Dr. Pretlow and Colleagues

Treatment

Dr. Pretlow’s latest paper, “Treatment of Child/Adolescent Obesity Using the Addiction Model: A Smartphone App Pilot Study,” will soon appear in the highly-respected print publication Childhood Obesity and can also be found online. Today, let’s gain a better acquaintance with the team behind this estimable work, and give credit to their accomplishments.

Carol M. Stock received her Masters of Nursing degree from the University of Washington and her Juris Doctorate degree from Seattle University, which makes her both a Registered Nurse and an attorney. Among many other interesting professional experiences, Ms. Stock has specialized in Native American/Tribal Health Care and spoken at many health care conferences. She has taught at Northwest University and Seattle Pacific University, and is a principal of the consulting firm Carol M. Stock & Associates.

Dr. Stephen Allison (in some countries, the letters MBBS are used instead of MD) is a Fellow of the Royal Australian and New Zealand College of Psychiatrists, and is currently Associate Professor of Child and Youth Psychiatry in the School of Medicine at Flinders University in Adelaide, South Australia. 47 of his publications can be found online.

Leigh Roeger, PhD, is a Senior Research Fellow in the Psychiatry Department, also at Flinders University. His expertise is in the mental health of children and adolescents, and among his interests are social network analysis and system dynamics modeling. 21 of his papers are available online, and his bio says:

Current projects include developing mHealth apps based on the Behavioural Activation approach for treating depression to improve outcomes in young people experiencing high levels of distress associated with chronic health conditions.

Dr. Robert A. Pretlow, a Princeton University honor graduate, went on to the University of Virginia Medical School for his MD degree. He is a Fellow of the American Academy of Pediatrics, and holds a Master of Science in Electrical Engineering. He founded eHealth International, Inc., and Weigh2Rock.com, a lively and innovative website for kids and teens.

More from Dr. Pretlow

All Childhood Obesity News posts are approved by Dr. Pretlow before publication, and here is a handy list of the posts he has personally written, plus a few extras.

Using the Psychological Food Dependence-Addiction Lens

Medical Science and Food Addiction

Medical Science and Food Addiction – Part 2

Childhood Obesity Conflicts of Interest

Ending Childhood Obesity Through Healthy Eating & Exercise?

Food Addiction and Childhood Obesity: Now What Do We Do?

The Weigh to Rock: A Nutritionist’s Guide Through Child Obesity

Obese Youth and Motivation

Food Supplements and Childhood Obesity (guest post at Fooducate.com)

Interview with Dr. Pretlow

Addiction to Highly Pleasurable Food as a Cause of the Childhood ObesityEpidemic: A Qualitative Internet Study

and of course the book –

Overweight: What Kids Say –What’s Really Causing the Childhood Obesity Epidemic

Your responses and feedback are welcome!

Source: “Biography,” carolstock.com
Source: “Stephen Allison,” researchgate.net
Source: “Dr. Leigh Roeger,” flinders.edu.au
Image by Liebertpub.com

RDoC and the Future of Food Addiction and Eating Disorders

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It becomes more and more evident that all addictions are one. Apparently, whichever addictogenic behavior or substance gets to a person first will lay claim to an addiction-prone person, and if that addiction is ostensibly cured, another one will step up to take its place. (The illustration above is of the mythical Hydra. Cut off one head, and two more grow out.) The important message here is that any treatment must metaphorically rip out addiction by the roots, rather than clipping off the branches. If the underlying causes are not addressed, the whole effort is doomed to futility.

The Research Domain Criteria, the new framework in which research on mental disorders can be conducted, is the wave of the future. Hans W. Hoek says the RDoC project “aims to bridge neuroscience and genetics to inform diagnostic classification and clinical management” and describes how some researchers use its constructs “across biological units of analysis to describe the advances in the neurobiology of eating disorders.” He also says:

Interest in the addiction model of binge eating is increasing, leading to new approaches to treatment methods involving the use of opiate, dopamine and cannabinoid receptor blockers for Binge Eating Disorder.

Although Binge Eating Disorder (BED) is mostly associated with bulimia nervosa, the condition gets around, and gangs up with other symptoms in other eating disorders in what is called diagnostic crossover. But that’s not all–it also shows up as part of the pattern in various psychiatric conditions such as borderline personality disorder. Pamela Keel writes:

The Research Domain Criteria (RDoC) initiative encourages examination of basic dimensions of functioning across multiple units of analysis with the explicit goal of creating new systems for classifying mental disorders that will translate neurobiological and behavioral research into improved comprehension and treatment of psychiatric illnesses.

