Name: Robert A. Pretlow, MD

Bio: Robert Pretlow is a pediatrician and founder/director of Weigh2Rock.com, an online weight loss system for teens and tweens, used by clinics, hospitals, schools, private practitioners, community centers and health clubs worldwide. He lectures frequently on childhood obesity, both nationally and internationally, and is author of the new book, “OVERWEIGHT: What Kids Say: What’s Really Causing the Childhood Obesity Epidemic?”

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    Obese Youth and Motivation

    January 2nd, 2014

    Content

    Research shows that obese young people have a significantly lower quality of life rating — the same quality of life rating as young cancer patients who are on chemotherapy. Ostensibly, the low quality of life of obese youth is due to their being obese (not being able to wear cool clothes, not getting a boyfriend/girlfriend, being teased, etc.). Healthy eating and exercise are the conventionally recommended solutions for this. Thus, if obese young people are truly miserable being obese, why don’t they simply eat healthy, exercise, lose weight, and not be miserable anymore? Obviously, something else is going on.

    We’ve now completed two consecutive five-month studies with our app, involving 87 obese young people, many of them severely obese. The app’s approach is based on the addiction treatment model of withdrawal and abstinence from problem foods, snacking and excessive food amounts. Motivating these youth to actually engage and try the app was a daunting endeavor. Given the low quality of life rating of obese youth, one would think that they would jump at any chance to eliminate their obesity. This should be particularly true for a new approach that is different from healthy eating and exercise, with which they’ve not previously had success. Such was not the case with participants in our two studies. Most resisted the app intervention, several vehemently.

    It’s difficult to distinguish willful pleasure-seeking with food versus true out-of-control eating and inability to change in obese young people.

    The quandary is whether obesity is due to brain changes, which the individual cannot help, or is it a voluntary choice?

    Several youths in our studies reported that they have been overweight so long that they are accustomed to it. They are fatalistic that they will always be that way and don’t know how to change. One 400-lb. 21-year-old stated that he didn’t care about being obese as a teen — he believed that he would never be thin — yet what finally motivated him to lose weight in our study was “not wanting to die from obesity.” A 287-lb. 17-year-old stated that he wouldn’t worry about health issues from his weight until he was an adult, and his current lack of concern was a “teenager thing.”

    Most obese youth in our studies rated the question “How much does being overweight bother you?” as a 10 on a scale of 1-10 (1=least important, 10=most important) and their commitment to lose weight similarly. Even so, many became quite angry when asked to eliminate problem foods and especially to reduce the large food amounts to which they were accustomed. Several dropped out of the study as a result. Others would not admit what they were actually eating, adamantly claiming they were eating only small amounts, in spite of the fact that they continued to gain weight. When we confronted their claim as physically impossible, they accused us of calling them liars.

    Why would obese young people so vehemently resist measures to decrease their obesity? The rub of course is that any approach requires decreasing food intake. It would seem that they fear loss of food more than they are bothered by being obese. Withdrawal symptoms (grouchiness, depression), tolerance (needing to eat more and more for the same effect), loss of a stress coping mechanism, and giving up food’s pleasure as their main relief from life’s pain are likely factors. Moreover, as with other addictions, obese youth may be compelled to overeat just to feel normal.

    Your responses and feedback are welcome!

    Image by LisaValder.

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    Gluten: Not Addictive or the Problem, Says Dr. Pretlow

    December 9th, 2013

    Dr. PretlowHi Childhood Obesity News Readers,

    I need to jump in on the gluten posts series. [Editor's Note: "Dr. Mark Hyman Indicts Gluten," "Dr. Daniel Amen Identifies 5 Brain Patterns of Overeaters," "9 Ways Gluten Goes Undercover" and "Dr. William Davis Warns of Gluten"]

    I have a problem with the incrimination of gluten as a major cause of obesity or even as a major health problem. I’ve read (with consternation) Dr. William Davis’ book, Wheat Belly. He starts off with evidence that in certain schizophrenics wheat consumption may induce opioid effects, yet the effect is mild, and it has been documented only in schizophrenics. Dr. Davis then jumps to the conclusion that wheat is addictive and causes obesity, and further he lumps gluten enteropathy with this, in an incrimination of wheat for the entire population.

    Gluten enteropathy definitely causes celiac disease, but the prevalence is quite low. The recent claim that gluten punches holes in the gut, exposing the immune system to toxic antigens and inducing total body inflammation is not accepted by mainstream medicine.

