Dr. Nicole Avena at the Symposium

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Nicole Avena, Ph.D., is a research neuroscientist and molecular biologist who has published more than 75 journal articles; co-authored Why Diets Fail; and written What to Eat When You’re Pregnant. She regards sugar as addictive, and at the Congress gave a presentation titled “Evidence for addiction-like responses to highly palatable foods, and how findings could inform obesity treatment methods.”

The idea that psychiatrists and psychologists should “own” obesity may not be accepted in some circles, but the magazine Psychology Today seems fine with it, as shown by the fact that Dr. Avena’s column “Food Junkie” has frequently appeared in its pages. She is apt to say:

The overlaps between drug addiction and obesity have been uncovered, both in terms of behavior and brain changes. For example, studies show that when obese people are shown images of foods they desire, their dopamine system is activated as if one were showing drug stimuli to a drug addict.

Introducing this speaker at his WPA Symposium, Dr. Pretlow described her as having “a novel theory that the eating disorders field is resistant to considering obesity as an eating disorder because ED professionals do not like telling people to restrict what they eat.” Obesity, eating disorders, and addiction invade each other’s territory all the time.

The idea is that if the profession could be accepting of the food addiction construct, a lot more troubled people would currently be receiving treatment. Under a constant onslaught of toxic chemicals, the human brain undoubtedly undergoes changes, but that is not the whole story. When behavior-modification methods are able to treat both drug addictions and food addictions, the smart thing to do is to use them.

Great minds think alike

On the Symposium’s audio track, Dr. Avena’s talk begins at 3:15 and covers a lot of information about animal research and the physiological similarities between drug addiction and food addiction. She speaks of looking at overeating “through the lens of addiction,” which recalls Dr. Pretlow’s phrase, “the psychological food dependence-addiction lens.”

Although many factors contribute to obesity, the food that is available to people has a great deal of mischief to answer for. This is particularly true of highly processed “hedonic” food which is created to service the recreational eating market and has very little connection with nutrition.

The hazard is complicated by the fact that sugar is so cleverly hidden behind euphemisms and inside of food products that might never have been suspected of smuggling it into vulnerable human bodies. Of course it is also found in very obvious places, like holiday candy, which is out segue into…

HALLOWEEN ALERT!

Childhood Obesity Halloween Prep
An Early Start on Halloween
Get the Jump on Halloween!
Halloween Preparedness Starts Now
Halloween’s Inexorable Approach

Your responses and feedback are welcome!

Source: “Feeding Your Addiction,” PsychologyToday.com, 09/06/17
Image: Messe Berlin by Dr. Pretlow

Dr. Pretlow’s WPA World Congress Symposium

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At the World Congress of Psychiatry earlier this month, one of the four main themes was “Comorbidity of mental and physical diseases.” If ever there was a human state that almost universally combines the realms of physical and mental disorder, morbid obesity is that state. It is no use to protest that some very wide and heavy people seem quite well-adjusted.

A woman might wear an armor of fat because of intimacy fears that result from early abuse. As long as she feels safe, protected by all the extra pounds, she could feel happy. But is it the same as being mentally healthy?

People compulsively overeat to fill the emptiness inside — that idea is so familiar, it has become a cliche. But a truth is staring us in the face: If we really paid attention to that well-worn trope, helping people who have emotional difficulties would be a more urgently-felt societal need.

The big call to action

Dr. Pretlow would like to see more psychiatrists and psychologists regard disordered overeating and the consequent obesity as a psychological problem. Obesity should be classified, by the official classifiers, as an eating disorder. Eating disorders are properly treated by psychiatrists and psychologists.

Another important point is that addiction-model methods seem to be effective in treating obesity — and if something works there should be more of it. Yes, surgery and inpatient rehab facilities show good results, but are out of most people’s financial reach.

More importantly, neither of those options is something a kid should be put through if it can possibly be avoided. One thing is for certain, childhood obesity is not going away any time soon, so we had better figure it out.