BED is one of the conditions that the Diagnostic and Statistical Manual is uncomfortable with, because of the way it is set up. Children are especially difficult to squeeze into DSM-5’s system, which does not cope well with their primary problem: having no “off” switch. They have “loss of control” (LOC) eating or disinhibited eating behaviors, labels which are not particularly helpful when science is clueless about finding that “off” switch. A number of researchers contributed to a symposium exploring how productive it might be to explore BED in the context of the RDoC framework. A study completed by several authors from diverse institutions had this to say:

RDoC, a proposal for classifying psychiatric disturbance based on dimensions of observable behavior and neurobiological measures, may be particularly useful for describing psychopathology in children with disordered eating.

Four authors from the University of Kentucky, who definitely consider BED an addictive behavior, reported on the “acquired preparedness model of risk for addictive behaviors.” But not all the critical opinion is favorable. Sanjay Srivastava discusses one of the early funding opportunity announcements based on RDoC, quoting the “overview:”

Clinical presentations of eating disorders are highly heterogeneous, involving broad and often overlapping symptomatology… dysregulated functions and associated neural circuits should be a critical focus of study, and, ultimately, the target of assessment and treatment for eating disorders.

This writer’s objection is that the RDoC paradigm makes no mention of family, social environment, media, culture, or numerous other factors commonly associated with eating disorders, and he calls these omissions “not a good sign of where things are headed.”

Your responses and feedback are welcome!


Source: “Classification, Epidemiology and Treatment of DSM-5 Feeding and Eating Disorders,” medscape.com, 2013
Source: “Application of the Research Domain Criteria (RDoC) Framework to Binge Eating: Insights into Component Processes that Cut Across Current Eating Disorder Diagnoses,” psychopathology.org, 10/05/12
Source: “Where is RDoC headed? A look at the eating disorders FOA,” hardsci.wordpress.com, 05/24/13
Image by Biodiversity Heritage Library

Eating Disorders and Cross-Addiction

don't eat

Some addicts specialize in substances, some in behaviors, and some engage in both. Addiction can involve a substance like cocaine or a behavior like gambling. An eating disorder can result from a certain type of food acting as an addictor for a particular person, or it can be behavioral, like binge eating and purging. Ex-smokers and recovering alcoholics are notorious for gaining weight. People weaned from unhealthy food dependency might turn around and become hooked on the technology that tracks their daily calorie-burning activity. Dr. Vera Tarman says of her patients:

Another pattern that I discovered were the people who had once suffered from anorexic disorders coming into treatment for cocaine or crack addiction.

Statistically, the overlap between all kinds of addictions is huge. StepsToRecovery.com offers an interesting perspective on the similarities between people with substance abuse disorders and eating disorders, and the traits they share:

Examples include feeling anxious in social situations and being more prone to depression…

It has also been suggested that both groups suffer from an addictive personality, which makes it logical that an addiction to habits related to eating could lead to alcohol or drug addiction, or vice versa.

Cross-addiction could logically be called omni-addiction or any-addiction. To take a very pertinent current example, advocates of marijuana decriminalization scoff at the charge of addictiveness, while detractors swear they can point to numerous marijuana addicts. But the contradiction is only an apparent one. It is summarized succinctly by Joe Rogan, who maintains that if someone is addicted to marijuana, it’s only because “marijuana got there first.” As Dr. Tarman emphasizes, it is all “the same disease of compulsion and obsession, with different manifestations.”

The StepstoRecovery website notes that among girls between the ages of 11 and 17, the number one desire is to be thin. Eating disorders happen, and when they happen in conjunction with alcohol addiction or drug addiction, things can get serious really fast.

There is indeed evidence of an increased prevalence of substance misuse among eating disorder sufferers, particularly those with binge eating disorder and bulimia. For example, once diagnosed with binge eating disorder the lifetime risk of alcohol or drug abuse is 25%, while as many as 40% of people with bulimia also suffer from substance abuse.

This page mentions one of the many iterations of Mattel’s popular female role model, Slumber Party Barbie, released in the 1960s. This doll…

…came complete with scales displaying the permanent value of 110 lbs. and a book entitled “How to lose weight,” which only contained the phrase “Don’t eat.”

Other Implications of Cross-Addiction

The notion of cross-addiction is also related to the problem of diagnostic crossover, which is particularly noticeable in patients with eating disorders, who tend to shift between diagnoses, at least as the various diagnoses are defined by the Diagnostic and Statistical Manual of Mental Disorders. An article about cognitive behavioral therapy (CBT) notes that it takes a trans-diagnostic approach “with the goal of treating eating disorder psychopathology across diagnoses, rather than a specific diagnosis.”

The treatment addresses the shared, underlying core beliefs (i.e., over-evaluating and controlling one’s weight and shape) in order to break the maladaptive cognitive and behavior patterns that have maintained the eating disorder.