    Dr. Davis — along with Dr. Hyman and Philip Werdell — also claims that wheat is addictive because digestion converts the starch to sugar, which is absorbed into the bloodstream. Sugar has been found to be addictive in rats. However, Volkow & Wise (2005) concluded that food addiction appears to be a sensory addiction. In contrast to drugs, which activate the reward system through direct pharmacological effects, pleasurable food activates the system through fast sensory signals, as well as slow processes, such as rising brain glucose.

    Actually, simple sweet taste has been shown, in more than a hundred studies, to calm infants and children during uncomfortable procedures (Harrison et al., 2012; Miller et al., 1994).

    Kristjan Gunnarsson, in his Kris Health Blog, discusses how wheat glutens form opioid peptides:

    “I believe that humans are able to become addicted to these substances. The process often starts in childhood, when kids are rewarded with candy when they behave well, contributing to psychological dependency as well. Judging from the above studies and personal experience, I think it is highly likely that junk food causes addiction in the brain of many people, causing them to become unable to change their diet despite wanting to.”

    Nevertheless, similar to William Davis, Kristjan Gunnarsson is lumping sugar and junk food addiction together with gluten opioid peptides.

    Few of the young people posting or responding to polls on Weigh2Rock.com and few of the 87 obese youth in our two app studies have mentioned bread or other wheat products as problem foods. Rather it is candy, soda, chips, ice cream, french fries, and other fast food with which they have the biggest problem. And the foods they eat in excessive amounts at meals hardly include bread or wheat products. Excessive amounts of fatty meats, potatoes and fried foods like chicken strips are where most of their calories at meals come from.

    To summarize, the gluten thing may be another ploy to obfuscate the fact that it is mainly excessive amounts of ANY food that’s responsible for obesity. Nearly all the 87 obese youth in both of our two pilot studies reported that consumption of large food amounts at meals (at home) was the main contributor to their overweight. Likewise, reducing amounts at meals contributed the most to their weight loss, but was much more difficult than avoiding problem foods and eliminating snacking. Most of the obese youth in our study became overtly upset when asked to reduce food amounts at meals, and several dropped out of the study rather than do so. Thus, instead of incriminating specific constituents of food as the cause of obesity, we should look at why people consume large amounts in the first place, and keep doing so, even though they are aware that it will result in further weight gain. Using food as a coping mechanism would seem to be the culprit, in my humble opinion.

    1) Problem food addiction seems to be a sensory addiction (taste, texture, “mouth feel”) rather than a direct narcotic effect on the brain by certain food ingredients. For example, bulimics vomit up consumed foods, yet are still addicted to the foods. And, as previously noted, Volkow & Wise (2005) concluded that in contrast to drugs, which activate the brain’s reward system through direct chemical effects, pleasurable food activates the system mainly through sensory signals.

    2) From results of our two studies, excessive food amounts consumption appears to be a different type of addiction, probably a behavioral addiction similar to nail biting, rather than the classic addiction (cravings) of problem foods. And, consumption of excessive food amounts likewise does not appear directly related to action of food ingredients on the brain. Instead, it seems to be the mechanical action of eating (biting, chewing, swallowing) that the individual is hooked on. However, consumption of excessive food amounts is facilitated by food sensations (taste, texture). Snacking is similar. Both typically do not involve specific foods but rather whatever food is available, though the food has to be palatable (not hyperpalatable). I recall a post from a mother on our site lamenting that she had removed all junk food from her house, yet her obese daughter then binged on apples!

    Dr. Pretlow

    References

    Harrison, D., Beggs, S., & Stevens, B. (2012). Sucrose for procedural pain management in infants. Pediatrics, 130(5), 918-925.

    Volkow, N. D., & Wise, R. A. (2005). How can drug addiction help us understand obesity? Nature Neuroscience, 8(5), 555-560.

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    The Weigh to Rock: A Nutritionist’s Guide Through Child Obesity

    October 25th, 2012

    young and fat

    Nutritional therapists and dietitians play an indispensable role on the front lines of obesity treatment, as most physicians likely refer their obese patients to a nutritionist at some point. In addition, many nutritionists receive self-referrals from patients who are ready to face their weight problems. Typical obesity therapy by nutritionists consists of instructing the client about healthy eating and supplying meal plans. But does this nutritional approach actually help obese clients?

    Nutritionists, whom I’ve informally surveyed, are unaware that new evidence suggests obesity is not a nutritional problem, but rather a psychological one. In my years of practicing pediatrics, I taught overweight kids about healthy eating, exercise, and portion control. My successes were limited.

    Most of my patients struggled to lose weight, even though they hated being fat; and if they lost weight, they soon gained it back. I was frustrated. Something else was going on and defeating their efforts. This mystery frustrates nutritionists as well. In my determination to find answers, I set up an interactive, open-access website where I invited overweight and obese kids to share their stories and struggles.