At the World Congress

Dr. Pretlow chaired a symposium he describes as exciting, with stellar talks by each speaker. The topic: “The applicability of addiction-model methods for disordered-overeating and obesity intervention.”

In his opening remarks, Dr. Pretlow expressed appreciation for Dr. John Foreyt, who initially made clear the concept that the roots of obesity are 99% psychological. As time went on, Dr. Pretlow became more and more persuaded by evidence, to the point where he now says:

Candid accounts from thousands of obese individuals have confirmed to me that obesity is primarily a psychological problem.

The symposium, known familiarly as S-123, has a page of its own describing details and providing links to the individual abstracts. It was co-chaired by Caroline Davis, and the other participants were Nicole Avena and Fernando Fernandez-Aranda.

A very thought-provoking question inevitably arises, concerning how things have been sorted out by the most important book in the field. The Diagnostic and Statistical Manual of Mental Disorders extends recognition to under-eating as a bona fide eating disorder, but leaves overeating out in the cold, deprived of its rightful status.

There is still time for Halloween topics

Allergies, Addiction, Childhood Obesity, and Halloween: All Scary
Rethinking Halloween With SAAD
Halloween Proximity Alert: It’s a Childhood Obesity Issue
Will Childhood Obesity Kill Halloween?
Last-Minute Halloween Hints

Your responses and feedback are welcome!

Image by World Psychiatric Association; Fair Use

Psychiatry, Psychology, Obesity

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Dr. Pretlow has just returned from the World Congress of Psychiatry. As a background to discussing that, it is useful to have a sense of what the current thinking is in other parts of the world. For that purpose we look at a Vice article in which Amelia Tait dissected one of the many disputes current in the United Kingdom.

The topic is directly related to what Dr. Pretlow recently journeyed to Berlin to discuss. Tait’s piece is titled, “Is Obesity a Psychological or Physical Problem?

The article’s subhead explains in detail:

David Cameron wants to cut people’s benefits if they don’t seek treatment for their obesity, but does the NHS recognise that overeating can be caused by underlying psychological issues, rather than biological ones?

The writer defines overeating as “compulsive eating, without purging, that is usually done with discretion.” She interviewed Dr. Cary Savage, whose research has shown that children might be dangerously susceptible to advertising techniques, especially when it comes to food products. Dr. Savage reminds us that no one has perfect control over her or his behavior.

Tait references the recent demise of Britain’s fattest man, noting that many psychologists would say he “suffered from a mental illness that compelled him to eat.” In practical terms, this means that a politician’s threat of welfare benefit cutting is likely to be ineffectual in changing the behavior of people who suffer from mental illness.

The journalist interviewed a 20-year-old youth who brought his weight down from 373 pounds to just over 220 pounds in a year. His childhood was marred by the death of his brother, compounded by his mother’s endless grief. Eating became, in his own words, an addiction, and pasta was his drug of choice — like, 15 times a week.

Tait learned a very telling detail of the young man’s history:

Daniel’s brother’s disease made him extremely thin, and Daniel recalls being shocked at being able to see his bones. “I think all of this really had an impact on me,” he says. “Being a small kid and not wanting to go like him definitely helped me to binge eat.”

Dr. Jen Nash of the British Psychological Society told the reporter:

Obesity is a complex issue, and food addiction is a relatively new and controversial term. Although food addiction does have a number of similarities to other addictive behaviors, we do not yet have enough data to fully and confidently conceptualize it in this way…

The challenge we have in the NHS is that obesity is dealt with in medical settings and in a medical paradigm, and so medical causes and solutions are the primary approach.

Tait remarks on the same phenomenon that Dr. Pretlow has noticed:

The main issue with food addiction and overeating not being classified in the DSM-5, and being widely considered as biological issues, is that there is not much psychological support out there.

