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    Good News From “Eating Disorders: The Journal of Treatment & Prevention”

    November 17th, 2017


    Recently, Dr. Pretlow learned that he has received an award from Eating Disorders: The Journal of Treatment & Prevention (EDJT). His article, “Addiction to Highly Pleasurable Food as a Cause of the Childhood Obesity Epidemic: A Qualitative Internet Study,” was named one of the top 25 in the journal’s history. Dr. Pretlow’s contribution appeared in 2011, in Volume 19, Issue 4 of EDJTP.

    When the history of this publication is mentioned, please understand that it encompasses more than 1,100 articles altogether. Since it began 25 years ago, that means an average of only one piece of writing per year was chosen. The entire list can be seen at Taylor & Francis Online.

    EDJTP founder and Editor-in-Chief, Leigh Cohn, wrote:

    As the Senior Editors and I retire, we decided to create this Top 25 Articles list as a way to look back at our years with the journal. The awards and Last Words from us are in Volume 25, Issue 5.

    One of these Last Words is “Goodbye, Eating Disorders,” written by Cohn, which relates how the journal was born and recalls some of the startling revelations that the job brought to light. It came as something of a surprise, for instance, to learn how many men struggle with eating disorders, since traditionally (and stereotypically) this type of problem has registered on the public consciousness as a predominantly female issue.

    In what might be a slightly bemused tone, he says, “Inadvertently, I found myself at the epicenter of the eating disorders community.” Over the ensuing quarter of a century, that community has grown amazingly, and the growth was not free of conflict.

    Cohn writes:

    I began to question the validity of treatment and prevention studies, because I would sometimes hear terrible things about certain doctors, even though they were highly respected in academia as authors and speakers. Individuals shared horror stories about certain experiences at treatment facilities that were considered state of the art. Conversely, someone else would declare that they recovered under that same doctor or treatment center.

    Before saying goodbye, Leigh Cohn introduces the new co-editors-in-chief. One is Catherine Cook-Cottone, a psychologist who is also an associate professor at the State University of New York in Buffalo. The other is Leslie Karwoski Anderson, Director of Training and a Clinical Associate Professor at UC San Diego’s Eating Disorders Center, whose expertise lies also in editorial matters.

    As if all this were not significant enough, here is the impressive part: “The three of us have spent two years on this transition…” Many human-led enterprises could benefit from such careful preparation.

    Another feature of the current issue of EDJTP is the four-part farewell authored by all the senior editors, including Arnold E. Andersen, M.D., and Margo Maine, Ph.D. Like any specialized field, obesity can be a small world, and founding Senior Editor John P. Foreyt has crossed paths with Dr. Pretlow before, at a conference two decades in the past.

    Dr. Pretlow says:

    Dr. John Foreyt, a psychologist and Director of the Behavioral Medicine Research Center at Baylor College of Medicine in the US, spoke about the psychological causes of obesity. After his talk I asked Dr. Foreyt, “What percent of the causes of obesity are psychological?” He replied “99%.” I was shocked by his answer.

    That excerpt is from Dr. Pretlow’s opening remarks while chairing a symposium at the World Congress of Psychiatry in Berlin last month.

    Dr. Pretlow sees obesity as primarily a psychological problem that resembles an addictive process to the point where it can be successfully treated by the same modalities that work for people hooked on hard drugs. He supports the application of addiction-model methods for treatment of disordered overeating and obesity.

    Your responses and feedback are welcome!

    Source: “Goodbye, Eating Disorders,”, 11/06/17
    Source: “Eating disorders: A 25-year perspective,” tandfonline, 11/06/17
    Image: Fair Use

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    Emotional Momentary Assessment and Childhood Obesity

    November 16th, 2017


    Emotional Momentary Assessment (EMA) was developed for the benefit of researchers looking for a better way to collect data, and it helps patients, too. The particular subsets of patients we are interested in are overweight and obese children and adolescents. Once EMA had been shown to benefit adults health professionals were eager to employ it with younger people, and the signs are encouraging.