This intriguing thought comes from Dr. Tarman:

Anorexics resist food the same way as the drug addict resists withdrawal from their drug.

It is strangely echoed by a bulimic patient on a website where people write in anonymously to share their struggles:

Even just eating a leaf of lettuce will be followed by an almost animalistic panic to get the “poison” out of me. I feel this panic in every cell of my body like some deep-rooted survival instinct.

Dr. Tarman adds:

While an eating disorder may be a dual diagnosis alongside an addiction for some, it is just as likely a possibility that it IS part of the addictive disorder itself… If the person is a food addict, rather than suffering from a true eating disorder, then the typical treatment used for eating disorders is not only not helpful (hence the high rate of recidivism and relapse in eating disorders), but actually dangerous.

Your responses and feedback are welcome!

Source: “Finally Sober, Suddenly Fat: Food Addiction is Another Drug Addiction,” RecoveryWireMagazine.com, 05/02/13
Source: “Starving Yourself to Achieve the Impossible Figure of Barbie,” StepsToRecovery.com, undated
Source: “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents,” NIH.gov, 04/01/12
Source: “Arianna-C-Podcast,” mentalpod.com, 01/30/15
Image by The Fat Diaries

 

“Bite Size” Hits the Ground Running

Bite Size

Last week, Childhood Obesity News explored the four individual stories of obese kids from the film Bite Size: Emily, Moy, Davion, and KeAnna.
Guess what just happened over at iTunes? Bite Size has arrived there.

We have said this before, but it is worth restating—this collection of mini-biographies is particularly well-suited to communal viewing and to post-viewing discussion. When a family watches together, they will have some stuff to talk about. For parents, there is no need to be formal or structured. Children will not need encouragement to share their reactions.

In schools, health classes could devote entire semesters to mining the depths of Bite Size. Each story is a rich resource that offers numerous jumping-off points for sharing ideas about aspects of the prevention and treatment of childhood obesity. Ask kids who their favorite child or grownup is, and go from there. For that matter, it could be a date movie. Hashing over the issues it brings up could influence your decision about whether you really want to spend the rest of your life with this person.

Remarks from Bite Size Director Corbin Billings

We asked some questions that were graciously answered by Bite Size director Corbin Billings.

Q: How were the 4 kids found/chosen/recruited/cast?

A. When it came to recruiting the kids to film in Bite Size, the most important thing to me was that the four stories were relatable. We wanted to capture a diverse sample of all the communities commonly afflicted by the obesity epidemic. This meant profiling boys and girls from the Latino, African-American, and White communities. But more important than capturing differences in race and socioeconomic status was identifying replicable solutions people could emulate in any environment. To this end, we searched for children already enrolled in four sectors of obesity prevention: weight loss boarding schools, in-school health and wellness support groups, school team sports, and free community nutrition and exercise classes (like those offered by local YMCAs). The first step was identifying organizations whose missions aligned with our own and were open to allowing us to film. Second, we visited the groups to meet the kids and parents in attendance. I like to say the rest was the result of dumb luck and perseverance.

Q. The received wisdom is that childhood obesity is more prevalent in one-parent homes, which are in fact overwhelmingly single mother homes. Three of the Bite Size kids are in two-parent homes, one has a mother who died, but her father is present. In other words, the proportion of dads here doesn’t match statistical reality. Not that we are implying it should. The question is, how intentional was it that we ended up with four fathers here?

A. True. Statistically, childhood obesity occurs more often in single-parent homes, specifically those run by single moms. This was especially apparent in the Mississippi Delta, the part of the country that struggles most with both adult and childhood obesity, type two diabetes, and teen pregnancy. One of the stories we followed in the region focused on 23 African-American girls, aged 12 to 14, who were united by their school guidance counselor in a health and wellness support group known as “Si Se Puede.” Out of this rather large sample, only one girl, KeAnna, had a relationship with her biological father. Her mother had passed away from breast cancer when she was two years old. Although it was KeAnna’s magnetic and charismatic personality that ultimately convinced us to focus on her specifically, I couldn’t ignore how rare it was to find a girl whose biological father was an active pillar of support. Although it was obvious that KeAnna’s dad loved his daughter with all of his heart, he was far from a perfect role model. For example, he repeatedly refused to change his eating habits and would laugh whenever KeAnna asked him to diet with her. In short, while the stories we focused on in the film did not perfectly mirror the statistics in this way, the reality was evident behind the scenes.

Q. What is your personal take on the question of whether food addiction is comparable to, say, cocaine addiction? Is food addiction a disease comparable to alcoholism?

