Childhood Obesity News has been taking a closer look at what happened when two different groups of obese young people participated in trials of Dr. Pretlow’s W8Loss2Go smartphone application. Dr. Pretlow outlined the process in an earlier post, remarking that challenges arose in the recruitment of participants despite the fact that they were offered compensation in the form of free use of a snazzy new iPhone during the four-month study, plus $50 per month. These incentives were in addition to the central prize — what should have been an eagerly-seized-upon opportunity to bring their weight down into the healthy range.
The challenges didn’t end there. Despite filling out motivation questionnaires, in which participants seemed to indicate maximum enthusiasm and to justify the expectation of enthusiastic cooperation, there were obstacles. Childhood Obesity News talked about some of them last time, in light of the fact that most applicants rated their unhappiness with their overweight condition as 10 on a scale of 1 to 10.
But as it turned out, many of the participants resisted various aspects of the W8Loss2Go program — particularly the part about, you know, eating less. The need to eliminate major problem foods was met with anger, as was the necessity to cut the total amount of food eaten. The reluctance to eat less was so pronounced, it caused several kids to drop out of the study.
Surely, the need to reduce food amounts should come as no surprise to anyone over the age of, say, 5. But let’s move on to the exit questionnaires completed by the 27 Seattle participants who went the distance with the second study. This set of questions asked for ratings from 1 to 5, with 5 being the highest.
In answer to the question, “Why did you choose to participate in this study?” “The money” got an average rating of 3.07; “To use an iPhone for free” got 2.56, and “To lose weight” got 4.48, which is pretty darn close to 5, or the highest possible rating. Yet resistance was apparent during the trial of the application.
There was also a category of answers characterized as “other,” and the kids were asked to expand upon their choice of “other” as a reason. One person mentioned hoping for a boost in confidence and mood, and another the possibility of learning how to eat better even if weight loss wasn’t a result. More than one mentioned the novelty of the approach as appealing, and one liked the idea of convenience.
But those answers do not provide clues to why some kids, especially the dropouts from the study, demonstrated such strong resistance to the necessity of reducing the amount of food consumed. There are low-calorie foods that can be eaten in generous servings. In the study, the child’s separation from problem foods is gradual, one problem food at a time.
Were they expecting some hitherto undiscovered magic that would render calorie count irrelevant? If obese young people are as unhappy as their motivation surveys indicated, where does all the resistance come from? “Obviously,” says Dr. Pretlow, “something else is going on” — and as readers of Childhood Obesity News know, that something is food addiction. Dr. Pretlow writes:
Withdrawal symptoms (grouchiness, depression), tolerance (needing to eat more and more), loss of a coping mechanism, and losing food’s pleasure as their main relief from emotional pain are likely factors. Moreover, as with other addictions, obese youth may be compelled to overeat just to feel normal.
Just as a heroin addict learns to accept the trade-off of chronic constipation, or a meth addict becomes comfortable with tremors, lousy skin, and cracked teeth, a mere detail like weighing 300 pounds may seem inconsequential compared to the compulsion of addiction. Food addiction is the reality that W8Loss2Go was designed to avoid or overcome, but as the classic 12-step paradigm has it, the program doesn’t work unless you work the program.
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Image by Jesse Jacobson