    In this kind of research, the subjects agree to perform certain actions, and everything depends on the whether they actually follow through on what they’ve signed up for. A better compliance rate means better data for the researchers and better results for the subjects, who are presumably trying to accomplish something, like an improved state of health.

    Compliance rates are influenced by comfort and familiarity with the technology. Most kids are adept at using technological devices like cell phones and activity monitors.

    When the patients are children and teens, EMA is attractive for very good reasons. It can stand alone as a treatment modality, without bringing pharmaceuticals into the picture. Also, it is not surgery.

    EMA’s Adaptability

    All studies have different needs and constraints, so a dozen researchers might design a dozen different protocols to come at the same problem from different directions. EMA’s advantage is that it can cover a lot of angles, and is almost infinitely adaptable.

    A Children’s Hospital of Pittsburgh research team discovered that most attempts to quell pediatric obesity have disappointingly unspectacular results. According to the research team:

    EMA methodology may assist weight-loss efforts by clarifying the antecedents of participants’ eating behavior, by improving accuracy of self-monitoring and by specifying the temporal relationships of the target behaviors. A second, equally important value of the EMA approach is its ecological validity, that is, that its results can be generalized by its ability to perform measurements in the real world: the authentic surroundings of the respondents.

    Carried out by the Weight Management Center, a 2009 study with 20 subjects hoped to assess the possibility of using EMA to “examine important domains relevant to interregulatory health processes in overweight adolescent females.” Each participant wore an activity monitor, which senses motion and other physical states, and also transmits and records information about physical activity (PA), sleep cycles, and other variables.

    The device can be worn on the wrist, waist, ankle or thigh. The authors say:

    The intervention consisted of four weekly, four bi-weekly, and three monthly individual sessions. Information focusing on nutrition, PA, and behavior change was presented in ~45-min sessions using cognitive–behavioral therapy and motivational interviewing followed by ~30 min of PA.

    Participants received calls from a trained staff member for three extended weekends across the intervention. Participants were called twice on weekdays and four times on weekends for a total of 14 calls between 4 PM Thursday and 9 PM Monday. Each call consisted of a brief structured interview to evaluate current eating, PA, affect, and social context and lasted between 5 and 10 min.

    Medicine and health promotion are related fields, of course. It makes sense that the technologies of information and communications are important to both of them, especially when it comes to data collection. As we have seen, EMA takes snapshots of a person’s daily life, randomly, or at crucial times (like deciding to go off the rails and eat everything that doesn’t eat you first), and ties them to other contemporaneous phenomena.

    EMA tracks several factors at once, and every scrap of data can be marshaled into an algorithm. There are physical measurements like heart rate, and mental/emotional events are documented the moment they bubble up in the brain. Also, the subject does not have to remember past events. The immediacy, or “momentary” nature of the reportage, is a feature.

    Your responses and feedback are welcome!

    Source: “Utilizing Ecological Momentary Assessment in Pediatric Obesity to Quantify Behavior, Emotion, and Sleep,”, December 2009
    Photo via Visualhunt

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    What Is Ecological Momentary Assessment For?

    November 15th, 2017


    Childhood Obesity News is looking at Ecological Momentary Assessment (EMA).
    Part data-collection technique and part therapeutic modality, EMA is, consequently, adaptable to many situations.

    These meaningful words are from a 2010 study:

    EMA methods are particularly well-suited to studying drug use. Drug use itself is a discrete, episodic behavior that lends itself to event-oriented recording…

    Moreover, many theories of drug use emphasize the role of the immediate situation in drug use, with emphasis on immediate internal experience (e.g., the user’s mood, craving, or withdrawal state) and external situational factors (e.g., the presence of the target substance, substance-related cues, social pressures to use)…

    Theory has similarly emphasized the role of the acute effects of drugs (i.e., reinforcement, euphoria, relief of stress), which also lend themselves to momentary assessment.

