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    Trackers and Other Wearable Tech

    January 23rd, 2018

    abacus earring

    The world’s first wearable technology may have been the abacus ring. From China’s 17th Century Qing Dynasty, the tiny portable calculator was operated with the point of a pin. Of course, there was no electronic component. But it was technological, and it was wearable.

    The rise of wearable devices

    Only a few short years ago, researchers were not sure if fitness monitors were suitable for kids. The University of California recruited 24 children in the 7- to 10-year age range and tried out three different fitness trackers on them. The scholars were interested in both the quantity of actions, such as the number of steps taken in a day, and the quality or intensity of those actions.

    Most popular with the kids, for reasons that did not necessarily square with the researchers’ agenda, was a waterproof monitor worn on the wrist and able to differentiate between five different exercise intensity zones. It even measured sleep duration.

    Meanwhile, other researchers from Iowa State University called on child subjects to compare the merits of seven different fitness trackers. In measuring energy expenditure, all were found to be accurate within 10%. At the time, scientists were very interested in working with the video game industry to create “reward-incentivized games” that would encourage exercise.

    A good idea?

    A Clemson University team learned that people who keep food journals are more adept weight losers and are more successful at maintaining their losses. So they invented the Bite Counter, a wearable instrument designed to measure the number of bites taken, by keeping track of how many times the wrist is rolled in the fork-to-mouth motion.

    The scientists estimated that 100 bites per day should lead to weight loss. However, that seems a rather reckless pronouncement, because you never know when someone will come along and interpret that guidance as an endorsement of the 100-bites-of-chocolate-covered-bacon diet.

    Psychology professor and co-inventor Eric Muth told the press:

    Food trackers allow individuals to record their behavior during mealtimes and can help users pay more attention to environmental factors — such as portion size and the size of one’s plate — that tend to cause overeating.

    Around the same time, Spanish biomedical researchers, specifically aiming to combat childhood obesity, invented a shirt equipped with sensors that measure heart and lung activity in real time, and wirelessly transmit the date to a central location. The shirt is described as both comfortable and lightweight, but why was a need for this item felt? Here’s how it was explained:

    Today the control of cardio-respiratory function is done through calorimeters, which measure a person’s energy expenditure. Patients have to carry these devices a specified time; however, they have the disadvantage that their usage can be uncomfortable. Furthermore, patient’s lack of discipline in their use can result in unreliable collected results.

    Your responses and feedback are welcome!

    Source: “Image Of The Day: 300-Year-Old Chinese Abacus Ring From The Qing Dynasty,” AncientPages.com, 09/12/15
    Source: “Fitness Trackers For Kids: Could They Monitor Eating Habits, Fight Childhood Obesity?,” MedicalDaily.com, 05/24/14
    Source: “Wearable Tech Takes on Weight Loss With a Bite Tracker,” Yahoo.com, 08/11/14
    Source: “Specialists Design Shirts to Combat Childhood Obesity,” CarlosSlim.org, 09/28/14
    Photo credit: Pitel on Visualhunt/CC BY-SA

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    This Thing Called Relapse

    January 22nd, 2018

    cat-tempted

    The cumulative effect of several W8Loss2Go studies has caused Dr. Pretlow to say this:

    Caving in the moment of food temptation, with motivation getting pushed aside, but feeling remorse afterwards, has been a problem for kids in our studies.

    Behavioral scientist Paul Dolan of the London School of Economics and Political Science is featured in a short video (under 7 minutes). Using tools and techniques that include “surveys, big data, lab studies, and field experiments,” he trains people to automatically repel temptation.

    In addiction recovery, a relapse consists of an episode that turns into a spiral. The whole trick is to never take that first step back into bondage. Dolan’s work is to help his fellow humans form new habits and avoid the fateful episode. As one subject expressed it, “I found out things about myself that I never knew.”

    Using a protocol that has been shown to work successfully for children, Dolan trains a young man to eat vegetables. Dolan says:

    If we can get him into good habits, this will be a long-lasting, long-term impact on Pete, Selena, the children, and the children’s children. That’s how much this matters.

    It sounds boringly earnest, but actually is rather entertaining. Because this show was made for television, with the need to attract ratings, romance was added to the mix by recruiting people who, as the title implies, aim to “Lose Weight for Love.” Dolan’s method of discouraging relapse has been effective for public speakers, people with anxiety disorders, and alcoholics. This time, it’s compulsive eaters.