It seemed possible that this sorry state of affairs might change, considering that one of the four announced themes of the WPA World Congress was “Comorbidity of mental and physical diseases.” The time seems ripe to take a hard look at obesity and think about where, among the confusing plethora of terminology, it might belong.

REMINDER: Halloween is coming — and Childhood Obesity News has compiled a virtual encyclopedia of seasonal treats and tricks, so don’t miss out!

Your responses and feedback are welcome!

Source: “Is Obesity a Psychological or Physical Problem?,” Vice.com, 07/30/15
Photo via Visualhunt

Newest Obesity Stats Alarming

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The year 1975 was a little over 40 years ago, and during the intervening time, the rate of childhood obesity has multiplied by 10. Who says so? A meta-study utilizing data from 2,416 previous studies on close to 129 million subjects.

Here is the title of a report from The Lancet: “Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults.” If that doesn’t raise some red flags, then nothing will.

The report includes plenty of charts, which Forbes writer Bruce Y. Lee describes thusly:

The curves in nearly every case look like ski slopes, except that they are going the wrong direction: upwards.

On a list of 200 countries, Singapore is in the best shape, but even there the rate of obesity among girls has doubled during the time frame. Within another 10 years, the worldwide cost for the medical consequences of obesity is on track to reach $1.2 trillion annually.

Unfortunately, expenses will mount more voraciously in the countries that can least sustain them. For some reason, the South Pacific islands have the most dismal numbers. Although conditions in developing countries are likely to worsen, the child obesity rate in wealthy countries “may have peaked,” according to the Associated Press. This is cold comfort, when the obesity rate among American children and teens is already pushing 20%.

What is going on?

Lee calls it a “complex systems problem” of which questionable food and beverage ingredients are only one factor. Cities, workplaces and schools are generally not designed for practical walking purposes, and kids have fewer places to get healthful exercise than ever before. People sit and stare at the screens of electronic devices all day.

We are also negatively impacted, Lee says, by “the things that are in our environment (e.g., more pollution, more medications) and many other systems that affect diet, physical activity, and metabolism.” Nobody really has a handle on exactly what the ubiquitous chemical atmosphere is doing to humans, but all suspect that the effects are devastating.

Since the report hit the news, professionals in many fields are reacting. From the world-famous Mayo Clinic, pediatric psychologist Dr. Bridget Biggs expressed alarm via local news outlets, and with good reason. In addition to pediatric obesity intervention and prevention, bullying is an area of her expertise. Of course obesity is a chief cause of that kind of abuse. Dr. Biggs has studied “social barriers and facilitators to healthy eating and physical activity” and the motivators that compel overweight teens toward weight loss.

Dr. Pretlow has just returned from Berlin where about 10,000 mental health professionals attended the World Congress of Psychiatry. On the event’s program page, four main topics are listed, and one of them is “Comorbidity of mental and physical diseases.” Dr. Pretlow says:

Candid accounts from thousands of obese individuals have confirmed to me that obesity is primarily a psychological problem.

That is exactly what he travelled there to speak about, and Childhood Obesity News will have more to say on the subject.

Your responses and feedback are welcome!

Source: “Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016…,” TheLancet.com, 10/10/17
Source: “Childhood Obesity Increased More Than Tenfold Since 1975,” Forbes.com, 10/10/17
Source: “Children’s obesity rates in rich countries may have peaked,” StatNews.com, 10/10/17
Source: “Summary,” Mayo.edu, undated
Source: “Psychiatry of the 21st Century: Context, Controversies and Commitment,” Wpaberlin2017.com
Image source: mattz90/123RF Stock Photo

Obesity and Food Addiction Terminology Roundup

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In the effort to stop obesity from taking such a tremendous toll in resources, both human and financial, one obstacle is the uncertainty over vocabulary. A marvelous array of possibilities are open. Sure, there is an obesity epidemic — that is obvious — and there is nothing wrong with calling it that.