A. Yes, I believe sugar and highly processed junk foods can be addictive, just like drugs. When we eat, a brain hormone called dopamine is released. We interpret the flood of dopamine as pleasure and the programming in our brain changes to make us want to perform the behavior over and over. Similarly, drugs like cocaine also flood the brain with dopamine. We seek to replicate the euphoria, leading to addiction. Highly processed, sugar-packed foods hijack the same brain pathways as drugs, causing some people to lose control over their cravings and consumption. This point is made evident by one of the students in the film named Emily. She finds it nearly impossible to satiate her craving for sugar, comparing herself repeatedly to a drug addict. In fact, the only way she was able to fight her food addiction (short of asking her parents to put locks on the cabinets) was to enroll in a health and weight loss boarding school she identified as food rehab.

That third reply is especially interesting right now because of the publication in the journal Childhood Obesity of Dr Pretlow’s “Treatment of Child/Adolescent Obesity Using the Addiction Model: A Smartphone App Pilot Study.” All these things contribute toward legitimizing and mainstreaming the concept of looking at the obesity epidemic through the psychological food dependence-addiction lens, as advocated by Dr. Pretlow.

Many thanks to Corbin Billings and everyone involved with the creation of Bite Size!


Image by Bite Size

The Difference Between Shame and Guilt

people of walmart

Addiction guilt is one of the facets of Dr. Pretlow’s investigation of childhood obesity, and today we look at what several experts say about guilt, and the subtle differences between guilt and shame. These observations include an assertion that might seem shocking—that for an addict, guilt can be a healthy motivator toward recovery. Remember the anti-obesity billboards that caused so much controversy a couple of years ago in the state of Georgia? The University of Carolina’s Dr. Miriam Labbok said this about them:

While guilt and fear are motivators, they have to be meted out with the answer to the situation. The ads with the children do not offer help to them.

Tricia Greaves Nelson, writing about the hidden causes of overeating, says:

Emotional eaters are extremely sensitive. We feel deeply, so we’re very prone to feeling guilty, and therefore use food as a form of punishment because we feel bad about a lot of things and we just end up taking it out on ourselves.

Dr. Garret O’Connor of the Betty Ford Institute describes shame as malignant, depleting, and exhausting. It has no upside, but is pure destruction, a toxic emotion that urges a person to conceal the problem and shun treatment. What is the difference between guilt and shame? Researchers from the University at Buffalo’s Research Institute on Addictions and Virginia’s George Mason University aimed to find out. Guilt, they came to understand, can be a healthy kick-start.

Guilt is what makes an addict embrace a moment of clarity to see that their young children don’t deserve this kind of life or the brokenness that they have caused their family. This is when guilt can motivate to get someone into treatment for their substance abuse problem.

Brené Brown, who is really smart about shame and guilt, explained how they differ in her TED Talk. Shame is the feeling of never being good enough, and one of its favorite challenges is, “Who do you think you are?” Shame is focused on the self, an entity that feels immutable. But guilt focuses on behavior, and behavior can be changed. Brown capsulizes the difference:

Guilt: I’m sorry. I made a mistake.
Shame: I’m sorry. I am a mistake.

Last time, we mentioned how Dr. Pretlow’s most recent paper notes the difference in addiction guilt between boys and girls in his studies—the girls feel it more. This would come as no surprise to Brown, who says shame is “absolutely organized by gender.” She contends that for women, shame results from a web of conflicting and competing (and often, mutually exclusive) expectations about their identity. According to an old saying, a woman is supposed to be a lady in the drawing room, a magician in the kitchen, an angel in the nursery and a floozie in the bedroom. And nowadays, a competent employee at work. It’s a lot of hats to wear, and something is bound to go terribly wrong somewhere along the line.

But for men, shame only has one definition: being perceived as weak. Brown quotes research, done at Boston College, on the question of what a man needs to do in order to conform with male norms. In the United States, a man is supposed to hold the idea that work and status are the most important things, and he must always show emotional control—except when breaking out into natural male violence. A woman is supposed to be “nice, thin, modest and use all available resources for appearance.” No wonder they experience more guilt over food addiction! Brown sums it up:

Here’s what you need to know. Shame is highly, highly correlated with addiction, depression, violence, aggression, bullying, suicide, eating disorders. And here’s what you even need to know more. Guilt is inversely correlated with those things.

Brown suggests that the sharing of experience, as in support groups, is important because it grows empathy, which is the antidote to shame:

If you put shame in a Petri dish, it needs three things to grow exponentially: secrecy, silence and judgment. If you put the same amount of shame in a Petri dish and douse it with empathy, it can’t survive. The two most powerful words when we’re in struggle: me too.