    A lot of compulsive eaters are more accurately compulsive drinkers. Their big problem arrives in cans and bottles. Dolan meets with Phil, who is obsessed with sugar-sweetened beverages, and shows him how to rewire his brain. The method involves a joystick, and slides projected on a screen. The obese youth is instructed to “push” away the fizzy drinks, and “pull” the healthy beverages toward him. Apparently, change can be achieved in as few as five daily 15-minute sessions.

    EMA revisited

    Because substance use is episodic and apparently related to mood and context, Ecological Momentary Assessment (EMA) seems to work pretty well on it. In fact, substance use research is where EMA is most often found, particularly in the areas of alcohol and tobacco, where the specter of the lapse episode — or “slip” — is a relentless stalker.

    A 2010 study looked into the problem of temptation that leads to relapse, which had long troubled therapists because patients couldn’t describe it well, once the moment had passed and battle was lost. The results were bias and inaccuracy, which are the very difficulties that the immediacy of EMA appears to overcome.

    As some researchers pointed out, drug use can’t really be understood unless information about periods of non-use is also available. Likewise…

    […] without a comparator or “control,” we cannot know what is particular to lapse episodes, versus being typical settings for the person or the person’s experience during withdrawal and a struggle to maintain abstinence.

    Here is the crux of the matter:

    Relapse investigators have been particularly interested in the initial lapse to drug use, as it represents a pivotal transition from abstinence back to use. This imposes particular challenges, because the initial lapse episode is a unique event — there is no second first lapse… The strategy in EMA studies is to engage subjects in ongoing monitoring, so that they are poised to record the first lapse if and when it does occur.

    Your responses and feedback are welcome!

    Source: “BBC One’s ‘Lose Weight for Love”’ (best bits),” PaulDolan.co.uk, 07/11/17
    Source: “Ecological Momentary Assessment (EMA) in Studies of Substance Use,” NIH.gov, December 2010
    Photo credit: Les Chatfield (Elsie esq.) on Visualhunt/CC BY

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    Devices and EMA — a Match Made in Heaven

    January 19th, 2018

    robots-wearable-tech

    Childhood Obesity News mentioned a meta-study designed to assess the usefulness of EMA (Ecological Momentary Assessment) in evaluating PA (physical activity). It spoke of eligibility criteria: validity, reliability, objectivity, norms, and standardization. PA can be tracked by gadgets that use mechanical and electronic means to monitor physical activity via many different parameters such as “direct and indirect calorimetry, maximum oxygen consumption/VO2max, doubly-labeled water consumption, or energy expenditure.”

    When it comes to behavior, questionnaires depend either on self-reporting that is performed by the patient, or on secondhand narration that originates with professionals or other staff members who relate their direct observations of the patient. In either case the reporting is subjective, because it depends on impressions formed in the mind of an individual, whether that individual is the patient or someone whose job it is to take notes.

    For the researcher who wants the most complete and accurate picture of subjects’ behavior, many caveats and nuances are involved. For instance, it would seem straightforward enough to accept that devices track activity most accurately. To relegate this important task to self-reporting seems unwise. But the authors make this counter-intuitive point:

    Furthermore, as objective methods do not differentiate between periods of inactivity and periods when the device is not being worn, subjective methods are preferred for measuring sedentary behavior.

    For this and other reasons, EMA and wearable devices are seen as a match made in heaven — capable, when they team up, of wringing almost every drop of information from any situation. The idea of using mobile phones to administer EMA protocols has been around for years.

    The introduction to a 2010 study set forth the problems:

    Children often experience difficulties remembering the intensity and duration of activities after 24 h or more has passed since the behavior… Also, when used alone, accelerometers and pedometers are unable to measure mood during or the context of activities, which may be the important factors that influence behavior.

    The report offered exhaustively detailed explanations of every aspect of the study, and was very optimistic about the prospects of overcoming limitations via “technology-enabled real-time self-report assessment strategies.” That optimism has been proven to be justified. A few years later, a meta-study with very strict criteria published its results:

    This systematic review examines current use of mobile health technologies in the prevention or treatment of pediatric obesity to catalogue the types of technologies utilized and the impact of mHealth to improve obesity-related outcomes in youth.

