A resource for health professionals, parents, teachers, counselors & kids on the childhood obesity epidemic.

In the areas of weight management and eating disorders in kids and teens, several different components are involved. Negative behavior cycles need to be broken, and patterns need to be restructured. Some behaviors need to be eliminated, and others put in their place. Equally important is the long-term maintenance of both elements — the permanent extinction of some behaviors and the perpetual repetition of others. If all this can be accomplished, the likelihood of relapse is minimized.

Two major problem categories are anorexia nervosa (AN) and bulimia nervosa (BN). Cognitive behavioral therapy achieved some early successes with those. Basically, all eating disorders have something in common — a constant concern with food, eating, and weight. AN and BN are about the obsessive need to eat less and weigh less. Even though it seems on the surface to be the diametrical opposite, BED or binge eating disorder leading to obesity comes from the same roots – constant concern with food, eating, and weight. BED is included, along with some other diagnoses, in a category dubbed EDNOS, or “eating disorder not otherwise specified.”

It looked promising

Ten years ago, the United Kingdom’s Health Development Agency (using sources from everywhere) issued a report called The Management of Obesity and Overweight. Authored by Caroline Mulvihill and Robert Quigley, the report was subtitled “An analysis of reviews of diet, physical activity and behavioural approaches.” Among many other useful explorations of the literature, it offered a comparison between behavioral modification programs that were family-based and those that were not family-based. Reviewing family-based modalities that had been tried so far, the researchers wrote:

These programmes included behaviour modification, dietary and exercise education, with a mix of sessions involving the child, parent(s) and, in some cases, the entire family. The review concluded that while some findings appear promising, the small size of some of the studies and the disparate nature of the interventions mean there is ‘at present insufficient evidence to recommend any specific programme’.

Although family-based programs were regarded favorably, there was not at the time enough solid evidence for the authors to recommend any specific one. They also looked at reports about behavior modification programs without parental involvement – well, one, actually, because that’s all they could find in the literature, and it involved kids from 9 to 19 years of age. The report says:

This compared a three-part cognitive–behavioural ‘obesity-training’ programme combined with a calorie-reduced diet and an exercise programme, against a group that received the same diet and exercise component but received muscle relaxation training instead of the psychological component. The intervention lasted for six weeks. Both groups significantly reduced their percentage overweight over the course of a year. No statistically significant differences were found between the two treatment groups.

Progress

Almost a decade later, the U.S. National Institutes of Health issued a report titled Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents. Despite the development of successful treatment programs, relapse and non-recovery still were prominent occurrences. In fact, AN patients were noteworthy for dropping out before the end of the structured treatment programs, and because of non-completion, could not even be counted in the relapse vs. non-relapse statistics.

Family-based behavioral treatment for obesity still looked promising because of short-term successes, but once the intervention was over, patients would revert to old behaviors and gain weight. Families are especially crucial because for the most part children and youth cannot avoid living with them. For a kid, the family home and the people in it are the most significant and influential features of the environment, and if they don’t change, the outcome of any intervention that involves only the child is apt to be dismal. The report puts it this way:

The persistence of weight-related problems may occur because environmental stimuli, which had fostered the previously learned, maladaptive behaviors, have not been modified.

This is reminiscent of a famous quotation attributed to Albert Einstein (though he probably didn’t say it), the one about how doing the same thing over and over again, and expecting different results, is the definition of insanity.

Your responses and feedback are welcome!

Source: “The Management of Obesity and Overweight,” Prevenzione PDF, October 2003
Source: “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents,” NIH.gov, 04/01/12
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Attention modification training (AMT) has been employed with children before, to treat anxiety and a number of other mental health issues. One of its most important uses is the treatment of substance abuse problems. Since food is a widely abused substance, AMT offers hope in the effort to end childhood obesity. Perhaps the most startling thing about a recent study is the implication that a single session of attention modification can make a significant difference in behavior.

The AMT study was carried out by the UC San Diego School of Medicine. Lead author Kerri Boutelle, PhD, believes that AMT training, based on classic Pavlovian conditioning, could be provided in the form of a computer game. The subjects in the exploratory study were 24 kids between 8 and 12 years of age, all overweight or obese, divided into two groups. PsychCentral’s senior news editor, Rick Nauert, describes how the study worked:

One group underwent an attention modification program (AMP) in which they watched pairs of words quickly flash upon a computer screen. One was a food word, such as “cake;” the other was a non-food word, such as “desk.” After the words had flashed and disappeared, a letter appeared on-screen in the place of either the food word or the non-food word.

The viewing child was asked to immediately press the right or left button associated with the letter’s location…. The AMP trained attention away from food words because the letter always appeared in the spot of the non-food word while in the other group, the condition trained attention was split with the letter appearing half of the time in the food word location and half in the non-food word location.

Although obesity obviously has multiple contributing factors, the theory behind AMT says that a major factor is “an abnormal neurocognitive or behavioral response to food cues.” Some people are inherently oversensitive to food cues, but they can be turned around. These researchers believe that the victim can be trained to ignore or disregard specific cues so their problematic nature is neutralized.

Two-way street

Mental health disorders can lead to obesity, just as obesity can cause mental health disorders. It is also apparent that the longer a person has been obese, the more difficult reversal is. This is one reason why so much emphasis is placed on early intervention. When people get older, behavioral therapy still has a chance, although as Dr. Pretlow says, “Overeating needs to be addressed much deeper.” To get to the root causes of obesity in an individual is obviously vital. But the world simply doesn’t have the resources to provide years of talk therapy for every morbidly obese person.

There is definitely a place for “interventions that break maladaptive behavior patterns before they become ingrained.” Adolescents with eating disorders who participate in cognitive behavioral therapy have higher recovery rates than adults, says the National Institutes for Health. When symptoms have existed for a shorter time, with less severity, treatment has a better chance of success.

One of the first things any behavioral therapy has to do is identify what behavior is modifiable. For most people, it is totally possible to increase their physical activity, to drink more water, to limit their sedentary time interacting with computers, and to consume more vegetables and fruits. Dr. Bryan P. Walsh wrote:

We become what we think about all day long. If you want to be skinny or more fit, you need to act lean, feel lean and do the things a fit person does. The more you feel, experience, and act as if you have already achieved your goals, the more likely the goals will become your reality. True, this can be very difficult to do, but if you do not have the right attitude for fat loss, you won’t achieve fat loss.

In ending addiction, 12-step programs have a well-deserved reputation for efficacy if, as the saying goes, the person works the program. Still, they are not the only way out. There have always been people who managed somehow to do it on their own with a “fake it till you make it” strategy. It isn’t easy, but it’s like an acting job. You act like a person who doesn’t eat sugar, until you become a person who doesn’t eat sugar.

Acknowledging rules takes strength and so does following them by rote. Sometimes people never get to the root causes of their addictions, but succeed in escaping from them anyway. Success is much more likely when basic problems are discovered and addressed.

Your responses and feedback are welcome!

Source: “Attention Training Helps Kids Avoid Obesity,” PsychCentral.com, 02/17/14
Source: “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents,” NIH.gov, 04/01/12
Source: “The Missing Fat Loss Manscript,” FatIsNotYourFault.com, 2010
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