    Episodic; role of the immediate situation; mood, craving or withdrawal state; presence of the substance; triggering cues; social pressure; stress; the desire for euphoria… This all sounds very familiar. Everything the authors say about drug use is also true of eating disorders.

    In 2006, Debbie S. Moskowitz and Simon N. Young wrote:

    A review of the use of EMA methods in eating disorders concluded that patients are willing and able to engage in EMA studies, and the method makes it possible to collect data that could not be obtained with other study designs.

    The authors noted that EMA methods had been used to help depressed adolescents and children, and they themselves studied patients with bulimia who “recorded their perceptions of social interactions, concurrent self-perceptions and moods, and eating behaviors after each social interaction for up to 22 days.”

    A 2014 study declared in its Objective that the context of eating episodes in obesity is not well understood. The researchers went on to examine “emotional, physiological, and environmental correlates of pathological and nonpathological eating episodes.” Fifty adult subjects, mostly women, documented every episode of eating, along with the associated emotional, physiological and environmental conditions, for two weeks.

    They were asked to distinguish between loss of control, binge eating, and nonpathological overeating. It turns out that loss of control and binge eating are more likely to be associated with emotional and physiological cues. The study authors wrote:

    Results support distinctions among the different constructs characterizing aberrant eating and may be used to inform interventions for obesity and related eating pathology.

    Many obesity professionals have made the comparison between hard drugs and food. While there may be debate over whether compulsive overeating is a substance addiction or a behavioral addiction, the important thing is, it behaves like an addiction and is shown to be responsive to methods that address addiction.

    Your responses and feedback are welcome!

    Source: “Ecological Momentary Assessment (EMA) in Studies of Substance Use,”, December 2010
    Source: “Ecological momentary assessment: what it is and why it is a method of the future in clinical psychopharmacology,”, January 2006
    Source: “Ecological momentary assessment of eating episodes in obese adults,”, November 2014
    Photo credit: Theo Crazzolara via Visualhunt/CC BY

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    What Is Ecological Momentary Assessment?

    November 14th, 2017


    Anyone familiar with the culture of the “Sixties” knows the influence of ancient philosophies. Traditions from places like India emphasized the importance of checking in with yourself in real time, and experiencing the present fully conscious — “Be here now.” This is why Ecological Momentary Assessment (EMA) sounds familiar. It is a form of data collection, and also of cultivating self-awareness.

    The technique behind Ecological Momentary Assessment is to describe what is going on at certain moments of the day. The moments may be scheduled, or random, or dependent on a certain behavior, like drug use or an eating binge. Or any combination of those. The person pauses to take stock of, and document, current thoughts, feelings, and behaviors.

    Why do researchers like this? Because self-reporting is dicey at best, and “retrospective recall” makes it worse. Even studies that require subjects to make a diary or journal entry at the end of the day are not satisfactory. The farther away events are in time, the less reliable the memory becomes. There is a concern that sources of bias may intervene.

    When the objective is to learn about something as complicated as, for instance, obesity, the tools need to competently handle many complex factors all at once. For these reasons, researchers call the data derived from EMA “ecologically valid,” or at least more valid than some other kinds.

    It is ecological because the subjects are in their natural environments and doing what they normally do. One source describes EMA as…

    […] a group of methods, developed by personality/social psychologists […] which permit the research participant to report on symptoms, affect and behavior close in time to experience and which sample many events or time periods.

    In other words, it provides the scope to include several dimensions of behavior in the one study, including social interactions and mood, and the interactions between those factors. A potential difficulty has been spotlighted, in that the procedures required by EMA are more demanding than “more global types of assessment.” But Debbie S. Moskowitz and Simon N. Young found that…

    […] impulsivity does not seem to prevent the use of EMA methods, because they have been applied successfully to patients with borderline personality disorder, bulimia, attention-deficit hyperactivity disorder (ADHD) and violent patients.