    The section titled “Usability” is extensive and lavishly footnoted. For instance:

    Studies described the best placement and accuracy of mobile device(s) to record PA and dietary intake (22, 34, 35, 37, 47), ways to lessen user burden (43) and which non-intrusive and practical devices (34, 37, 47) will actually be carried and used by participants (15, 22).

    The authors go on to speak of incentives, social connections, privacy and sharing issues, competition, user-friendly formats, motivational techniques, language, positive feedback, costs, software and hardware compatibilities, and many other factors that need to be taken into consideration.

    Your responses and feedback are welcome!

    Source: “Using Ecological Momentary Assessment to Evaluate Current Physical Activity,” NIH.com, 07/14/14
    Source: “Investigating children’s physical activity and sedentary behavior using ecological momentary assessment with mobile phones,” Wiley.com, June 2011
    Source: “Prevention and treatment of pediatric obesity using mobile and wireless technologies: a systematic review,” NIH.gov, 01/12/15
    Photo credit: NYC Media Lab on Visualhunt/CC BY-SA

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    More on Ecological Momentary Assessment

    January 18th, 2018

    field-notes

    The most recent Childhood Obesity News post, “Ecological Momentary Assessment and Teens,” noted that Ecological Momentary Assessment (EMA) works effectively in combination with technological data-gathering devices. When researchers are able to capture 81% of the expected survey data from adolescent subjects, it is considered satisfactory.

    Let’s look at another study, this one concerned with the compliance rate to EMA among 461 teenagers who had ever smoked cigarettes at all. Also investigated were several covariates “including gender, race, smoking rate, alcohol use, psychological symptomatology, home composition, mood, social context, time in study, inter-prompt interval, and location.”

    What might be problematic is, the information about most of those variables is the product of self-reporting. Realistically, any teen in the survey could spin tall tales, and even lie about whether they had ever smoked or not. It seems as if the biggest question was:

    To date, there has been little detailed research into the predictors of EMA compliance. However, patterns or predictors of compliance may affect key relationships under investigation and introduce sources of bias in results.

    There is good reason for concern. A study using the EMA/wearable technology combo may seem to be rife with objective facts, but that is not true to the extent accepted by some practitioners. At any rate, this study found EMA protocols are less likely to be complied with by boys who smoke and drink and have bad attitudes.

    One school of thought holds that any data that is the product of self-reporting should be disregarded. Nevertheless, EMA is showing up a lot in the domains of rehabilitation, sport science, and behavioral medicine.

    A recent meta-study on using EMA to evaluate current physical activity (PA) included children, adolescents, and adults, and even encompassed one study of elder activity. Trouble is taken to define such terms as “physical activity,” “exercise,” and “sedentary behavior,” which helps to ensure that all debate participants are on the same page, as it were. This is actually encouraging, because it often seems that opposing parties in an argument are not even talking about the same subject.

    The objective was to discover whether EMA “fulfills the criteria of validity, reliability, objectivity, norms, and standardization applied to the tools used for the evaluation of physical activity.” The researchers arrived at these conclusions:

    Ecological momentary assessment is a valid, reliable, and feasible approach to evaluate activity and sedentary behavior. Researchers should be aware that while ecological momentary assessment offers many benefits, it simultaneously imposes many limitations which should be considered when studying physical activity.

    This article goes into a great deal of detail about methodology, hardware, software, and planning. One disadvantage of EMA is that it requires active participation and is considered “a more burdening and time-consuming approach for participants in comparison with retrospective methods.” Usually, a retrospective method requires only a reporting session at the end of the day. Another drawback is, as mentioned, the need to bring all participants into alignment in regard to the definitions of terms.

    Your responses and feedback are welcome!

    Source: “Factors predicting compliance to ecological momentary assessment among adolescent smokers,” NIH.gov, 10/04/13
    Source: “Using Ecological Momentary Assessment to Evaluate Current Physical Activity,” NIH.com, 07/14/14
    Photo via Visualhunt

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    Ecological Momentary Assessment and Teens

    January 17th, 2018

    breakfast-coffee-notebook

    In several previous posts, we looked at Ecological Momentary Assessment (EMA) which is, among other things, a tool that helps researchers collect data. Today we scan two reports from the National Institutes of Health for details that may or may not turn out to be salient. In young fields like this one, many discoveries lie in wait. A researcher never knows what stray notion might collide with which unexpected finding, and set off a revolution.