******
Treatment of Child/Adolescent Obesity Using the Addiction Model: A Smartphone App Pilot Study will appear in the next print edition of the journal Childhood Obesity, and is already available online via Liebertpub.com.

Your responses and feedback are welcome!

Source: “’Stop Sugarcoating’ Child Obesity Ads Draw Controversy,” ABCNews.go.com, 12/02/12
Source: “The Hidden Causes of Overeating,” Hypesrus.com, 02/05/15
Source: “Guilt can be Healthy in Recovery but Shame is Toxic.” kleantreatmentcenters.com, 08/01/13
Source: “Listening to shame,” Ted.com, March 2012
Image by PeopleofWalmart.com

Addiction Guilt and Hope

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A new paper, Treatment of Child/Adolescent Obesity Using the Addiction Model: A Smartphone App Pilot Study,  will appear in the next print edition of the journal Childhood Obesity. This publication signals another advance in spreading the idea of using the addiction approach as a treatment for child/adolescent obesity. It’s mostly about the W8Loss2Go program, whose basic points Childhood Obesity News has covered in the past.

The paper’s authors were Robert A. Pretlow, MD, MSEE, FAAP; Carol M. Stock, JD, MSN; Stephen Allison, MBBS, FRANZCP; and Leigh Roeger, PhD.

Dr. Pretlow says his team hoped…

…through a process evaluation, to identify potential moderators of treatment effect as well as to better understand the most appealing and useful elements to children and adolescents of an addiction-based obesity intervention delivered through youth-popular smart phone technology.

Such a device can help very much with things like figuring out the necessary math. The excessive food amounts withdrawal stage, which takes three months, requires lessening the amounts eaten at mealtime by small increments.

Obesity and Self-Blame

Pilot studies of the smartphone app begin and end with a self-reporting questionnaire, which includes the question, “Does calling overweight/obesity an addiction affect your guilt or self-blame about your weight?” Participants answer that the A-word makes the guilt worse, better, or makes no difference. About half of the participants said “worse.” In a similar vein, participants also rated whether the addiction model approach used in the program had caused their guilt about being overweight to increase.

The subject of addition guilt is very germane to the program’s goal, and may even be an area it is dangerous to leave underexplored. Many years ago, Doreen Virtue suggested in her book Constant Craving that guilt about eating is the mind admitting to itself that the hunger is purely emotional, and not physiologically real. In the W8Loss2Go pilot studies, Dr. Pretlow has learned that participants who felt addiction guilt had poorer results in attempting to lose weight. Conversely, those who were not made to feel guiltier by the addiction model did better.

Gender Differences in Weight Loss

Dr. Pretlow’s team also learned that girls are more likely than boys to report that they experience addiction guilt. 66.7 percent of the girls admitted to it, against only 11.1 percent of the boys. The third pilot study turned up “the same findings on this question but not as dramatic…,” with 43 percent of females and 25 percent of males.

A vital thing to remember about addiction guilt is that it’s far more likely to be a problem that comes up during recovery, rather than during active addiction. The reason is not far to seek—any bad feeling can be smothered with the substance of abuse. New Life Recovery Program has this to say:

You may wonder why there is guilt and shame after overcoming your addiction..
Seek professional help to deal with the guilt and shame…
Make right your wrongs by seeking forgiveness of those closest to you. Remaining clean and sober is the greatest tool you have to repair the damage caused in active addiction.
Once you can truly forgive you, succeeding in recovery is so much easier.

Rev. Al Rosenblum adds:

When we lose control of our will to an outside force, it exposes our inner weakness causing guilt and shame. The guilt and shame from our addiction causes an increased need for comfort driving us back to the addiction. When we enter into an addiction, we create a self-perpetuating cycle… that feeds itself.
We hate what we are doing but believe we need it to comfort us from the overwhelming pain of hopelessness.

A friend of the W8Loss2Go project makes this suggestion:

If there is a way to make females see “addiction” as a reduction of guilt, then resistance to addiction-based therapeutic techniques might decrease. Is there some education around the term “addiction” that would help females in particular understand that
1) their overweight is not their fault and,
2) since it’s a addiction, it can be beaten — there is hope.

To which Dr. Pretlow replies,

“Hope” is a good idea, as many obese young people feel hopeless to do something about their overeating/obesity.

Your responses and feedback are welcome!