But consider, for instance, malaria. An important step was to recognize that malaria is spread by mosquitoes, which then led people to take mosquito abatement measures. Knowing the vector is important. To mistake malaria for an airborne contagion would be counter-productive. Language matters. This is a roll call of the many Childhood Obesity News posts that have considered the language of obesity.

Addiction is a top concept. Some say it is impossible for a person to be addicted to a specific food. Others say it is all too possible, because that’s the kind of addict they are. Some say yes, a lot of people appear to be hooked on cheese, but really it’s just the casein, because there is a lot of it in cheese.

Then maybe casein is addictive, or rather the casomorphin within it that might affect the body and brain like an opioid. But casein is in a lot of other dairy products too. Admitting that a dairy product could be an addictor would open, excuse the expression, a large can of worms.

Biomarkers are another problem. There is a blood test for malaria. The parasites are either in a person, or they are not. However, for an eating disorder called overeating, there no blood test. Diabetes can be a comorbidity with obesity, and there are biomarkers for diabetes, but not for the compulsive overeating itself. A lab technician can say yes, there is heroin in someone’s blood, but not whether the person is a heroin addict.

Why it is so important to define and delineate? The Diagnostic and Statistical Manual of Mental Disorders is…

[…] the basis of psychiatrists’ authority to pronounce upon our mental health, to command health care dollars from insurance companies for treatment and from government agencies for research.

In other words, the position that a condition occupies in this book can decide what kind of treatment a patient gets, and even whether they will receive care at all. In extreme cases, when lawyers and judges become involved, words can matter very much. A diagnosis from the book of mental disorders, once assigned to an inmate, can make the difference between life and death.

Back in 2011, when the long-awaited 5th Edition, or DSM-5, was still being compiled, Dr. Pretlow thought it would be useful to recognize food addiction as a true addiction, although many professionals in the field disagreed. Another post featured the “Top 6 Reasons Why Food Addiction Falls Within the Already-Established Criteria for Addiction as Set Forth in the Current Edition, DSM-IV.”

The role of tolerance in addiction is important, and an understanding of it can help to figure out what food addiction is or is not. How does this fit with “comfort eating”? There can be little comfort in trying to feed an ever-increasing need, yet that seems to be what a compulsive comfort eater attempts to do, just like any other addict.

A certain number of people must eventually realize that comfort is not what they really want, after all. They might come to regard comfort-seeking as no longer an appropriate response. Maybe they want to be the kind of person who seeks results and redress, rather than consolation.

Maybe they want to be an activist in the world, instead of a reactor. Maybe they want to be the person who can comfort others. These are all possible reasons why comfort is not enough, no matter how much of it a person can get hold of.

REMINDER: Are you ready for Halloween? This page lists several useful seasonal posts for parents.

Your responses and feedback are welcome!

Image source: fberti/123RF Stock Photo

BFRBs, the Dual Evil of Soda, and Cosmic Big Mama Cat

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Medical researchers who specialize in obesity, especially of the childhood variety, are always trying to figure out what is going on. As soon as one question seems to be answered and one fact seems to be in the bag, along comes new information about cholesterol or fat or microbes, and a committee decides to rewrite the textbooks.

Some mysteries resonate eternally, like, “Why is it so difficult to inspire motivation in obese young people who are obviously not living their best lives?” and “Is it even possible to kickstart the motivational apparatus in another person, young or old?”

Other puzzling questions are on their way to being answered, like exactly how to pin down and classify the disorder that looks an awful lot like food addiction, and actually seems more closely to resemble an addiction to the physical actions involved in eating. Sometime the edges blur. Dr. Pretlow has described displacement-behavior eating as involving such motor actions as “licking, sucking, biting, chewing, and swallowing,” which alleviate stress for many people. These activities provide relief from tension.

Strange pathways

But if blowing off steam is the unconscious intention, why do people find it hard to switch from their habitual motor activities to more benign ones, like isometric exercise? There might be complicated psychological roots. Mammals tend to lick their offspring, mechanically and repetitively, often for extraordinary lengths of time. (Is a mother cat under that much stress, really?)