    The point of EMA is for the subject to pause, at predetermined or random times, and describe the present moment so that the subjective experience can be matched up with what’s going on in the universe right then. A 2009 study posited that:

    To provide the most-effective weight-management interventions for children and adolescents, practitioners are encouraged to assess all factors that target weight-related behavior change.

    But how? In a study that looked into the connections between behavior, emotions, and sleep in obese teenage (11-19) girls, the researchers found that “technological devices that gather objective data have reasonably high compliance rates.” Specifically, they were talking about the BodyMedia SenseWear Weight Management System, which monitors “calories expended, physical activity duration and intensity, and sleep duration and efficiency.”

    An armband collects metabolic data, and a watch-type display gives real-time feedback on the steps taken and the calories burned. Together these are called an actigraph.

    In the course of three long weekends, the 20 adolescent female subjects were asked to make 14 cell phone calls to report on their status. This particular study had no parental involvement with the weight-management protocol.

    The subjects were screened to establish that they did not suffer from diabetes or cardiovascular disease, were not currently enrolled in another weight loss intervention, and were not suicidal. According to the study:

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

    The writers of another multi-author study say that in recent years, the combination of wearable sensors and EMA has shown that a combination of the two technologies offers “tremendous potential for identifying drivers of human behavior and accelerating behavioral medicine research.” Their subjects were 20 adolescents (both sexes) and the researchers set out to “determine the feasibility and acceptability of a novel, intensive EMA method for assessing physiology, behavior, and psychosocial variables utilizing two objective sensors and a mobile application (app).”

    This paper includes very detailed information on the methods and measures used, including context and location questions. Apparently, compliance was pretty good, because the report notes that the participants “provided approximately 81% of the expected survey data.” Overall…

    The findings support the use of an intensive assessment protocol to study real-time relationships between biopsychosocial variables and health behaviors.

    Your responses and feedback are welcome!

    Source: “Utilizing Ecological Momentary Assessment in Pediatric Obesity to Quantify Behavior, Emotion, and Sleep,” NIH.gov, 12/17/09
    Source: “The promise of wearable sensors and ecological momentary assessment measures for dynamical systems modeling in adolescents…,” NIH.gov, 09/27/16
    Photo credit: Tony Hall via Visualhunt/CC BY

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    Childhood Obesity Developments in the United Kingdom

    January 16th, 2018

    brighton-amusement-ride

    Because the United Kingdom is an English-speaking place with similar laws to the U.S.A. and a very familiar obesity problem, Childhood Obesity News has been tracking what goes on there. It is possible that awareness of how the Brits handle things could help America pick up some good ideas, or at least avoid predictable obstacles.

    Brighton and Hove, although it sounds like a couple of different places, is actually the name of one city on the southern coast of England. It is a resort town, which may evoke visions of enthusiastically active kids partaking of many forms of exercise, but that is apparently not the case. It may or may not be pertinent that in the 2001 census, amongst all the main sections of England and Wales, this town had the highest percentage of people identifying themselves as followers of Jedism, a creed inspired by the Star Wars movies.

    Inspired by the discovery that “almost one in five local four and five-year-olds was overweight” Public Health England created a program. Interestingly, this organization is mainly made up of food and drink industry representatives, which seems both counterintuitive and counterproductive to the purpose of helping kids avoid obesity.

    Anyway, the rationale behind the Change4Life campaign (established in partnership with Disney and Sports England) was explained by Public Health England deputy director Angela Baker:

    It is worrying that we are seeing so many more children leave primary school overweight than started, and we hope our Disney-inspired programme is one way of helping to reduce this… Any 10-minute burst of activity counts as a “shake up” and goes towards the hour of physical exercise each child should do each day.

    In the same month, a member of parliament from South Shields, another coastal town but this time on the north side of England, wrote a column about the paradoxical conditions in the United Kingdom where “we have one of the worst records of food insecurity and child obesity — both forms of malnutrition.” Pulling no punches, Emma Lewell-Buck wrote:

    The harsh reality is, that the combination of low income and a food system which makes unhealthy food more convenient, attractive and frequently cheaper than healthy food, is toxic for children’s health. It leads to children being overweight and obese, vitamin and mineral deficiencies, poor growth, development and poor mental health.