Source: “Treatment of Child/Adolescent Obesity Using the Addiction Model: A Smartphone App Pilot Study”, Liegertpub.com
Source: “How To Deal With Post Addiction Guilt And Shame,” newliferecoveryprogram.com, 10/13/11
Source: “Addictions, The Guilt & Shame Cycle,” go2grow.org, 2009
Image by Kevin McShane

 

Bite Size – KeAnna

Keanna

The introductory material about Bite Size can be found in the earlier Childhood Obesity News post about Emily, one of four young people whose stories are told by the film. We also “met” Moy, a gaming enthusiast and novice filmmaker. Today’s discussion focuses on KeAnna—though it takes an unexpected turn. KeAnna is 13 when we meet her. Like Davion, the subject of yesterday’s post, she lives in Mississippi. Unlike any of the others, KeAnna suffered the loss of her mother when she was two.

Her father is not willing to change how the house runs, just to support his daughter’s weight loss efforts. He says, “Even with bad influences, it’s still your decision.” (True enough, but only after a certain age. Babies get no choice about what they are fed.) KeAnna’s way of handling the less-than-supportive home environment is to entertain herself by making cheeky remarks to her relatives, while she righteously eats limited amounts.

She’s a funny young woman with personality to spare, which may or may not work in her favor. It seems to be true of both kids and grownups, that someone with a laid-back disposition and a capacious sense of humor is more easily tempted into the byways of “fat acceptance” and the dangerous rationalizations of fatlogic.

At School

Lisa Ross, a counselor who is overweight and diabetic, helps KeAnna and her friends start an after-school group called Si Se Puede, or “Yes we can.” The girls make a commitment to give up their biggest problem food – just like the kids from the pilot studies of Dr. Pretlow’s W8Loss2Go program. Ms. Ross talks about how the culture is so embedded in food. She tries to get the school district to buy some sports equipment, a futile effort in “the fattest part of the fattest state—also the poorest part.”

The girls listen to a guest speaker, an obese woman who started trying to kill herself at age 13. At a campfire ceremony, they write down the hurtful names they have been called, then burn the pieces of paper and promise not to call anyone ugly names. They pledge to respect others and to insist upon respect for themselves.

Nobody in the club loses any weight. (Hmmm… how would they have done with W8Loss2Go?) There is, however, one luminous silver lining—these kids love to dance, and they don’t mess around—it is strenuous exercise. A volunteer choreographer helps Si Se Puede put together a dance show, and all the parents and siblings turn out for the high-energy event.

The Return

When the film crew checks back a year later, KeAnna asserts that convenience stores and fast food joints are everywhere, making temptation inescapable. She has made no progress toward escaping obesity and may never be ready to take the necessary steps. But remember the plot twist we promised? Ms. Ross, the counselor, has lost 30 pounds through diet and exercise, and has the diabetes under control. She has gained full realization of the importance of teaching by example. Her back yard, lush with fresh produce, inspires her to say, “This is our own Garden of Eden, and I’m Eve.”

The director of Bite Size is Corbin Billings, and Joshua Lipton is director of photography. The rest of the well-deserved credits can be seen at the end of the film, via Vimeo on Demand, and on March 24 by way of iTunes, Google Play, and more. The work touches on many issues that Childhood Obesity News is concerned with, and is a particularly good launching pad for family discussions. Its seemingly straightforward documentary approach reveals hidden currents and nuances. It wraps up with a list of sensible everyday goals.

For more information: Bite Size
BiteSizeMovie on Facebook

Your responses and feedback are welcome!

Source: “Bite Size”
Image by Bite Size

 

Bite Size – Davion

Davion

Bite Size is a captivating film that follows the weight loss journeys of four American kids. Childhood Obesity News already took a close look at two of them, Emily in Florida and Moy in Southern California. The other two young people are both from Mississippi, which is appropriate, since that state has a pretty bad track record where obesity is concerned. The most recent numbers say that, “Mississippi has claimed the title of fattest state for the ninth consecutive year,” not a record that anyone wants to brag about holding. Forbes Magazine noted a calculation of the relative wealth of American states:

To determine the richest and poorest states in the U.S., personal finance site WalletHub evaluated the 50 states and the District of Columbia according to income, GDP per capita, and tax dollars per capita… Mississippi ranks 51st, overall, and across all three metrics.

The state most deeply sunk in poverty is the one with the worst obesity problem. Can it possibly be a coincidence? This is not the type of question Bite Size deals with, and it just might be that we can learn more from its intensely personal stories than from a boatload of statistics.

Davion, a very large youngster, is 12 when we first meet him in the film, and he has diabetes. It runs in the family, but he was diagnosed younger, by many years, than any of his relatives. Unlike many of his obese contemporaries, Davion has a goal.  He wants to play football. The most obvious complication is his almost total inability to do any physical activity. The other big obstacle is the presence of anger control issues. The world gives Davion a hard time, and he is eager to return the favor. A teacher characterizes him as having a big heart, but there is also a demonstrably bad attitude.

