Dr. Robert Pretlow graduated with honors from Princeton University. He received his MD from the University of Virginia Medical School, where he also did his internship and residency in pediatrics. He is board certified in pediatrics and is a fellow of the American Academy of Pediatrics. He has a Master of Science in electrical engineering from Old Dominion University.
Dr. Pretlow has published 15 articles, has been awarded 5 U.S. patents, and has presented 46 abstracts, keynotes, plenaries, panels, and tutorials at national and international conferences. He lectures frequently on childhood obesity in adolescents and teens and the use of the Internet in medicine.
Dr. Pretlow is founder and director of Weigh2Rock, an online weight loss system for teens and preteens, used by clinics, schools, private practitioners, hospitals, community centers, and health clubs, worldwide.
He has two children, a boy and a girl.
Key articles by Dr. Pretlow
British Journal of Nutrition:
Interview with Dr. Robert A. Pretlow on Food Addiction
The following interview was conducted by Childhood Obesity News head blogger Pat Hartman:
One school of thought is in favor of healthy choice eating, with the emphasis on health, but seems averse to any suggestion that obesity should even be mentioned. What are your thoughts on that?
Dr. Robert Pretlow (RP): I wholeheartedly agree that healthy nutrition and a healthy relationship with food are of paramount importance in children. And, I absolutely agree that we must be very diligent to de-stigmatize obesity. It is like any health problem – an injured arm or a skin malady – it is treatable and preventable. But…saying “it’s not about fatness or bodies, it’s about health,” is along the same lines as the debate about being “fat and fit.”
Okay, what is it about?
RP: Excessive body fat is definitely a medical problem in children, and is associated with type 2 diabetes, polycystic ovarian syndrome, high blood pressure, pseudotumor cerebri, bowing of leg bones, fatty liver disease, cardiovascular risk factors, and joint problems. Furthermore, aside from substantial self-esteem effects, obese kids also are not able to move as they would like, not able to fit in amusement park rides, and not able to fit in stylish clothing. The kids, who post on the weigh2rock.com site, agonize openly about these effects every day. Obesity is a separate issue from nutrition and appears to result from an addictive dependence on unhealthy food.
Your research on childhood obesity came straight from the source, the kids themselves, communicating with and through your Weigh2Rock website, which has now been in operation for more than 11 years — how did it start?
RP: It started with an idea that the Internet could be used to help providers monitor and manage their patients (eCare). I created an open access website where overweight kids could learn about overweight health issues and weight loss strategies and receive online support from other overweight kids. Over 30,000 children and teens have posted more than 135,000 bulletin board messages and in excess of 1300 days of chatroom transcripts. After reading only a few thousand of the messages, I realized that childhood obesity intervention efforts were going in the wrong direction.
Once the Weigh2Rock project was underway, did anything surprise you?
RP: The online support community idea tapped into something extraordinary. Not only did overweight and obese kids have an enormous need to anonymously obtain information and communicate with others with the same problem, the site also opened up a vast knowledge base of what overweight kids think and feel about their problem, which they will simply not reveal in the real world.
And it seems one of the things they revealed, is that in many cases, their attachment to eating, their inability to resist certain foods, their behavior surrounding food, all of these things are so much like addiction, you can’t tell the difference.
RP: I’m convinced that the food addiction paradigm is the overwhelming cause of the childhood and adult obesity epidemic. It’s not every food, but mainly highly pleasurable foods like junk food and fast food.
Do you agree with the school of thought, that says the addiction-prone personality is the primary cause, and the substance is secondary? Will addiction-prone people always find something to get addicted to?
RP : I think every brain is addiction-prone. It’s the brain’s way of shielding from emotional pain. Some people are simply more sensitive or less able to tolerate that pain, which may be genetic. The same is true for displacement activity, such as nail biting, hair pulling, hangnail picking, and eating. It’s a characteristic of all brains, including animal brains. Some animals and people are just more anxious (nervous).
Is addiction-proneness in the personality, or is there a physical basis for it? Is addiction caused by something in the organism itself that is defective or insufficient or badly regulated?
RP: Everything is genetic and, in that sense, addiction proneness is hardwired. Nevertheless, traumatic life experiences, such as child abuse, sexual abuse, dysfunctional families, etc., definitely add to the brain’s need to shield from emotional pain, i.e. addiction and displacement activity.
If it is something physical, then how can it be corrected? What is the secret to fixing humans so they are born without a propensity for addiction, and don’t develop one?
RP: It’s probably not a physical defect that can be fixed, anymore than excessive anxiety is a physical defect that can be fixed.
Why do some people not succumb to any addiction? What’s their secret? Is it in the body or the mind?
RP: If you knew that, you’d be famous forever! Why do some people not bite their nails? It probably has to do with heading off the addiction or displacement behavior habit early, before it’s deeply entrenched in the brain. A girl may stop biting her nails at the first sign because she’s afraid of getting germs or not looking cool. But if she had the habit for years, it will take major effort and time to change the brain’s pattern. The same is true for addiction. Most of us are averse to drinking alcohol a lot or taking drugs. Thus our brains never develop the changes that make it super difficult to stop. If you were exposed to heroin every day for a year, you’d definitely experience significant unpleasant withdrawal symptoms when it was discontinued.
It almost seems as if a physical basis for addiction is the only hope for being able to do anything about it. Because if it’s all psychological, all in the “addiction-prone personality,” then there’s not much that can be done, human nature being what it is.
RP: Motivation is the key to change. A plastic surgeon told me about a patient, whose severed finger he reattached. The man was a heavy smoker and had tried for years to stop, and was not able to quit when the surgeon ask him to quit for the sake of his reattached finger. The surgeon finally told the man that if he didn’t stop smoking there was a 100% chance that he would lose his finger. The man promptly quit smoking and had not restarted at last report.
It kind of looks like, if the problems that lead to food addiction or any addiction are to be solved, every family would have to become fully functional, with parents who have both the will and the skill. Making that happen is a big job.
RP: Unwanted, unloved kids will be an eternal cause of everything from psychologically damaged people to people who are desperate because they can’t stop eating.
It’s tempting to think, let’s make a rule, the government could compel all prospective or new parents to take a Parent Effectiveness Training course. But we already have stuff like that. For instance, when domestic situations are so out-of-hand that a court intervenes, people are ordered to take anger management courses and the like. Does it make an appreciable difference?
RP : Probably not.
What do you see as the best hope for treating obesity in children and teens?
RP: Residential treatment centers, which I feel are much preferable to, for instance, bariatric surgery. A 12-step program in a residential setting doesn’t have the negative life-changing side effects, and is not quite as expensive.
Any parting words?
RP: A recent article in Pediatrics said the global approach to childhood obesity “has shifted from treatment to prevention.” It’s pretty sad that the current generation has essentially been written off. We absolutely must get the substance dependence approach noticed.