    The people’s representative scolded the current administration for trying to deprive school children of their free lunches, and brought up several other food-related matters that could, in her view, be handled much more effectively. There, as here, the social “safety net” unravels more with each passing day. In the demographic of kids under 15, about one in five is subject to food insecurity rated moderate or severe.

    The lunch debate has been a real can of worms. The government announced that thousands of children would be added to the free school breakfast program. The only catch was, thousands would first be kicked off of the free lunch program. The Conservatives said they had science showing that breakfast helps kids just as much, but only costs one-tenth as much as lunch. Of course, celebrity chef Jamie Oliver got into the mix and called the cancellation of the lunch program a disgrace.

    Your responses and feedback are welcome!

    Source: “Health chiefs hope Disney-inspired plan will combat childhood obesity in Brighton and Hove,” BrightonAndHoveNews.org, 07/17/17
    Source: “Foodbank Britain: Is Malnutrition The New Normal?,” HuffingtonPost.co.uk, 07/17/07
    Source: “Jamie Oliver calls Theresa May’s plan to scrap free school lunches a ‘disgrace’,” Independent,co.uk, 05/19/17
    Photo credit: Andy Walker (Bear Clause) on Visualhunt/CC BY-ND

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    News From the Flaky Fringe

    January 15th, 2018

    astronaut-chow

    As Childhood Obesity News has noted during other visits to the outer limits of probability, a lot of people are called crackpots until, without having changed in any substantial way, they suddenly become geniuses. A subject as large as obesity is bound to attract a lot of theories. Among them, an effort to revive the “forgotten food sense” is an idea that might, as they say in Hollywood, have legs.

    Salience is the quality of being noticeable, prominent, or important. Ryan S. Eldera and Gina S. Mohrb published a report called “The crunch effect: “Food sound salience as a consumption monitoring cue.” What they say, basically, is that the sound produced by chewing is an intrinsic sensory cue that somehow contributes to the perception of satiety. Consequently, more attentive listening could lead to reduced food consumption.

    Or maybe to increased food consumption. Given that marketers communicate for only one reason, which is to induce consumers to buy more product, the last sentence of the Abstract is rather troubling:

    Our findings are valuable to both researchers interested in understanding how sensory cues are connected to consumption and marketers utilizing sound in their communications to consumers.

    Todd Hollingshead wrote about the research, on behalf of one of the institutions concerned, Brigham Young University. (The other was Colorado State University). He says “people eat less when the sound of the food is more intense.”

    What it suggests, in practical terms, is that consciousness of the sound of mastication is a good thing, so turn down volume of the TV, stereo, or whatever, as you chomp and crunch. And enjoy your own internal soundtrack, as part of an exercise in mindfulness.

    A related worry

    At the same time, Sarina Locke reports, there is concern about the ascendency of what is essentially baby food, for people who are not infants. All kinds of nutriments come in plastic pouches, which may in itself be a problem. Maybe phthalates and similar packaging materials, just on their own, contribute to obesity.

    Some experts are against the gratuitous pureeing of food, for the same reasons cited by Eldera and Mohrb. To persuade toddlers to swallow them, the vegetables probably contain too much sugar. Mush packets are given to kids at an age when they really should be getting more practice at chewing. The mush diet could impede the proper development of both dentition and speech.

    Locke interviewed Sarah Hyland of the Australian Institute of Food Science and Technology, who warned of the dangers in depriving children of the “sensory perception of texture and simple tastes.” She went on to say:

    It’s a reminder of the importance of visual, colour and textural cues in eating solid food for reasons of jaw development, speech development, and sensory literacy.

    At the other end of the age spectrum, the purees seem to be very popular with elderly folks who may have compromised chewing ability, or physical dysfunctions that make eating difficult. But that’s not all. Busy adults apparently love the convenience of sucking a meal from a pouch.

    Your responses and feedback are welcome!