With determination and a lot of hard work, Davion makes the team. His school must be one of the state’s more fortunate educational venues. Not only does it have football equipment, but treadmills and other exercise machines, of which the aspiring athlete makes use. Coach Hatcher seems like a nice guy but, frustrated by what he perceives as Davion’s lack of motivation, he dishes out some tough love.

Keep on Truckin’

With renewed spirit, Davion says he’ll never quit on football. As time goes by, we see him running more, interacting with teammates, and generally getting squared away. But he still feels disrespected, and a short temper leads him into a fight with a kid who calls him fat. The oatmeal hits the fan and he loses all privileges, including football.

He has the self-awareness to reflect, “I don’t think before I act.” After appropriate counseling, the coach gives him one more chance. Davion’s mother comes to see him play the last game of the season, an act that has particular significance. When the film crew revisits a year later, Davion is at football camp and off insulin. He is still quite large, but much more agile and possessed of a positive attitude. “I’m not nearly done yet,” he says.

Reviewers Ann Hornaday and Michael O’Sullivan wrote of the film:

Billings leaves it to viewers to contemplate how low-cost food has made obesity and diabetes overwhelming issues for poor communities, and how even middle-class families can’t get systemic support for weaning their children off the sugar that permeates their lives, even when they try to eat sensibly.

Wellness coach Donna Morin has this to say:

While Bite Size presents a gloomy image of the state of health in this country, it leaves us with a brighter side, too. A message of empowerment. Changes begin to happen in some of the families around food and exercise, but perhaps the most empowering change of all is the boost in self-esteem these children get from their coaches and teachers.

Bite Size can be seen via Vimeo on Demand, and on March 24 will be available on iTunes, Google Play, and other VOD platforms. More information can be found on Facebook.

Your responses and feedback are welcome!

Source: “Bite Size”
Source: “Mississippi is the fattest state,” CalorieLab.com, 05/05/14
Source: “The Richest And Poorest States In 2014,” Forbes.com, 10/13/14
Source: “Watch online: ‘Accidental Love,’ ‘Bite Size’ and ‘Resistance’,” WashingtonPost.com, 03/06/15
Source: “ It Takes A Village: Review of Bite Size Movie.” BetterOffWell, undated
Image by Bite Size

 

Bite Size – Moy

Moy and his father

Moy (short for Moyses) is one of the four young subjects of Bite Size, a very engaging movie that lets the kids and the grownups all speak their own truths. (Childhood Obesity News  has already looked at Emily’s story, and will look at the other two in the coming days.) Director Corbin Billings has made the point that the film isn’t about shaming anyone. He says:

We get the emotional struggle these kids go through. You have to love yourself to want to lose weight and make that change. My line of thinking was, if you emotionally invest in these kids, suddenly it becomes a motivation factor in your own life. ‘Well, if they can do it, so can I.’”

This motivational impulse is present for both young people struggling with obesity and their parents. In the eyes of their children, parents are finished products, entities as immutable as the Sphinx. But adults can grow and change too. In fact they often want to grow and change, but don’t quite know how to go about it. The mothers and fathers in Bite Size are, for the most part, vitally concerned with making a commitment to beneficial change.

Moy: Creative and Sedentary

At age 11, Moy is the youngest of the film’s subjects. He lives in a middle-class area of East Los Angeles. Moy is a classic all-day-at-the-computer kid, with the telltale signs of a nerd in the making (in the best possible sense, of course.) Video games are his jam, and the Bite Size camera rather pointedly makes the connection between extensive screen time and constant snacking.

Apparently, Moy also has “mad skilz,” as the kids say, as an indie filmmaker, and the beginnings of a sly, self-deprecating sense of humor. He foresees that life will present him with a certain amount of combat opportunity, and wants to have some advantages other than the capacity to squash his opponent with sheer weight.

Moy’s father, Felipe, is always giving him pep talks, clearly affectionate in nature but not always tactfully expressed. He sets a good example of staying in shape, but is also a big consumer of chips, soda, and other varieties of junk food, so his son can’t help pointing out a stance that, to him, looks very much like hypocrisy. When a bad school report card shows up, Felipe gives his son a bit of a hard time, and threatens that he will end up working at McDonald’s—the unintentional humor being that, to a kid like Moy, a job at a fast-food franchise probably sounds like quite an attractive future.

Family Activism

Moy is Hispanic, and while his dad is very Americanized, his mom primarily speaks Spanish. Determined to improve the home food environment, she takes Moy to the MEND Program where they both learn about nutrition, behavior change, and active play. Still, it’s basically a household where one parent strives to follow better precepts while the other loves to cook up a pan of brownies. And Moy says being overweight doesn’t bother him much. So life just kind of drifts along, until the day when Felipe has chest pains and is hospitalized to see what’s what. It isn’t a stroke, only a wake-up call.