For a new little animal, the gentle massage of its mother’s tongue is one of the first connections with the outside world. It serves all kinds of useful functions, waking the nerves, tuning up the lymphatic system, encouraging the blood to circulate through its proper channels. Plus, being licked probably feels great.

Conversely, in most human cultures, mothers do not lick their infants. But somewhere in our psyche, do we hold a faint, indirect, roundabout memory of the comfort of being licked? When a human is emotionally bereft, can the mind reach back into the depths of mammalian history and recover a vague sense of the value of being licked, and conflate the very different states of licking and being licked?

What if all we really want is to be licked, like a kitten, by a large, protective, loving entity who never tires of meeting our needs? But of course that satisfaction is not available to us, even though a very faint wisp of ancestral instinct is convinced that it should be. Desperate and frustrated, equipped with only a vague impression that licking is good, the subconscious twists and misdirects the impulse.

The booby prize

Struggling with this deprivation, in addition to all the other problems that started our trouble in the first place, the most we can achieve is the consolation prize, also known as the booby prize. Unconsoled by Cosmic Big Mama Cat, we settle instead for licking an ice-cream cone, and take in a bunch of calories, and put on pounds, and then have yet another problem to contend with.

A large body of literature has collected around touch hunger, skin hunger, touch deprivation, touch starvation — it goes by many names. (A typical example is “Touch Hunger, and How it Affects Our Eating Behavior,” from the Center for Mindful Eating.)

The point is, how much of what we call motor activity is a perverse response to touch deprivation? If we had our druthers, we would much prefer to be touched. Doing the touching occupies a poor second place. But out of emotionally urgent necessity, we warp that need to be touched into a compulsion to touch other things — mainly food — with our lips and teeth and tongues and esophagus.

When it comes to eating as a tension-relieving Body Focused Repetitive Behavior, the stereotypes tend to center on the more active motions, like biting and chewing. The sight of someone tearing into a steak or enthusiastically crunching an apple pretty much says it all. In a casual sense, we think of motor-action food as the kind that displays a lot of athleticism in the jaw area.

But strangely, soda comes under the same heading. Dr.Pretlow wrote:

Motor-action foods, which also taste good, are eaten in the largest amounts. This applies to sugar-sweetened beverages, which essentially are sugar, water, and flavoring. The swallowing displacement behavior action with sugar solution results in copious consumption in contrast to granular sugar containing the same calories.

Millions of words have been written about the evils of sugar-sweetened beverages and their cousins, the artificially sweetened beverages (which may even be worse), yet very few writers have recognized the potential for harm that these drinks present by being not only in the substance addiction suspect pool, because of the sugar; but in the motor addiction camp at the same time.

Your responses and feedback are welcome!

Source: “Treatment of Child/Adolescent Obesity Using the Addiction Model: A Smartphone App Pilot Study,” PMC, 06/01/15
Photo credit: Ben Ramsey via Visualhunt.com/CC BY-SA

Relationship Between Food Addiction and BED

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Some might ask why Childhood Obesity News is even talking about Binge Eating Disorder (BED). “This is an adult problem,” they might say. But they would be operating on outdated information, as Caroline Davis, Ph.D., points out. Sadly, these days binge eating increasingly shows up as early as middle childhood. The journal Current Obesity Reports published Davis’s paper about compulsive overeating as an addictive behavior.

It comes as no surprise that the pattern of overeating known as Binge Eating Disorder (BED) is very much connected with a high body mass index, a.k.a. obesity; and so is the phenomenon commonly known as food addiction. The public has gotten used to recognizing that term, although Dr. Pretlow considers “disordered overeating” a more appropriate descriptor.

Either way, there are arguments for it as a legitimate addiction. The idea that overeating can be an addictive behavior is supported by the existence of 12-step programs specifically designed to address it, and by a great deal of anecdotal evidence from overeaters who found that the programs modeled on Alcoholics Anonymous had worked for them.