    Source: “The crunch effect: Food sound salience as a consumption monitoring cue,” ScienceDirect.com, July 2016
    Source: “The sounds of eating may reduce how much you eat,” BYU.edu, 03/14/16
    Source: “Are we raising ‘generation suck’ who drink food with no need for chewing?,” Abc.net.au, 08/25/16
    Photo by Marco Gomes on Visualhunt/CC BY

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    Dr. Pretlow Presents a Webinar

    January 12th, 2018

    dr-pretlow-speaking

    At this moment, almost the entire homepage of the Food Addiction Institute (FAI) is occupied by information about the webinar it will sponsor — featuring Dr. Pretlow — on the evening of Sunday, January 14. The topic is “Treatment of Child/Adolescent Obesity as an Addictive Process,” and the time is 7 PM Eastern Time. Please go to this page for links and phone connections and all that good stuff.

    Although the website is primarily geared for health professionals, all visitors are invited to view previous webinars or partake of several other resources, including acquaintance with the educational institution’s Mission:

    Advocating widespread acceptance of food addiction as a disease of substance abuse and the availability of effective abstinence-based solutions.

    The FAI is always on the lookout for promising new ways to treat food addiction, a type of substance dependency that ties the person to one or more specific foods, or that manifests as volume eating, where the addictor seems to be the act of consumption itself.

    Childhood Obesity News has mentioned the Institute before, in several contexts. A post titled “The Food Addiction Institute Viewpoint” discussed the thoughts of Dr. Vera Tarman on Binge Eating Disorder (BED) and the failure of DSM-5 to include a food addiction diagnosis. As a result, Dr. Tarman predicted that many food addicts would be steered into a category that does not apply to them and “probably be given treatment that could ultimately undermine their recovery.”

    Dr. Tarman and Phil Werdell, also of the FIA, co-authored the book Food Junkies: The Truth About Food Addiction, and Werdell feels that at least the inclusion of BED in the most recent Diagnostic and Statistical Manual is a step in the right direction, which could pave the way for the acceptance of food addiction as a Substance Use Disorder in the next edition.

    The Institute also offers information on several self-help groups for recovering food addicts, with special attention to the 12-Step fellowships, of which Overeaters Anonymous is a venerable example. The FIA was mentioned in “Questions of Terminology” as one of the groups very interested in seeing that language is conscientiously applied throughout the mental and physical health fields.

    Peripheral Professions in Obesity Treatment” described the three-year FAI/ACORN Food Addiction Professional Training which was developed there. To have actually experienced the problem is a requirement. Recovering food addicts are clients first, and then progress to being assistants, and finally become co-professionals getting ready to launch out on their own. They can find jobs or independently set up shop as coaches or consultants, taking the load off psychiatrists and psychologists.

    Your responses and feedback are welcome!

    Source: “Webinar Schedule 2018,” FoodAddictionInstitute.org, 2018

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    More BFRBs Revisited

    January 11th, 2018

    drinking-from-bottle-silhoutte

    Childhood Obesity News is going back over the collection of posts about Body Focused Repetitive Behaviors (BFRBs). Just about everyone has either seen or done this: A person enters a semi-trance state, where the brain is somewhere else and the mechanical arm apparatus picks handful after handful of popcorn from a bowl and conveys each handful to the mouth, over and over.

    Sure, the salt makes the popcorn tasty — but more than likely the real attraction is the eating process itself, with all the biting, crunching, chewing, and tongue acrobatics, and the interesting sensation of matter proceeding down the gullet. Sure, food is very attractive and sometimes shows indications of being addictive. But eating can have drug-like effects on mood and mentation, and often gives every appearance of being addictive, in and of itself, with little relation to the substance in question.

    Chewing is not necessarily the only addictive motor action. Apparently, swallowing alone can provide stress relief, which helps to explain the enormous popularity of soft drinks. “More about BFRBs” went into additional detail about the concept of the hand-to-mouth motion as a powerful addictor.

    We have talked about aggressive chewing, and stress eating in people and dogs, and “eating your stress,” and the relationship between inappropriate and disruptive chewing behavior and ADHD. There are also shared characteristics between BFRBs and another alphabetical problem, OCD (Obsessive-Compulsive Disorder), in which things must be done only one way, under perceived threat of some dark and terrible result. As we described:

    A person might feel that it is a rule to eat cookies only in a certain mathematical progression. You can eat three, but if you mess up and eat four, then you have to go to the next multiple of three, which is six. Or, a person might hold a belief that the whole package of cookies has to be finished at one sitting, because to do otherwise would open the door to existential chaos.

