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    Obesity and the Built Environment

    July 25th, 2014

    Temptations

    Why can’t some children resist temptation? Why can’t most of them understand that it’s better to have a larger reward later than a smaller reward now? Why is it that, for some kids, whatever goes in the eyes (like a TV commercial for junk food) also goes into the mouth? Appetitive traits arise from both genetic and environmental influences. A National Institutes of Health report on appetitive traits in children says:

    In this paper we describe the results of new studies using behavioural tests and psychometric questionnaires in large samples to show that individual variation in these appetitive traits relates to body weight throughout the distribution. We also describe twin studies and genetic association studies supporting a strong genetic component to appetite.

    It might be useful to have a notion of what psychologists and social scientists mean by “built environment” and “social environment,” which are often set in opposition to each other, although closer examination reveals a fuzzy borderline. Dr. Mia A. Papas, of the University of Maryland School of Medicine, is a pediatrician concerned with the many ways in which diet, exercise, and the environment interact. She says:

    The built environment encompasses a range of physical and social elements that make up the structure of a community and may influence obesity…. [T]he environment can be thought of as “all that is external to the individual,” with the term “built environment” encompassing aspects of a person’s surroundings which are human-made or modified, as compared with naturally occurring aspects of the environment.

    But wait, isn’t the built environment assumed to be a separate phenomenon, in contrast to the social environment? Yet here is a scientist saying that social elements are part of the built environment, and the real contrasting element is the natural world of soil, plants, rocks, and weather.

    Dr. Papas goes on to enumerate ways in which the built environment impacts human health. What happens when we always walk on cement and never on grass? What about those thousands of chemicals we absorb every day? The built environment also encompasses more tangible things, such as “housing, urban development, land use, transportation, industry, and agriculture.” The “food desert” concept, for instance, comes under the heading of the built environment.

    Dr. Papas led a meta-study whose team first scoured through hundreds of scientific abstracts to find articles about suitable studies whose data, taken together, would clarify some points. They ended up with 20 applicable studies, but only three concerned children. (The great majority chose subjects from among adolescents and/or adults.) From this scant evidence they formed a not very surprising conclusion: Younger children are more influenced by their immediate environment, and teens are more influenced by the larger built environment.

    Where it gets complicated

    Often, the built environment can’t be changed. In other cases, it can be changed at great trouble and expense, including participation from the social environment in the form of, for instance, protest groups who have their own reasons for not wanting the built environment altered in that particular way. Before exerting influence to change some part of the built environment, it’s important to understand why it matters, and to hold a reasonable degree of certainty that the change will actually have some impact on childhood obesity.

    Researchers look, for instance, at children’s proximity to fast food joints and/or health food retailers. They ask how the kids get to and from school. They also look at the proximity of parks and open spaces where kids can engage in physical activity. Dr. Papas’s team found that kids in poor neighborhoods live closer to playgrounds, which should be something to cheer about. It certainly sounds good on paper.

    But therein lies the trouble with a lot of studies. The factors they try to measure, and the problems that arise when the researchers have to line up data from studies conducted by various individuals from different institutions at different times, and fit it together somehow — it gets kind of crazy. We can count the number of playgrounds in a neighborhood, but what if no children play there, because the park is a hangout for gang members? The measurement becomes meaningless. This is the sort of conundrum that can make these studies so frustratingly uninformative.

    Your responses and feedback are welcome!

    Source: “Appetitive traits in children. New evidence for associations with weight and a common, obesity-associated genetic variant,” NIH.gov, 07/25/09
    Source: “The Built Environment and Obesity,” OxfordJournals.org, 05/28/07
    Images by theimpulsivebuy

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    CBT and Appetitive Traits

    July 24th, 2014

    Yella Mella Macra

    Childhood Obesity News has been looking at the different varieties of cognitive behavioral therapy. The biggest stumbling block, in these or any modalities, is longevity. Something may work for six months or a year, or while attention is focused on the problem – in other words, as long as meetings with a therapist continue. The difficulty is that, left to their own devices, many patients will revert to their old ways.

    In the long term, what messes things up is the difficulty of extinguishing appetitive traits. Whether these traits are inborn or developed in the earliest stages of life, to counteract them it is necessary to cultivate really strong, enduring new habits. The National Institutes of Health website mentions this in connection with the ways in which people respond differently to the “obesogenic environment,” saying, “One plausible mechanism for this variation is the early expression of appetitive traits.”