Davis mentions that there is “compelling and accumulating bio-behavioral evidence” to indicate that if food contains enough sugar, fat, and salt, it can indeed be an addictor. She goes on to say:

In addition, evidence of the biological parallels between drug and food abuse, as demonstrated by preclinical experiments, human brain neuroimaging studies, and behavior genetic research, has further strengthened the credibility of the food-addiction construct.

Whether compulsive eating is a substance addiction or a behavioral addiction, the results are pretty much the same: obesity and assorted co-morbidities. More to the point, substance addiction and behavioral addiction are both addressable by the same therapeutic modes.

The second half of Davis’ title, “Overlap Between Food Addiction and Binge Eating Disorder,” suggests the image of a Venn diagram: One big circle is all the food addicts (or, more accurately, eating addicts), and another big circle holds all the people with BED. Although, as the author says, BED “appears to be a behaviorally-distinct subtype of obesity with an unique risk profile,” the circles meld into each other.

The overlapping area represents the many characteristics they share. Davis says of BED:

In particular, individuals with this disorder display a hyper-reactivity to the hedonic properties of food as seen by greater food cravings, preoccupation with thoughts of food, emotionally-induced overeating, and a greater preference for sweet and fatty foods.

Surely, the same is true of the eating addict. In the psycho-behavioral realm, there are many similarities between BED and drug abuse, to the extent, says Davis, where “many have adopted the perspective that an apparent dependence on highly palatable food — accompanied by marked emotional and social distress and deficiency — is, in essence, an addiction disorder.”

Excessive and compulsive food intake are common to both. Loss of control is a huge factor for both. Davis wrote:

The parallels between an apparent “loss-of-control” over food intake and compulsive drug taking have been recognized by clinicians for decades, albeit mostly in circumstantial reports, and with particular reference to the pronounced cravings they have in common and the similarities in their mood-enhancing effects…

Ah yes, cravings and mood enhancement. One thing about food-induced attitude adjustment is, it never lasts. Whether hooked on a substance or a behavior, a person is desperate for a reliable supply, and needs more the next day, or in a couple of hours. A binge eater, on the other hand, might chill out and avoid acting out for a while, but sooner or later something will trigger the mechanism that demands, “Shovel it in.”

Your responses and feedback are welcome!

Source: “Compulsive Overeating as an Addictive Behavior: Overlap Between Food Addiction and Binge Eating Disorder,” Springer.com, 02/13/13
Image by Pat Hartman

The Web Assists Physicians and Patients

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One of the major obstacles in defeating childhood obesity is, the methods that work best for adults, namely inpatient rehab facilities and bariatric surgery, are not particularly suitable for children. Certainly, the aim is to help. But how does it feel to be judged inadequate and then sent away to a strange place to be “fixed”?

What is the cumulative toll on a child’s psyche? As for surgery, there are no guarantees, and where minor children are involved, the ethical and legal ramifications can become complicated.

Perhaps worst of all, inpatient rehab and surgery are not “scalable.” Apparently, there is no way to make either of them less costly. We probably won’t see an assembly-line style operating room where several doctors each perform one step in the stomach-stapling procedure while teenagers flow past them on a conveyor belt.

An obesity intervention program

Not long ago, a report was published in JAMA Pediatrics by researchers who saw the need for “cost-effective, scalable clinical approaches for improving obesity rates in children” as a public health priority. The team was led by Elsie M. Taveras, MD, MPH, of Massachusetts General Hospital for Children. The scientists recruited 549 children of ages 6-12, distributed among 14 primary care practices.

All the subjects had Body Mass Index (BMI) scores in the 95 percentile or higher. This was a three-arm clinical trial, and success would be measured by improvements in the BMI.

