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

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

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

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

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

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