    Obviously, OCD could perpetrate overeating in myriad ways, which all add up to self-sabotage.  Technically, body-focused repetitive behaviors qualify as a coping mechanism, because they are used to cope with stress. But as coping mechanisms go, having a BFRB habit is not a promising path.

    People seem to be massively infected with stress, because they love to crunch. Legions of scientists intensely research such concepts as “fracturability” and “first-bite hardness” for the benefit of corporations. On the most basic level, there really is nothing wrong with that.

    No one wants to discourage chewing. Chewing is the very basis of the “fletcherizing” fad that swept the country, once upon a time. Horace Fletcher, the guru of chew, preached the gospel of chewing each mouthful of food dozens of times. The benefit to the digestive system is undeniable, but this practice also does something for the emotions.

    As we learned, a major religious institution was interested in Fletcher’s teachings because people who practiced them tended to drink moderately, if at all. This might have been mere coincidence, resulting from personality differences between alcoholics and folks who try out new “crackpot” theories. Or maybe industrious, devoted chewing was a BFRB that relieved stress to the point where people felt no need to get drunk.

    Your responses and feedback are welcome!

    Photo on Visualhunt

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    Body-Focused Repetitive Behaviors (BFRBs) Revisited

    January 10th, 2018

    problem-in-substance-quote

    This is a retrospective look at some of the many interesting aspects of Body-Focused Repetitive Behaviors (BFRBs), with links to posts that expand on the basic points. But first, why does this quirky-sounding problem matter? What does it have to do with childhood obesity? Only everything!

    Disorders do not often present with neatly delineated edges, and until more is known, people will unavoidably conflate various conditions that may or may not have any meaningful connection. For now, we know that displacement behaviors fill a certain function for troubled people, and BFRBs can reasonably be said to fall into that category.

    To counteract nervous stress, people pick at their skin, bite their nails, pull their hair, or stroke their mustache. It looks like compulsive eating might also be fairly called a displacement behavior.

    People do these activities unconsciously or semi-consciously while watching TV, studying, traveling by car, talking on the phone, sitting in class, or browsing the Web. While thinking of something else, they do compulsive actions that not only take a toll on the affected body parts, but alienate onlookers. Noisy and obnoxious snack-munching can be as off-putting as picking scabs.

    BFRBs negatively affect a person’s social life. Many obese people feel that opprobrium is constantly aimed at them, but the reason might not be what they think. Maybe a friend is bursting with the need to say, “Look, I don’t mind that you’re fat. I’m tired of hearing you chew and slurp!”

    Versatility in BFRB manifestation

    Apparently, BFRB satisfaction can manifest as either an upper or a downer. Feelings of discomfort and emotional distress can be calmed by squeezing pimples or plucking out eyelashes; or feelings of listlessness and boredom can be elevated to a more bearable plane.

    Either way, to an objective academic eye they look like self-mutilating behaviors, and are classified as OCD Spectrum Disorders, which are closely related to OCD, or Obsessive Compulsive Disorder. A doctor who specializes in the field notes that clients are very frustrated by their inability to stop doing these things.

    In the various WeightLoss2Go smartphone app trials, Dr. Pretlow has seen a recurring pattern that almost makes no sense. In the big picture, children and teenagers have less trouble eliminating their special problem foods, and more difficulty with cutting down their amounts of plain old everyday mealtime foods. While there is plenty of evidence that the food industry makes an effort to invent addictive products, this does not explain why overweight kids cling to over-serving themselves with mundane Mom food.

    Unless… there is more going here than flavor, or response to chemical additives. There is wider involvement, in the pleasures of chewing and swallowing, in the repetitive motion of the hand from the food source to the mouth.

    This is good news because therapists have ways of dealing with other BFRBs, that also work on compulsive grazing and snacking. Childhood Obesity News wrote about a chain of adolescent treatment centers that had found success with nine different therapeutic modalities. Topics range from physical barriers to the realization that these particular disorders are extraordinarily susceptible to the benefits of group therapy.

    Your responses and feedback are welcome!

    Image: Quotation from podcast “#342 — Christopher Ryan,” VoiceBase.com, 03/25/13

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