According to the study:

Five of the 14 practices including 194 children received clinical decision support tools where the existing electronic health record was modified to alert pediatricians to a child with a high BMI. Links were provided to growth charts, obesity screening guidelines and referrals for weight management programs.

For this group, family members were given educational materials. They had followup visits where the emphasis was on changing behavior. They cultivated habits that would produce more exercise and sleep time, and less sugar consumption and screen time.

In five other practices (171 kids), the doctors used the computerized clinical decision-support tools, and families were able to work with a health coach through email, text messaging, and telephone. Another 184 children received “usual care, including no clinical decision support tool for obesity.”

What were the results?

Children with the greatest improvements in BMI were those with families and pediatricians that participated in, and were most faithful to, the intervention that included clinical decision support tools in pediatric practices and health coaching for the family.

So this computerized clinical decision-support program appears to be worth trying more often, and parental participation seems to count for a lot too, along with continuing personal contact with the professionals. Inevitably and unsurprisingly, the reachers also found that “participants who did not adhere as closely to the intervention did not achieve improvements in BMI.”

Integrated, interactive, and on the Internet

A movement that started with independent bands hoping to sell their music has grown into a field with something for everyone. For example, CloudVisit is a “video consultation websites and telehealth devices” company that helps a doctor set up the online part of the practice by providing a template with all the different features that might be needed for a subscription-based weight loss regimen. The clinician can put together a customized program with any or all of the available components — the video chat platform, the appointment calendar, wellness trackers, menu planners, and, of course, the practice management dashboard.

Economics aside, the benefits for patients are vast. Parents don’t have to take their kids out of school for appointments, or find babysitters for their other kids, or struggle to find parking. If they live in a city, telehealth tools cut down on the amount of traffic and pollution. If they live in the country, video consultation might be their only hope for finding out how to help their child. On the whole, these new developments excite and inspire.

Your responses and feedback are welcome!

Source: “Computerized decision support tools improve BMI in children,” Healio.com, 05/07/15
Source: “Pediatric Telemedicine Discusses Overcoming Childhood Obesity,” BroadwayWorld.com, 04/03/14
Photo credit: feverpitched/123RF Stock Photo

Childhood Obesity and the World Wide Web

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Technology and childhood obesity intersect in many places. The Internet is an obvious one, because here we are, using it right now. Three years ago, fitness trainer Ryan Halvorson pointed out the capacity of the social media platform Twitter to play a positive role in affecting the rate of childhood obesity.

Halvorson reviewed a study from the American Journal of Public Health whose authors looked at 1,000 tweets with the #childhoodobesity hashtag that originated with 576 different users. Based on those tweets…

[…] the researchers learned that individuals — many of them non-credible sources — were more likely to tweet about childhood obesity than organizations were. Tweets were also more focused on behavior modification as opposed to “environment or policy.”

But although more individuals tweeted, the government and media sources were much more likely to collect followers. The takeaway was to encourage organizations and qualified (rather than non-credible) individuals to reach for even larger audience shares.

Today, a search for the #childhoodobesity hashtag reveals a breathtaking array of resources from all over the world. It illustrates the fact that people are taking this epidemic seriously, and are coming at it from all directions. Facebook, Reddit and other social media platforms are also great places to find everything from the most reliable scientific news to outrageously irreverent rants based on personal experience, and the most idiosyncratic “anecdotal” reportage of successful remedies.

Obesity education and awareness

Since childhood obesity entered the public awareness in a major way, it became obvious that rural areas of America lacked sufficient weight-loss resources and paradoxically might even be “food deserts.” According to logic, it seems that farming areas should be dotted with roadside produce stands and weekly farmers’ markets. However, with the overwhelming hegemony of mechanized agricultural and the demise of small family farms, those elements of country culture have largely become nostalgic dreams.

However, electronic technology makes up for a lot of what industrial technology has stolen. Thanks to the medical profession — and to healers concerned with childhood obesity — the benefits of communications technology are many. Teleconferencing, continuing education for professionals and basic education for patients, plus the ability to keep up with the most current developments, are all important outcomes of the cyber revolution.