Since being “scared straight” worked for Felipe, he tries it out on Moy, bringing in his old friend to explain the realities of life with diabetes. The man demonstrates how he has to cut his finger every day for blood testing, and tells Moy, “You’re a walking time bomb.”

Moy’s dad joins up with MEND too, making the graduation party a family event, and his mom is very, very stoked. We also see Felipe reviewing the good results of a physical exam with Moy. When the filmmakers check back a year later, Moy has started to like sports. Why? Because he and Felipe discovered how to combine the best of both worlds, by working out with console-based fitness games. Fictional adventures, exciting stories, real-life exercise, and family togetherness are all there in one package.

Bite Size can be seen via Vimeo on Demand, and on March 24 will be available on iTunes, Google Play, and other VOD platforms. More information can be found at http://bitesizemovie.com or on Facebook.

Your responses and feedback are welcome!

Source: “Bite Size”
Source: “Exclusive: Watch a Clip of the New Obesity Documentary, Bite Size,” TheDailyMeal.com, 03/06/15
Image by http://bitesizemovie.com

Bite Size – Emily

Emily

The film Bite Size explores the lives of four young people, ranging from age 11 to 13, then catches up with them one year down the road. It tracks the weight loss journeys of two girls and two boys, all diagnosed as clinically obese. Two are coastal kids, Emily in Florida and Moy in California, while two live in Mississippi. This is Emily’s day.

Bite Size assumes a certain amount of knowledge on the part of the viewers, and does not over-explain. Indeed, no omnipotent narrator supplies a voice-over. Children, parents, professionals, and school staff members all tell their experiences in their own words. The tone of the film is very low-key, never hysterical or preachy, and it accurately shows how life is pretty much a “two-steps forward, one-step back” proposition.

Outside Help for Obesity

Though hard-working and middle-class, Emily’s family is closest to privilege of all four. She lives what many would consider a glamorous life near Disney World, where her father used to work. His job, managing a candy store, made it hard for her to stay off the fudge. Emily finds being overweight a social liability, and at some point a doctor told her she was going to die. We also learn that her parents used to lock the food cabinets.

Emily’s big problem is that she always wants to eat and never feels full, and finds this constant hunger really painful. At 13, she is already a veteran of two semesters at MindStream Academy. She sees it as a rehab center for kids, and characterizes food addiction as similar to drug addiction. In the idyllic MindStream setting, she accomplished an amazing weight loss of about 80 pounds and learned, technically, everything there is to know about sustaining it. The staff there realized that she would need constant support, and Emily realized “I can’t be here for the rest of my life.” By the time Bite Size was filmed, she was losing ground.

Stopping Short of Perfection

Emily’s parents reveal that paying for her MindStream experience caused considerable distress to the family’s finances. They don’t complain, but after so much expense and sacrifice it must be frustrating to see such a disappointing return on their investment. There is even a scene where her father voices mild reproach over the fib Emily told about the acceptability of eating unlimited amounts of watermelon. He suggests that this habit might be feeding her addiction, causing her to crave sugar more by constantly feeding it into her system.

On the other hand, her parents like fast food and junk food and don’t seem very willing to change their ways, which Emily calls “emotionally wrecking” because temptation is always nearby. But as time goes on, they ceremonially give up soda.

Parents are always advised use exercise as an opportunity for family togetherness, and her dad takes her to a gym where they work off calories together. But Emily is less than stoked about doing these activities with her dad, and is especially reluctant to have her dad present when she steps on the scale to measure her weight-loss progress. She feels that it’s an invasion of her privacy.

One Year Later

When the film crew checks back a year later, Emily has regained considerable weight, which especially shows in her full face. She admits she is “mad at her old self,” but her new self is obviously struggling.

Emily has two obese older sisters, but in the film they are mere shadow presences. We don’t know their reaction to how the household changed to accommodate Emily’s needs, or how they feel about the family using up all its resources on her account. The viewer is left to imagine the various possible family dynamics. Did the parents go all-out because they saw Emily as their last chance to have a normal-weight child? Are the older sisters resentful of all the attention and money showered on her, or glad to have been left out of the whole weight-loss project?

The whole film is very even-handed, and while it allows the subjects to speak their own truths, and hints at deeper dynamics, it does not delve. Bite Size can be seen via Vimeo on Demand, and on March 24 will be available on iTunes, Google Play, and other VOD platforms. More information can be found at http://bitesizemovie.com.

Your responses and feedback are welcome!

Source: “Bite Size”
Image by http://bitesizemovie.com

 

Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
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