    These appetitive traits are specific vulnerabilities linked to eating behavior and physical activity preferences. One vulnerability is impaired satiety responsiveness, the failure to recognize and respond to internal “enough”signals. Another appetitive trait is high responsiveness to external food cues, encapsulated in the old saying, “I can resist anything except temptation.” This is one reason why corporations are under fire for the way in which they advertise products to children. The temptation-resistance mechanisms of little kids are undeveloped, and they don’t have the wisdom or life experience to recognize flagrant nonsense when they see it.

    “High motivation to eat” is an appetitive trait, which was characterized in the old days simply as “gluttony” and categorized as one of the seven deadly sins. Then there is impulsivity, which manifests in the inability to postpone an immediate reward, even if a greater reward is promised for the future.

    Remember a much-cited study from the 1970s, the “Marshmallow Test”? Kids were given a choice between one marshmallow now, or two marshmallows in a few minutes. Some figured out clever ways to restrain themselves, and a follow-up study showed that the self-binders did better on their SAT scores and had more success in avoiding recreational drugs.

    More recently, University of Rochester researchers wanted to know more about the rational process involved in making decisions when the stakes are short-term versus long-term rewards.

    Doctoral candidate Celeste Kidd was lead author of the study, and the co-author was Dr. Richard Aslin, who teaches brain and cognitive sciences. Kidd references the children’s “belief about the practicality of waiting,” though it is unlikely that children so young could identify or verbalize such a belief. But from a very young age, we have all internalized beliefs about the practicality of waiting and about many other things, even if we can’t articulate them.

    The Marshmallow Test revisited

    The experimenters set up a mini-world in which a child is offered the chance to use a small, grungy set of crayons now, or a splendid set of art supplies in a little while. Some wait for the better art supplies. But this isn’t the experiment, yet. This is only the setup. Pretend you’re a kid who dutifully waited for the fancy set of markers, only to be told by an apologetic grownup that the nice art supplies can’t be found, but you can still color your picture with the grungy crayons.

    An innate sense of unfairness kicks in. Even if you can’t clearly articulate your thoughts, they go something like, “Wait a minute. I met the challenge, I was good, I waited. And now I don’t get the reward? To heck with that. When the next opportunity comes to have a small reward now or a big reward later, I’m gonna be a YOLO kind of kid, and delayed gratification can go jump in a lake. Carpe diem!”

    And then the researchers did the marshmallow test, and found out that the kids who had been disappointed about the art supplies were less likely to opt for delayed gratification in the marshmallow test. The trust bond had been broken, and now they knew they lived in an unreliable environment, one in which promises are not always kept and virtue is not always rewarded. They went for one marshmallow now instead of two marshmallows later. Celeste Kidd says:

    Delaying gratification is only the rational choice if the child believes a second marshmallow is likely to be delivered after a reasonably short delay.

    Dr. Aslin adds:

    If they’re in an environment in which long-term gain is very rare, well then it makes perfect sense for them to behave impulsively, because that’s going to maximize their reward.

    Your responses and feedback are welcome!

    Source: “Appetitive traits and child obesity: measurement, origins and implications for intervention,” NIH.gov, 08/20/08
    Source: “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents,” NIH.gov, 04/01/12
    Source: “The Marshmallow Study Revisited,” Rochester.edu, 10/11/12
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    Varieties of Cognitive Behavioral Therapy

    July 23rd, 2014

    [plastic toy man speaking to computer: "So this operating system... Does it tell you to do things?"]]

    In the short term, many obesity interventions achieve an encouraging degree of success, but a year or five years later, a follow-up shows a different picture. As Childhood Obesity News has described, cognitive behavioral therapy or CBT is designed to promote behavioral change by breaking negative cycles of behavior and restructuring harmful patterns. To fulfill the needs of the all-important long term, a program must support behavior maintenance over time, and minimize the incidence of relapse. To do all that, it must somehow extend its sway beyond the individual and include other domains — the family, peer network, and community.

    CBT is such a useful therapeutic modality that it has evolved into another stage, characterized as “enhanced” and identified by the acronym CBT-E. About two-thirds of the clients who opt for it are said to have benefited, at least in the short term. It aims to change maladaptive behaviors and negative pathology, and especially to teach strategies for the prevention of relapse. The Counselling Directory defines CBT-E as a “transdiagnostic” treatment, describing it as:

    …an approach comprehensive enough to be applied irrespective of differential diagnosis and appropriate for the mixed patterns of difficulties that people with eating disorders typically experience over time…. It is a structured, tailored form of one-to-one talking therapy in which you and your therapist work together as a team. It focuses on helping you change your eating behaviours now and in the future (it does refer to the past but does not centre on it).