    The EMA tool can be used for many purposes. A 2006 study sought to determine whether there might be a better way to assess social functioning in the particular context of clinical psychopharmacology. In this field, it can takes months or years to discover what medication works for each particular patient, and in what amounts. To really fine-tune the dosage of these powerful drugs the practitioner needs “wide-ranging and detailed measurements of mood and behavior.”

    Many vital quality-of-life issues are concerned here. The symptoms of any disorder can throw a monkey wrench into social interactions, ranging from the mundane to the crucial. The ability to connect either a failed or a successful social interaction with other factors in real time (or almost) provides important clues in the pursuit of more successful encounters with others in the world.

    Moskowitz and Young wrote:

    In summary, measures that can be classified under the rubric of EMA methodology have been shown to be reliable and valid, can show excellent matching between the measure and the theoretical definition of the outcome, reduce reliance on retrospective memory and reduce the need to rely on the integrative judgements of either the clinician or the respondent.

    Your responses and feedback are welcome!

    Source: “Utilizing Ecological Momentary Assessment in Pediatric Obesity to Quantify Behavior, Emotion, and Sleep,”, December 2009
    Source: “Ecological momentary assessment: what it is and why it is a method of the future in clinical psychopharmacology,”, January 2006
    Images: @JesseFernandez (top), @thatcarlygirl (bottom)

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    The Continued “Quality of Life” Roundup

    November 13th, 2017


    Quality of life comes in several varieties, and none of them can perform its magic if the person is depressed. Britain’s National Obesity Observatory (NOO) discovered that when an obese child is depressed that depression seems to increase as time goes on. If the family lives at or near poverty level, the effect is even worse. Their work resulted in a 28-page report titled “Obesity and mental health,” which Childhood Obesity News had talked about. (The same post mentioned a few other interesting studies, too.)

    One of the Observatory’s conclusions about obese young people was that weight management programs can help, even though the benefit may not show up right away in the form of immediate weight loss.

    This seems to reflect a profound truth. To experience an epiphany, followed by an instantaneous change in behavior, is not the human way. People mull things over. Ideas take a while to sink in. A person might hear the same idea from multiple sources for years, and it doesn’t make a dent. Then one day someone frames it in exactly the right words, and everything clicks.

    For scientists to serve up immediate and exquisitely quantifiable results, seems hubristic, but they can’t be blamed for what might seem like unearned omniscience. The system they must operate in wants to see graphs and charts with crisp delineations. This is, after all, how funding is obtained.

    For the clinician, interventions that challenge family tradition and wider culture may not resolve anything in the short term. It’s not exactly like waving a magic wand, and no primary care physician or therapist should ever feel inadequate if results are not immediately apparent. Who knows what might happen 10 years from now? It’s always “better late than never.”

    The NOO report also confirmed that obesity can aggravate mental/emotional health that is already impaired, and vice versa. It goes both ways, and a vicious cycle can develop quickly. When two or more problems continually exacerbate each other, it’s called “spiraling out,” and it needs to be stopped.

    An audacious experiment

    In one post, Childhood Obesity News explored the official one-child policy that China pursued for some years. An awful lot of boys became obese, partly because parents and grandparents who enjoyed spoiling kids with junk food had fewer targets to concentrate their energies on. The Chinese childhood obesity epidemic led to brutal “fat camps” and deprogramming centers designed to cure internet addiction.

    Peripherally related

    In another post, Childhood Obesity News looked at the multi-generational, epidemiologically-oriented Framingham Heart Study. Data from this longitudinal study has been utilized in many different ways by numerous research teams. It was noticed that if a subject became obese during the study, their spouse or a sibling would become obese also, but the reasons are not clear and could be quite mundane.

