Dr. Pretlow has developed an iPhone application with interesting potentialities in the area of childhood obesity. Below, he describes the impetus behind the innovation and retraces the thinking that inspired it:
Charleston Children’s Hospital came to us about five years ago and said that the patients who go through their 8-week intensive face-to-face program, all lose weight, pretty much 10% across-the-board weight loss.
Their problem was, once the patients went home, many of them lived too far away, or didn’t want to take time off from school, or for the parents to lose work time. They just could not come back for follow-up, and they would gain the weight back again, so it was all just a waste of their time and energy.
And that’s typical. But the treatment of obesity in children is really not just an episodic thing. It’s an ongoing lifelong problem, that they’re going to have to have some support for, almost forever, whether it be peer support or mentor support. I think that’s the way it has to work.
What Charleston Children’s is doing, they use our online system that sends weigh-in reminders, and the healthcare provider of their kids can give continual ongoing messages, and even at five years, they are still weighing in periodically. It’s a kind of electronic accountability that keeps them cognizant that they’ve always got this problem.
Now, we’ve come up with this iPhone app. These smart phones could be used forever as a tool to help these kids deal with episodes of relapse on an indefinite basis.
One aspect of addiction is not widely understood. Many addictions stem from a person simply wanting to feel normal, or at least less bad. A lot of seemingly unbreakable habits start with somebody using a substance because they just want to feel better. Not even great, but just okay, would be acceptable.
If someone wants to get out of the negative zone and experience the positive vibes of a happy life, there’s nothing wrong with that. The instinct to escape pain is so basic, even the lowly amoeba possesses it. In humans, another part of the same big picture is a belief that the answer might be found in a substance.
If the substance is vitamin E, self-medicating is benign, it’s self-care. If the substance is morphine or caffeine, or even sugar, the result can be a life-threatening addiction. There is nothing wrong with wanting to feel better, except that a substance rarely yields the desired effect.
A substance stops working. With overuse, all the well-known syndromes set in. The person’s system develops tolerance. One drink (or slice of cheesecake) is too many, but there’s no such thing as enough. The brain starts manufacturing rationalizations and self-justifications. For a person with any degree of awareness, the mental struggle with addiction overthrows all peace of mind.
Someone who eats for comfort is coming from the same place as a person who asks a doctor for an anti-depressant prescription. Or maybe even from the same place as a classic (or stereotypical), William Burroughs-type junkie. As a method of self-medicating, comfort eating does the body no good. Even worse, it fails to perform the job it set out to do, which is help the person feel better.
How to escape comfort eating? Could something as simple as a little gadget help? An electronic device with some software? Probably so. It’s certainly worth giving it a go.
Pediatricians interested in a randomized control trial are invited to contact
Robert A. Pretlow, M.D., MSEE, FAAP, at: 206-448-4414 or
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