    CBT-E was created to address the roots of an eating disorder, whether it manifests as insufficient eating, as in anorexia nervosa, or excessive eating, as in binge eating disorder. That is the “transdiagnostic” part. In addition, the therapy developed branches. In CBT-Ef, the “f” stands for “focused.” It targets the eating disorder psychopathology, and is considered the “default” version.

    Then there is CBT-Eb, where the “b” stands for “broad.” It addresses the same issues and also incorporates additional focus on external factors. The directory explains:

    In particular, patients with low self-esteem, poor mood-regulation strategies, high interpersonal problems, and high levels of clinical perfectionism are well-suited for CBT-Eb, in which these four core features are targeted.

    In any case, 20 weekly outpatient sessions are usually recommended, stretching over five months. Anorexia nervosa seems to be a tougher case, with 40 weekly sessions recommended. The roots of eating disorders are found among the individual’s core beliefs, especially those related to the over-evaluation and control of the person’s weight and body shape. These unhealthy core cognitions or beliefs are what cause maladaptive cognitive and behavior patterns, and those patterns maintain the eating disorder in whatever form it takes. A succinct definition that sums it all up can be found in the “Eating Disorders Glossary”:

    Cognitive behavioral therapy (CBT) and Enhanced Cognitive behavioral therapy (CBT-E): A relatively short-term, symptom-oriented therapy focusing on the beliefs, values, and cognitive processes that maintain the eating disorder behavior. It aims to modify distorted beliefs and attitudes about the meaning of weight, shape and appearance which are correlated to the development and maintenance of the eating disorder.

    Your responses and feedback are welcome!

    Source: “What are CBT-BN, CBT-BED and CBT-E?” CounsellingDirectory.org.uk, 08/08/13
    Source: “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents,” NIH.gov, 04/01/12
    Source: “Eating Disorders Glossary,” feast-ed.org, undated
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    Cognitive Behavioral Therapy: Family-Based or Not?

    July 22nd, 2014

    [close-up of scale]

    In the areas of weight management and eating disorders in kids and teens, several different components are involved. Negative behavior cycles need to be broken, and patterns need to be restructured. Some behaviors need to be eliminated, and others put in their place. Equally important is the long-term maintenance of both elements — the permanent extinction of some behaviors and the perpetual repetition of others. If all this can be accomplished, the likelihood of relapse is minimized.

    Two major problem categories are anorexia nervosa (AN) and bulimia nervosa (BN). Cognitive behavioral therapy achieved some early successes with those. Basically, all eating disorders have something in common — a constant concern with food, eating, and weight. AN and BN are about the obsessive need to eat less and weigh less. Even though it seems on the surface to be the diametrical opposite, BED or binge eating disorder leading to obesity comes from the same roots – constant concern with food, eating, and weight. BED is included, along with some other diagnoses, in a category dubbed EDNOS, or “eating disorder not otherwise specified.”

    It looked promising

    Ten years ago, the United Kingdom’s Health Development Agency (using sources from everywhere) issued a report called The Management of Obesity and Overweight. Authored by Caroline Mulvihill and Robert Quigley, the report was subtitled “An analysis of reviews of diet, physical activity and behavioural approaches.” Among many other useful explorations of the literature, it offered a comparison between behavioral modification programs that were family-based and those that were not family-based. Reviewing family-based modalities that had been tried so far, the researchers wrote:

    These programmes included behaviour modification, dietary and exercise education, with a mix of sessions involving the child, parent(s) and, in some cases, the entire family. The review concluded that while some findings appear promising, the small size of some of the studies and the disparate nature of the interventions mean there is ‘at present insufficient evidence to recommend any specific programme’.

    Although family-based programs were regarded favorably, there was not at the time enough solid evidence for the authors to recommend any specific one. They also looked at reports about behavior modification programs without parental involvement – well, one, actually, because that’s all they could find in the literature, and it involved kids from 9 to 19 years of age. The report says:

    This compared a three-part cognitive–behavioural ‘obesity-training’ programme combined with a calorie-reduced diet and an exercise programme, against a group that received the same diet and exercise component but received muscle relaxation training instead of the psychological component. The intervention lasted for six weeks. Both groups significantly reduced their percentage overweight over the course of a year. No statistically significant differences were found between the two treatment groups.

    Progress

    Almost a decade later, the U.S. National Institutes of Health issued a report titled Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents. Despite the development of successful treatment programs, relapse and non-recovery still were prominent occurrences. In fact, AN patients were noteworthy for dropping out before the end of the structured treatment programs, and because of non-completion, could not even be counted in the relapse vs. non-relapse statistics.