    It turns out that researchers used the Framingham Heart Study subjects’ information to zero in on the “quality of life” question, with a study called “Dynamic spread of happiness in a large social network.” They were interested in the idea of emotional contagion, how it works, and how far its reach extends. In defining nodes, ties, components, and clusters, they used the same kind of analysis that Facebook uses when deciding who is shown which advertisements.

    These authors were not concentrating on weight an ingredient of happiness, but they did mention a couple of things known from previous studies:

    Happiness spreads significantly more through same sex relationships than opposite sex relationships… This result also accords with previous evidence on sex effects in the spread of obesity and suggests that people might be more likely to take emotional cues from members of the same sex. The spread of happiness seems to reach up to three degrees of separation, just like the spread of obesity…

    Your responses and feedback are welcome!

    Source: “Obesity and mental health,”, March 2011
    Source: “Dynamic spread of happiness in a large social network: longitudinal analysis over 20 years in the Framingham Heart Study,”, 12/05/08
    Photo via Visualhunt

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    Roundup: Quality of Life

    November 10th, 2017


    Last month, Childhood Obesity News posted a guide to some of the archived posts concerning quality of life. There are more! Today, we look back over some interesting angles on the quality of life experienced by obese children and teenagers, and how that quality can be improved.

    For instance, one group of researchers determined that a school-based weight management program could work, if correctly implemented. That means an intensive, instructor-led course; none of this self-taught or parent-taught stuff. In addition, one-year and two-year followups showed that the good results from the intensive, instructor-led type of program tended to stick.

    In testing the W8Loss2Go smartphone app, Dr. Pretlow noticed resistance among some of the young participants. Talks revealed that a kid might have been overweight for so long she or he just got used to it, and even developed a fatalistic attitude that disallows the possibility for change.

    We asked why obese young folks will pour their hearts out via anonymous forums, surveys, etc., and yet “take the 5th” in a person-to-person setting. Sometimes, a person will grow up and talk later, when school is a distant memory of “merciless cruelty.”

    Quality of Life Studies” and its sequel discuss some of the original research projects that have formed current opinion about quality of life among the young and obese. A classic study compared obese kids to young cancer patients undergoing chemotherapy treatment, and the observations included an interesting sidebar about the parents of obese kids: They rate their children as even more unhappy than the children rate themselves.

    Is it possible that parents overreact to a situation in which they themselves would be miserable, but where some kids seem comfortable? Perhaps mobs of overweight and obese children and teens will rebel against the the adults, chanting “We’re okay, go away!” Do we have that science fiction movie to look forward to?

    Scientists are trying to get a handle on the whole cause-and-effect thing. Does the physical condition of being overweight or obese make a child’s quality of life decline? Or does the messed-up life come first, so the child eats and puts on weight in reaction? As so often happens, the answer is both. Some kids never have a chance; they are born overweight and it only gets worse. The younger it starts and the longer a young person stays overweight, the less chance there is to ever reverse it.

    Of course, the other scenario happens too. A normal-weight child winds up in the wrong circumstances and, suddenly, food is their only friend. A vicious cycle can start with fatness and then become emotional distress, expressed by eating to “stuff” the feelings, but naturally that leads to more flab, and so on.

    Or emotional disturbance can turn people fat who never were before, and then they are even more upset, so a sturdy and resilient vicious cycle is constructed. Either way, it is a disastrous whirlpool to be caught in.

    Your responses and feedback are welcome!

    Photo credit: VFS Digital Design via Visualhunt/CC BY

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    Why Measuring Matters

    November 9th, 2017


    As we have seen, for the W8Loss2Go program, Dr. Pretlow initially tried a “cutting in half” method in which the participant would first take what for her or him would be a typical serving, then put back half, or even a quarter. The fraction was irrelevant because just “eyeballing” the portions didn’t work anyway. The mind is a trickster, especially when rewards are involved, and food is very rewarding.

