that little

19:32

bit of a reminder. And I hope that

19:35

has helped you today. I look forward to

19:37

seeing you back on the brand new episode

19:39

on Thursday. Have a good rest of your

19:41

week.