    Family-based behavioral treatment for obesity still looked promising because of short-term successes, but once the intervention was over, patients would revert to old behaviors and gain weight. Families are especially crucial because for the most part children and youth cannot avoid living with them. For a kid, the family home and the people in it are the most significant and influential features of the environment, and if they don’t change, the outcome of any intervention that involves only the child is apt to be dismal. The report puts it this way:

    The persistence of weight-related problems may occur because environmental stimuli, which had fostered the previously learned, maladaptive behaviors, have not been modified.

    This is reminiscent of a famous quotation attributed to Albert Einstein (though he probably didn’t say it), the one about how doing the same thing over and over again, and expecting different results, is the definition of insanity.

    Your responses and feedback are welcome!

    Source: “The Management of Obesity and Overweight,” Prevenzione PDF, October 2003
    Source: “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents,” NIH.gov, 04/01/12
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    Cognitive Behavioral Therapy for Eating Disorders

    July 21st, 2014

    [top ten fitness facts related to the benefits of exercise on the brain, stress and energy levels, and overall health]

    The National Institutes of Health website offers a succinct definition of Cognitive Behavioral Therapy and its usefulness:

    CBT is the most established psychological treatment for BN (bulimia nervosa) and BED (binge eating disorder), with demonstrated efficacy over pharmacological and other psychological therapeutic options. The goal of treatment is to identify, monitor, and tackle the cognitions and behaviors that maintain the disorder while heightening the motivation for change.

    CBT is said to have “accumulated one of the largest bodies of research evidence in any psychological field.” Its techniques have been around for at least 20 years, subjected to constant refinement, and adapted to more and more situations, as it becomes clear that the various types of eating disorders are fundamentally more alike than different.

    There was a period when a lot of attention centered around AN (anorexia nervosa), BN, and EDNOS. Actually about 70% of problems came under the last heading, which stands for “eating disorder not otherwise specified,” including not only binge eating but other behavior patterns close to, but not exactly aligned with, the official descriptions of AN and BN. What they all have in common is the patient’s constant preoccupation with food and body weight, along with the potential for alleviation by CBT which, while not universally successful, seems to be the best hope so far.

    Another trait shared by all eating disorders is the possibility of permanent damage to the individual’s health, which is also true of obesity. Since the explosion of the childhood obesity epidemic, the world is full of children who have joined the risk pool for developing serious lifelong conditions like metabolic syndrome, Type 2 diabetes, and heart disease. Obese kids are also in danger of going too far in the opposite direction and sliding into other kinds of eating disorders like AN or BN.

    As Childhood Obesity News has discussed, there seems to be a set of core cognitions (or what Dr. Bryan P. Walsh simply calls unhealthy beliefs) associated with the risks that obesity brings. They are “body dissatisfaction, dietary restriction, overvaluation of weight and shape, negative affect, and low self-esteem,” according to researchers in the CBT field.

    The National Obesity Observatory in the United Kingdom has identified four major areas that must be addressed — behavioral, biological, psychological, and social. Experts there arrived at the conclusion that it is more effective to concentrate on psychological factors than to focus specifically on weight loss.

    In both Britain and the U.S., there are not enough practitioners to go around, so entrepreneurial professionals are busy modifying CBT into a self-help modality available via electronic devices. Overweight youth are best served by interventions whose behavioral components modify both activity and diet. The NIH website says parents take an active role in this:

    Parents are also encouraged to utilize a behavioral reward system, in which successful goal completion (e.g., weight loss, reduced caloric intake, increased physical activity) is reinforced with rewards that are interpersonal and/or promote healthy behavior (e.g., family outings, bike riding, ice skating).

    The page also discusses family intervention strategies, centered around self-monitoring and stimulus control, which is a fancy way of saying “don’t keep potato chips and ice cream in the house.” Since parental success with weight control is a strong predictor of success in the kids, parents are strongly urged to step up and be excellent role models.

    Your responses and feedback are welcome!

    Source: “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents,” NIH.gov, 04/01/12
    Source: “What are CBT-BN, CBT-BED and CBT-E?” CounsellingDirectory.org.uk, 08/08/13
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    Behavioral Economics and School Lunches

    July 18th, 2014

    [graphic of people being served at a cafeteria]

    When a human is unhappy with the way things are going, three courses of action are possible: change other people (usually frustratingly futile), change oneself (difficult to varying degrees), or change the environment. Sometimes modifying the environment can be astonishingly effective, as a science called behavioral economics has shown when applied to school lunches.