    As a 10-year-old boy in the study noted, “Tt lets you get away with more than you’re actually supposed to have.” It became evident that some sort of measuring would have to be implemented, and there was an intermediary try-out stage, which Dr. Pretlow describes thusly:

    We had participants measure out their amounts at meals with measuring spoons, cups, and rulers. Then, they would remove 1/2 inch, 1/2 tablespoon, 1/4 cup, etc. from whatever portion they were serving themselves. That procedure also didn’t work very well, because their starting amounts were too indefinite and attempting to progressively reduce amounts was too inaccurate.

    Then the process was further refined:

    Finally, we had participants weigh their typical portions with a food scale. Then, they would remove an ounce, etc., and put it back. That procedure was an order of magnitude improvement in the amounts reduction process, because it turned the amounts they were eating into a number, which the app could then progressively reduce in small increments. And, participants were amazed that they didn’t miss the subtracted amounts.

    In an audio clip, we hear one of the participants express that very thought. Another, a young woman of 17, reported, “It works because it’s an ‘exact number, ‘ I can’t add more or less, there’s no decision.” Just as with anything worth doing, the setup involves a bit of focus. The person needs to choose a baseline group of frequently-eaten foods and enter some information and so on. Then,

    Participant will eat only those progressively reduced amounts from his/her logged foods list, and no other foods, until his/her weight starts dropping. If his/her weight drops and continues dropping, the food amounts are kept at that percent cut level. If his/her weight stops dropping, amounts are reduced by further percent cuts of all the foods logged, until the weight resumes dropping.

    Makes sense, right? There are a few other things to know, for instance:

    The “Tare” function of the scale allows zeroing out the weight of the plate and each food in turn, when the foods are added one at a time to the plate for the meal. Thus, there is no mess, and the meal is ready to eat.

    For younger kids, it’s really great when a parent or older sibling is on hand to help out. Hopefully, older kids will find a source of accomplishment and pride as they master the learning curve and become expert in helping the program to calibrate their servings. Some, like the young lady heard in this audio excerpt, will really get into it.

    Once again, we recommend the very thorough documentation of how the W8Loss2Go smartphone app can help to change a life. In particular, for a serious hardcore information-acquisition session, turn to these pages that explain the application’s rationale, methods, and instructions.

    Your responses and feedback are welcome!

    Image source: W8Loss2Go

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    Measuring for Improvement

    November 8th, 2017


    Childhood Obesity News has been looking at the importance of weighing food portions as part of the W8Loss2Go program. Today, Dr. Pretlow takes us back to the time when the importance of this step really began to impress itself upon him:

    Six years ago, kids on the Weigh2Rock website were reporting that they had a problem with certain foods, e.g. soda, chips, pizza, candy. They had cravings for these foods, difficulty resisting the food when in front of them, and difficulty not overeating it. Thus, initially our app intervention involved only withdrawal/abstinence from user-identified problem foods. That method worked very well with the kids in our study, and after 10 days they were amazed that they no longer craved their problem foods or had trouble resisting them.

    For the uninitiated, Weigh2Rock is the website about healthy weight, whose many sections include areas for pre-teens, teens, the over-18 crowd, and parents. There you will find an incredible amount of content, and endless opportunities for interactivity. The Success Stories anthology alone provides hours of satisfying reading.

    Back to abstinence from problem foods, and the disappearance of cravings for them:

    Yet, they didn’t lose much weight from that process. We then realized that the main issue contributing to their weight was eating excessive amounts at meals. So, we implemented the “cutting in half” method, where they would cut in half everything they ate at meals and put half back. Or, they would cut the half in half and put 1/4 back. Unfortunately, participants had great difficulty deciding how much to cut off and put back and even how much to serve themselves to start with.

    Our basic human nature is to delude ourselves about a lot of things. When doctors ask patients about their alcohol use, the assumption of a certain amount of under-reporting is built in. A few years back, a British study showed that if self-reported drinking information is accurate, about half the alcohol sold in England is being poured directly into gutters and drains, because otherwise its whereabouts cannot be accounted for.