Problems with obesity treatment

Rural doctors and patients are not the only ones who face challenges. As Dr. Pretlow often mentions, the two approaches to obesity with the best results so far — inpatient rehab facilities and bariatric surgery — are both prohibitively expensive for most families, no matter where they live.

In addition, both are unsuitable for children. Going away to ride horses or learn chess is one thing, but few kids would choose to be transported far from home to a “fat camp” where freedom is severely restricted and expectations are high. And bariatric surgery for children and even teenagers was long regarded as the last of all resorts, although that is changing fast.

We’ll discuss how the Web has made things better for everyone next. Your responses and feedback are welcome!

Source: “Can Twitter Help Childhood Obesity?,” Ideafit.com, 09/17/14
Source: “Health Information Technology,” AHRQ.gov, 05/12/13
Photo credit: Masa Israel Journey via Visualhunt/CC BY-ND

Peripheral Professions in Obesity Treatment

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Childhood Obesity News talked about how technology is helping doctors learn the difficult art of telling parents that their child is obese, among other things. Also, once the parents grasp the essential fact that the child needs attention and help, how does a primary care physician decide what advice to give them, when respected experts in the field can’t come to an agreement over something as simple as whether eggs are acceptable to eat or not?

We mentioned an innovative program that produces free-standing childhood obesity experts, who can perhaps assume an expanding role in relieving doctors of some of the burdens associated with diagnosing and treating kids in this all-too-prevalent kind of trouble.

A food addiction treatment option

FAI/ACORN Food Addiction Professional Training is a three-year program created by the Food Addiction Institute and administered by ACORN Food Dependency Recovery Services in Florida. The curriculum, directed by Philip Werdell, MA, has the following description:

This is a three-year experiential program focused on learning food addiction recovery from the inside-out, assisting experienced food addiction professionals, and developing ways to make a unique contribution to food addicts and the field of food addiction.

The program emulates the training regime developed for the staff of the residential eating disorder and food addiction treatment program at a renowned psychiatric hospital. Apparently, to even get into the FAI/ACORN, a person has to be a recovering food addict. The trainees participate in the program first as clients, second as assistants to experienced staff members, and then as co-professionals, while demonstrating their professional competency working to work on their own.

After the three years, then what? Private practice is an option. A graduate opened Gladness House, a recovery venue in Philadelphia, exclusively for food addicts. One might also become a food addiction coach or consultant, and in these capacities, work in league with physicians to serve the obese community.

Immersive simulations

SIMmersion‘s pitch is that it “builds highly engaging systems featuring interactive simulations, dynamic educational content, and extensive feedback.” They offer training in, among many other things, victim advocacy, autism social conversation, and alcohol screening. They can teach a nurse how to talk with adolescent patients about marijuana use, and coach a manager in the technique of obtaining an admissible confession from a suspected embezzler.

Like the computer-aided role-playing setup we recently described, SIMmersion uses the techniques of motivational therapy. But their method is a big step up, because this company employs highly trained individuals who pretend to be whatever is needed. Just as in group therapy or an acting class, the role-player takes the client through archetypal clinical scenarios that are destined to occur in real life.

The company’s clients are drawn from not only healthcare, but the military, legal, law enforcement, business, management, social, and education fields as well. For medical professionals, applications include:

Dealing with difficult patients; palliative care and bereavement counseling; talking to child and adolescent patients; patient compliance; treating patients from different cultures; underage drinking; HIV/AIDS counseling; mental health diagnosis; differential diagnosis; and talking to patients about health risk behaviors.

Several of those categories could be useful to the doctor wishing to interact most effectively with obese patients, even young ones.

Your responses and feedback are welcome!

Source: “FAI/ACORN Food Addiction Professional Training,” FoodAddiction.com, undated
Source: “Solutions,” SIMmersion.com, undated
Photo via Visualhunt

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