    School districts across the country are caught between a rock and a hard place. The meals they provide have to meet nutritional standards, which often means spending more money. If the food is so unfamiliar that kids don’t even want to try it, or if they try it and don’t like it, the school loses money. When schools have to discontinue the popular items that kids are willing to pay for, they lose even more money. But David R. Just and Brian Wansink, writing for Choices magazine, explain how this problem can be managed:

    By using tools that will both increase the sales of more nutritional foods and decrease the sales of less nutritional foods, behavioral tools can achieve nutritional goals while having a minimal impact on the bottom line.

    What tools are they talking about? Simple rearrangement, for one. The authors describe a Minnesota school where kids waiting to pay for their lunches had ample leisure time to contemplate an array of chips, snacks, and desserts. Placing such attractive nuisances at the checkout station is a familiar tactic used by grocery stores to encourage impulse buying. But in a school cafeteria setting, it is inappropriate and counterproductive. So Just and Wansink moved the junk food and placed fruit in that location, which increased not only the amount of fruit the kids bought, but the amount of it they actually ate.

    At a middle school in New York state, moving the salad bar had a noticeable effect on the popularity of salads, and not just because of the novelty. Salad sales remained strong. Changing the physical environment can also help to discourage the consumption of high-calorie, low-nutrition items. Research has shown that keeping the lid of an ice cream freezer closed can cut ice cream sales to students in half.

    The basics

    This method of helping kids develop good eating habits employs two simple principles: reactance and self-attribution. Reactance stems from a natural resentment against coercion, inspiring a spirit of rebellion that does not bode well for long-term behavioral change. Sure, we can stop kids from eating cookies at lunch by refusing to offer them, but the heavy-handed approach only guarantees the consumption of more cookies after school. It’s more effective in the long run to tuck the cookie machine away in a lightly trafficked area of the building. If soda vending machines have to be present, they too should be exiled to an out-of-the-way spot.

    Self-attribution is the dignity of making one’s own decisions, and parenting courses emphasize its importance even with very young children. “Do you want some corn for supper?” might be met with resistance. “Which would you rather have — corn or peas?” is a question that can produce amazing results. The child is so jazzed about having a choice, and making a choice, that the reality of eating a vegetable is of secondary importance. It works for older kids, too. When a school rule requires a kid to put a vegetable on the plate, only about a third of those vegetable servings actually get eaten. When there are two or more choices of vegetable, the likelihood of actual consumption increases. The authors write:

    [T]he object of using behavioral economics in school lunch rooms is to guide choices in a way that is subtle enough that children are unaware of the mechanism. These subtle changes often have the advantage of being relatively cheap and easy to implement…. To preserve choice, we will necessarily have to allow some individuals to purchase items that are less nutritious. But we can make these choices less convenient or less visible.

    Find out more about these theories and their implementation at SmarterLunchrooms.org.

    Your responses and feedback are welcome!

    Source: “Smarter Lunchrooms: Using Behavioral Economics to Improve Meal Selection,” ChoicesMagazine.org, undated
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    Obesity and Various Therapies

    July 17th, 2014

    [animated image of thin boy on diving board expanding to obese proportions]

    Attention modification training (AMT) has been employed with children before, to treat anxiety and a number of other mental health issues. One of its most important uses is the treatment of substance abuse problems. Since food is a widely abused substance, AMT offers hope in the effort to end childhood obesity. Perhaps the most startling thing about a recent study is the implication that a single session of attention modification can make a significant difference in behavior.

    The AMT study was carried out by the UC San Diego School of Medicine. Lead author Kerri Boutelle, PhD, believes that AMT training, based on classic Pavlovian conditioning, could be provided in the form of a computer game. The subjects in the exploratory study were 24 kids between 8 and 12 years of age, all overweight or obese, divided into two groups. PsychCentral’s senior news editor, Rick Nauert, describes how the study worked:

    One group underwent an attention modification program (AMP) in which they watched pairs of words quickly flash upon a computer screen. One was a food word, such as “cake;” the other was a non-food word, such as “desk.” After the words had flashed and disappeared, a letter appeared on-screen in the place of either the food word or the non-food word.

    The viewing child was asked to immediately press the right or left button associated with the letter’s location…. The AMP trained attention away from food words because the letter always appeared in the spot of the non-food word while in the other group, the condition trained attention was split with the letter appearing half of the time in the food word location and half in the non-food word location.

    Although obesity obviously has multiple contributing factors, the theory behind AMT says that a major factor is “an abnormal neurocognitive or behavioral response to food cues.” Some people are inherently oversensitive to food cues, but they can be turned around. These researchers believe that the victim can be trained to ignore or disregard specific cues so their problematic nature is neutralized.