    Probably, the patients are not even aware of speaking untruths to their doctors. They are telling it like they see it. And probably a 12-year-old who takes a serving of food, knowing that he is supposed to put back 50%, is not even aware of piling on twice as much food in preparation for that halving. As one of the WeightLoss2Go study participants said, “Numbers can’t lie, but my brain can.”

    Meanwhile, Peter Drucker, “the man who invented modern business management,” was publishing books that said things like, “If you can’t measure it, you can’t improve it.” This has even been characterized as of the two most important quotations in business. In fact, the writer who called it that employs a familiar metaphor:

    For example, it’s nearly impossible to lose weight without stepping on a scale once in a while to measure your results — if you don’t, you have no idea if you are succeeding or not.

    (To be continued…)

    Your responses and feedback are welcome!

    Source: “Alcohol consumption higher than reported in England,”, 02/27/13
    Source: “The Two Most Important Quotes In Business,”, 02/25/17
    Image by W8Loss2Go

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    The Purgatory of Rejection

    November 7th, 2017


    Two psychologists from UC Santa Barbara, Alison Blodorn and Brenda Major, wanted to know more about the dynamics of obesity-based rejection, and, in particular, about whether a person can be damaged by not even a real incident of being rejected, but by the mere expectation of it. They designed a study that “measured the effects of anticipated rejection caused by weight-stigmatizing situations.”

    The 160 subjects were heterosexual women and men, from 18 to 29 years of age, and with a range of body weights. Each one had to give a speech explaining their desirability as a dating partner, and from there the methodology gets complicated.

    Suffice it to say, as Blodorn did:

    Thinner women expected to be accepted and this led to increased feelings of positive self-esteem, decreased self-consciousness and less stress. Heavier women — or those with a higher BMI — who thought their weight would be seen expected to be rejected by their evaluator. This anticipated rejection led to lower self-esteem, greater feelings of self-consciousness and greater stress.

    So, yes, it turns out that psychological health can be negatively impacted by just the expectation of being devalued. But what about heavy men? This part is interesting and indicates, as always, a need for further investigation.

    According to the study findings:

    They didn’t expect to be rejected by an attractive female who was going to rate their dating potential when their weight was fully seen. It’s possible that these findings are limited to the dating domain, and more research needs to be done before we could say heavier men are not affected by weight stigma.

    In other contexts, some men report that, on the contrary, their weight has adversely affected their dating potential. But there is more to life than romance, and rejection comes in many flavors.

    Sometimes it feels like the whole world conspires to shun the obese. People mention things like walking into a certain clothing store and feeling the wall of condescending resistance go up. The same can happen in the wrong gym. In most media, the obese are presented as either laughingstocks, or projects to be worked on.

    Professional comedians are adept at describing incidents of rejection in various areas, partly because their guiding principle is “Do it for the story.” However, sometimes a person would rather not have been handed the material for a story. When filmmaker and funny guy Kevin Smith was refused an airline seat, creating standup comedy from the incident was not his first thought.

    A “listicle” from the website “This Is Thin Privilege” detailed some chilling perspectives. If you’re obese, the rest of the world is out there deciding whether people like you should even exist, and how keep any more of you from being born. The author says:

    There is big money for people who are trying to eliminate people like me. They especially want to eliminate children who are like me… They hail an “enlightened” future world that no longer has people like me in it.

    There is a whole month of the year dedicated to eliminating or preventing people like me. The very existence of people like me is called one of the top problems of our modern age.

    Apparently, many individuals wish that people would simply let them quietly succeed in being overweight. For This American Life, Ira Glass interviewed Lindy West, who for many years convinced herself that if she didn’t mention her excessive weight, others would not notice.