    Two-way street

    Mental health disorders can lead to obesity, just as obesity can cause mental health disorders. It is also apparent that the longer a person has been obese, the more difficult reversal is. This is one reason why so much emphasis is placed on early intervention. When people get older, behavioral therapy still has a chance, although as Dr. Pretlow says, “Overeating needs to be addressed much deeper.” To get to the root causes of obesity in an individual is obviously vital. But the world simply doesn’t have the resources to provide years of talk therapy for every morbidly obese person.

    There is definitely a place for “interventions that break maladaptive behavior patterns before they become ingrained.” Adolescents with eating disorders who participate in cognitive behavioral therapy have higher recovery rates than adults, says the National Institutes for Health. When symptoms have existed for a shorter time, with less severity, treatment has a better chance of success.

    One of the first things any behavioral therapy has to do is identify what behavior is modifiable. For most people, it is totally possible to increase their physical activity, to drink more water, to limit their sedentary time interacting with computers, and to consume more vegetables and fruits. Dr. Bryan P. Walsh wrote:

    We become what we think about all day long. If you want to be skinny or more fit, you need to act lean, feel lean and do the things a fit person does. The more you feel, experience, and act as if you have already achieved your goals, the more likely the goals will become your reality. True, this can be very difficult to do, but if you do not have the right attitude for fat loss, you won’t achieve fat loss.

    In ending addiction, 12-step programs have a well-deserved reputation for efficacy if, as the saying goes, the person works the program. Still, they are not the only way out. There have always been people who managed somehow to do it on their own with a “fake it till you make it” strategy. It isn’t easy, but it’s like an acting job. You act like a person who doesn’t eat sugar, until you become a person who doesn’t eat sugar.

    Acknowledging rules takes strength and so does following them by rote. Sometimes people never get to the root causes of their addictions, but succeed in escaping from them anyway. Success is much more likely when basic problems are discovered and addressed.

    Your responses and feedback are welcome!

    Source: “Attention Training Helps Kids Avoid Obesity,” PsychCentral.com, 02/17/14
    Source: “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents,” NIH.gov, 04/01/12
    Source: “The Missing Fat Loss Manscript,” FatIsNotYourFault.com, 2010
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    Kellogg — Good Corp, Bad Corp

    July 16th, 2014

    [Kellogg World Headquarters]

    Kellogg World Headquarters in Battle Creek, Mich.

    Previously, Childhood Obesity News considered the strange split personality of Kellogg. The corporation has donated money and support to a lot of good causes. For instance, FoodCorps (part of AmeriCorps) is an organization with more than 100 local groups in 31 states. It subsidizes 50 workers, by paying them stipends, to work on projects to reduce childhood obesity and increase access to healthful food. FoodCorps is supported by $2 million in private funding, much of which comes from the W. K. Kellogg Foundation. According to Nancy Knoche’s reportage for Nonprofit Quarterly:

    At the same time however, a group of corporate agricultural businesses and farms will be spending fifteen times as much–$30 million–on a public relations campaign to show that they are “committed to provide healthy choices.”

    And isn’t Kellogg one of them? Isn’t Kellogg one of the corporate agricultural businesses that spends a fortune on public relations and lobbying to ensure that the government does not make too many rules about what they may advertise to whom?

    For Time, Alice Park reported on online “advergames,” which she characterizes as insidious. Every month, about 1.2 million kids enjoy puzzles and arcade-like games while exposing themselves to the constant presence of company logos and the unremitting psychological pressure to express gratitude to the company by buying and consuming its products. In fact, some features of the games are not accessible unless junk food is bought.

    The effects

    A research team began by studying the online presence of corporations that had voluntarily pledged to abide by the Better Business Bureau’s CFBAI, or Children’s Food and Beverage Advertising Initiative. While they may have cleaned up their act in regard to television advertising, they were still working hard to capture the attention and brand loyalty of kids through advergames. Kids in one study spent 88% more time on advergame sites than on other Web pages.

    But that was only part of the research led by Dr. Jennifer Harris, director of Rudd Center for Food Policy & Obesity, who worked with 152 kids between 7 and 12 years old. It was set up so each child would play two randomly assigned games, with a snack break in between. The available foods included grapes and carrots, and processed fruit snacks, cookies, crackers, and chips. Of course every move was watched and recorded, and the children were questioned about their fondness for the various foods and their beliefs about the foods’ healthfulness. Park writes:

    Harris and her colleagues chose two advergames featuring unhealthy foods, two featuring healthy foods, and two control games that didn’t include advertising for any products…. The children who played the healthy advergames designed by Dole ate as much of the unhealthy foods as the youngsters who played the unhealthy advergames, but they also ate 50% more grapes and carrots than the unhealthy game players.