    It would just be a politely unspoken secret, as she very considerately refused to afflict these concerned friends with the crushing burden of her own failure. The strategy did not work, of course. West learned that, to normal-weight people, “You’re just a thin person who’s failing consistently for your whole life.”

    Glass suggests that, according to thin people, the obese should not only admit to their condition, but provide ample proof that they are working very hard to slim down. He says:

    As long as you’re a fat person who’s trying not to be fat, that’s acceptable. That’s a good fat person.

    Your responses and feedback are welcome!

    Source: “For heavier individuals, the anticipation of rejection drives down self-esteem,”, 03/21/16
    Source: “People Like Me,”, 2012
    Source: “589: Tell Me I’m Fat,”, 06/17/16
    Photo credit: Rich Moore via Visualhunt/CC BY

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    The Manly Art of Portion Weighing

    November 6th, 2017


    This discussion follows on from “Food Portions — Why Weigh?” In developing the W8Loss2Go addiction approach for weight loss, Dr. Pretlow has noticed that some kids resist a technique that really works. He says:

    The app incrementally reduces their amounts and instructs them how much to take off or add to their plate in real time. They claim that they don’t have time to weigh their meals, even though in a survey 3-5 minutes was the mean time kids in the study said it took to weigh a meal using the app and the Bluetooth connected food scale. Other reasons given were being embarrassed for anyone to see how much they ate or even admit to themselves how much they ate…

    Young people, and boys especially, can be very intolerant of anything that seems like fussing. Taking a bit from the scale, adding a bit — in some culturally misshapen corner of their minds, they might as well crochet a doily, because to aim for precision is somehow emasculating. Fussing is something that grannies do.

    This is, of course, a misapprehension. Aiming to get it just right is a desirable characteristic in any field, and an adept counselor can help lead a child to see that. Our relationships with electronic devices demonstrate the truth. If you want the machine to do something and it wants a certain combination of letters and symbols entered, it will only accept that combination and no other. Even a black-hat hacker needs to know what buttons to push. Sometimes a person has to back up and give it another go.

    A musician will generally make the effort to tune a guitar correctly. Of course, anyone is free to flaunt a slaphappy attitude in this and many other fields, but the results will not be pleasing. A drummer is arguably the most macho brand of musician, and guess what? Even percussion instruments need to be tuned. A drummer will devote time and care to the process, and anyone who implies that he is anything less than a stud might end up wishing they had kept their mouth shut.

    Attention to detail matters

    Obese youths may not spend much time on skateboards, but they know enough to grasp the principle. The smallest misjudgment or misapplication of speed or balance can bring disaster. For a science-minded kid, the importance of getting it exactly right should be an open and shut case. Of course accuracy matters!

    For an older teen, being stopped for Driving Under the Influence can go two very different ways, depending on how well the measuring instrument has been maintained. You’d better hope that someone took the trouble to check its accuracy. As previous generations used to say, “The devil is in the details.” Or “God is in the details.” Either way, the concept is clear. Attention to detail matters.

    In military boot camp, personal belongings have to be arranged just so. Anyone who thinks it’s stupid shouldn’t be there. Ask yourself, “Who do I want working in the office my paycheck comes from? Or doing a field tracheotomy on me? Some bozo who can’t fold his underwear right?”

    A hunter hoping to shoot an elk from 800 yards had better employ precision. When 250,000 people show up to watch a car race, both drivers and fans expect every member of every pit crew to be on top of their mechanic game, which includes very precise calibration.

    In other words, it is possible to plant the idea that seeking precision is not a trait of elderly women only. Fortunately, some adults have the ability to convey such ideas in ways that young people can relate to. Another thing that adults can do is place an appropriate amount of confidence in the efficacy of peer pressure. Certain kids are natural leaders, and if they come to believe that doing things well is cool, hip, or whatever the current expression is — they are capable of exerting enormous influence on their age-mates.

    Your responses and feedback are welcome!

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