    So, one thing the healthy games did was to make the subjects more likely to overeat — but at least some of the calories they consumed also contained nutrients. But wait, there is more:

    The children playing the unhealthy advergames for PopTarts [made by Kellogg] and Oreos, however, ate 56% more unhealthy snacks compared to those playing the healthy games, and 16% more compared to those in the control group. These youngsters also ate less fruits and vegetables than children playing either the healthy or control games.

    The researchers concluded that advertising embedded in the games influenced children to choose junk food and reject healthful food. But though Kellogg can be extensively implicated, the most egregious example originates with another company that makes candy and promotes a game called Mystic Chewie whose slogan is “I Predict You’ll Be Hooked.”

    In Britain, when accused of harboring 14 advergames on its website, Kellogg slid through on a technicality. Only kids in Canada, where the rules are not so strict, are supposed to access that website. Kellogg’s nominally British website only offered one game, which promoted a government-approved product. Not amused by such hair-splitting, the Local Government Association (to which the UK’s 400 local councils all belong) became inspired to crack down on loopholes and, at the very least, require health warnings on Internet advergames.

    On the other hand, Kellogg is kind enough to offer online visitors an ingenious tool that consumers can use to identify which of its products contains the most sugar, as well as the most fat, salt, fiber, or calories.

    Your responses and feedback are welcome!

    Source: “Waging a Battle against Obesity – Young Leaders vs. Corporate Interests,” NonprofitQuarterly.org, 08/26/11
    Source: “Can Online Games Influence What Kids Eat?” Time.com, 01/10/12
    Source: “ ‘I Predict You’ll Be Hooked’- Makers of sugary foods exploiting loophole to target kids with free internet ‘advergames’,” Mirror.co.UK, 03/22/14
    Source: “Taste the Possibilities,” Kelloggs.com
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    Childhood Obesity and Unanswered Questions

    July 15th, 2014

    [two brothers looking at a tablet computer]

    A few years ago, European countries tried something that seemed to work for a moment in time, then fell apart. Kellogg was one of the giant companies, along with Coca-Cola and McDonald’s, that made a voluntary pledge to not market unhealthful food products “to children under the age of 12 on TV, print and internet.”

    In the United Kingdom, Ofcom is the agency that regulates the communication industry, and by a strange coincidence, it was right around that time when Ofcom banned the advertising of such foods on children’s TV programs. It’s easy for a company to promise not to do what it has been forbidden to do anyway. In mid-2010, Ofcom reviewed the results to see how the ban affected behavior, and found that in the time since 2007, children had watched 37% less junk food advertising.

    Although the voluntary pledge covered the Internet, the Ofcom ban did not, and before too long the importance of the omission became apparent, especially when mobile devices came into wide use and were owned by more and more children. Also, officials had apparently not foreseen the massive participation by children in social media. Recently Harry Wallop looked into the matter for Britain’s Channel 4 and found that at least six junk food manufacturers used Facebook to directly engage with children. He wrote:

    We created an account for a fictional child who talked excitedly about their upcoming 11th birthday on various food brand pages — no less than three brands responded positively, including Kellogg’s Krave brand of sugary cereal.

    Through the power of TV publicity, Kellogg was shamed into apologizing for reaching out to an imaginary girl whose Facebook post mentioned that it was her 11th birthday. The company promised to be more vigilant in future, but this has the earmarks of a “we had to try it” strategy, like when a sleazy business double-bills the clients to see if they are paying attention because otherwise they pay that month’s fee twice.

    Advertising is, of course, most effective when not readily identifiable as such. This is especially true when children are the target. An important exploration of advertising’s impact was “The Food Marketing Defense Model: Integrating Psychological Research to Protect Youth and Inform Public Policy,” published in 2009. Two of this paper’s authors were Dr. Kelly Brownell and social psychologist John A. Bargh, and the third was Dr. Jennifer Harris, director of Rudd Center for Food Policy & Obesity at Yale University.

    The necessity for such scrutiny becomes more glaringly obvious as time goes on. Harris had found in other research, for instance, that a child might spend as much as 20 minutes at a time playing a corporate “advergame” online. Many people find the idea of kids soaking up 20-minute commercials utterly unacceptable. Solutions have been proposed, and some of them tried. Sweden took the extreme measure of disallowing any television marketing aimed at children, and varying degrees of restriction are practiced in other places. But here is a problem — the need for even more studies measuring the results. The Food Marketing Defense Model says:

    Discourse on the relative merit of these solutions is limited … by lack of thorough evaluation, open questions regarding how food marketing affects youth, and incorrect assumptions about how to protect them against negative influences.

    Your responses and feedback are welcome!

    Source: “Food companies play games with children’s TV advertising ban,” Telegraph.co.uk, 06/12/14
    Source: “The Food Marketing Defense Model: Integrating Psychological Research to Protect Youth and Inform Public Policy,” NIH.gov, 2009
    Image by Neeta Lind

     

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    Childhood Obesity and Boredom

    July 14th, 2014

    [graffiti that reads 'boredom']

    In his examination of the life of novelist and MacArthur Fellow David Foster Wallace, D.T. Max noted, “With the help of researchers, Wallace assembled hundreds of pages of research on boredom, trying to understand it at an almost neurological level.”

    “They sentenced me to twenty years of boredom,” goes the lyric of a Leonard Cohen song. “Boredom kills brain cells,” says poet and NPR broadcaster Andrei Codrescu. According to novelist Hector Malot, “Being bored is the worst kind of sickness.” Cartoonist Ace Backwords once proposed that boredom, not hatred, is the opposite of love. Evelyn Waugh’s biographer said of him, “The thing he feared most in life was boredom.” National Book Award winner Jonathan Franzen wrote, “Boredom is the soil in which the seeds of addiction sprout.”

    Surprising results

    Last time, Childhood Obesity News referenced the recent University of Virginia study in which psychologist Timothy D. Wilson left people alone in rooms with their thoughts. He found that, given the opportunity, people confronted by the intense discomfort of boredom would relieve it by voluntarily self-administering jolts of pain.

    But that came later. At first, the experimental subjects (male and female, ages 18 to 77) were simply placed in a room devoid of distraction for 6 to 15 minutes, and it bothered them a lot more than seemed reasonable. As a variation, Wilson allowed the stimulus-free periods to be carried out at home. When the reports came in, his team learned that participants were no happier to be alone with their thoughts in their own familiar environments. Some found the boredom so undesirable, they even cheated.

    Wilson borrowed equipment from a colleague and took the experiment to the next level. Subjects were told that while in the room devoid of other stimuli, they could give themselves a mild electrical zap to the ankle. They were allowed to try it out ahead of time, so they would know what kind of sensation to expect. What happened? Judy McGuire reported for Today:

    Many people are so uncomfortable with quiet contemplation that many of them — and especially men — would rather experience minor electrical shocks than spend time alone with their thoughts.

    We also considered the known devastating effects of boredom on deaf children and youth, and learned that it can cause depression, frustration, anxiety, exhaustion, headache, muscular tension, stress, lack of concentration, and even stomach troubles and eating disorders. To varying degrees, these same problems apply to any children and teens who experience boredom.

    Dr. Pretlow suggests that often the feeling identified as boredom could be anxiety or background stress with an inaccurate label slapped on it. For teenagers especially, and particularly for boys, admitting to anxiety or stress can be tantamount to confessing weakness. Admitting to boredom, on the other hand, can make a kid feel sophisticated and superior. Dr. Pretlow is very interested in the tendency of young people to snack when there is nothing to do. He says:

    More and more in our studies it seems that overeating in young people (and probably in adults as well) is due mainly to nervous eating or boredom, rather than comfort eating (depression) or cravings/addiction.

    McGuire interviewed psychotherapist Teri Cole, who remarked that “people are endlessly self-soothing in the moment.” To escape boredom they will do anything from eating ice cream to shocking themselves with electricity. But psychotherapist Paula Carino noted that quiet time is essential to our well-being, because in it we “learn to tolerate difficult feelings and thoughts.” The good news is, what people perceive as boredom can be repurposed and made into a helpful tool. If we resist the impulse to escape from contemplative isolation, we can burrow into it and deal with those difficult feelings and thoughts. McGuire wrote:

    Cole and Carino recommend meditation for their clients, and indeed Wilson pointed out that research subjects who already practiced meditation had a much easier time with the experiment. Studies have shown that along with improving one’s powers of concentration, meditation also lowers blood pressure and revs up your immune system.

    Clearly, meditation is one of the coping skills that can help kids free themselves from the “boredom eating” habit.

    Your responses and feedback are welcome!

    Source: “Farther Away: ‘Robinson Crusoe,’ David Foster Wallace, and the island of solitude,” NewYorker.com, 04/18/11
    Source: “Shocking study: People would rather jolt themselves than be alone with their thoughts,” Today.com, 07/03/14
    Image by Julian Frost

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