    After receiving several million visitors, and 134,000 anonymous messages over 10 years, I’ve learned a lot about childhood obesity. These kids proclaim that they’ve “overdosed” on healthy eating information, which they’re taught in school, as the following results from a poll on our site illustrate.

    Poll Results

    Participants indicate they need information on how to resist cravings for highly pleasurable foods. Furthermore, 37% of those sharing their weight struggles on our bulletin boards explicitly describe turning to food when they’re depressed, stressed, angry, anxious, lonely, fatigued, or bored. In the words of one 17-year-old girl (5’4”, 184 lbs.), “I want/need to lose weight […] yet I’ll just keep eating those chocolate bars to numb whatever feelings I have at that moment.” For many, or perhaps most, comfort eating appears to be unconscious or mindless, as another 17-year-old girl (5’7”, 181 lbs.) related, “I’ve been stopping myself from emotional and comfort eating and I’m only realizing how big of a problem it was for me that I was in total denial of.”

    Even when they realize that they comfort eat, the kids may be unable to stop, as a 13-year-old girl (5’6”, 177 lbs.) agonized, “I hate when I comfort eat… I DON’T KNOW HOW TO STOP. IT’S KILLING ME.” Many get trapped in vicious cycles, where they eat to comfort the anguish of being obese, as one 14-year-old (5’6”, 171 lbs.) lamented, “Every time I’m stressed I eat, and my weight is making me stressed.”

    I’ve observed that kids initially overeat because “the food is there.” It simply tastes good. But once their brains realize that pain, stress, or boredom are eased by the pleasure of food, kids may become unknowingly dependent on comfort eating and unable to stop, even when they become distressingly obese. Actual tolerance may develop. One 14-year-old girl (5’2”, 201 lb) remarked that food is “like a drug. What used to satisfy you before, now has no effect. I feel like I’ve become immune to the foods that used to comfort me. And like drugs, you keep moving on to bigger, worse things in order to get the same feeling as when you started out.”

    This compelling evidence points to a serious dependence on the pleasure of eating, quite similar to dependencies on tobacco, alcohol, and even drugs, as the main cause of the child and adult obesity epidemic. The way these youths describe their relationship with food comes close to satisfying all of the DSM-IV substance dependence criteria, which is the gold standard for diagnosis. Many kids use food as a “drug of comfort” that is more acceptable than alcohol and drugs. Dependence on highly pleasurable foods appears to be on a continuum. Overweight kids would seem to be partially dependent, obese kids fully dependent, and morbidly obese kids are likely in addictive tolerance mode where they eat more and more, or eat higher pleasure-level foods, in order to obtain the same degree of comfort.

    Comfort eating may induce brain changes. Neuroimaging studies reveal that low dopamine D2 receptor levels in the striatum are strikingly similar in obese and drug-addicted persons. A recent study in the March 2010 issue of Nature Neuroscience found that fatty foods, such as bacon and frosting, can cause a cocaine-like addiction in rats. Once the rats became obese from eating fatty foods, they would endure an electric shock to get to it. The rats’ brains showed the same low dopamine receptor changes as in the human studies when the rats were allowed unlimited access to cocaine or heroin. A 16-year-old girl summed it up this way: “A teen who does drugs or smokes would get in trouble if their parents found out. But no one’s going to ground you for eating, which can be equally as damaging, and is equally as difficult to stop.”

    Nutritionists should be asking obese kids about their lives and how they feel when they seek food. They should be advising parents to listen to their kids’ answers, which may alert them to a comfort-eating dependence. A 12-year-old girl (5’3”, 186 lbs.) remarked, “If parents took the time to actually listen to their kids… less kids would go to the fridge when they were depressed.” Too often, parents ascribe blame to their overweight children, which may induce further comfort eating.

    Obese kids need major support to break their dependence on the pleasure of eating, including ways to cope with life without turning to food, such as hobbies, pets, meditation, and counseling. Kids may not be in touch with their emotions and may be unaware that they use food to cope; they may simply say, “I just love to eat.”

    The mainstay of successful substance dependence treatment is abstinence. In response to my 2008 letter to the editor in Pediatrics, Jennifer J. Bowdoin, MS, claims that the addiction model for obesity will not work because “food is necessary for life [...] and is not a substance from which children can simply abstain.” Nevertheless, a poll on our site shows that most participants have a problem with mainly one food.

    Furthermore, the foods the kids have the most problems with are chocolate, fast food, chips, and candy. Those foods are not necessary for life.

    Fighting Addiction

    Abstinence from the most addictive foods — hyperpalatable foods such as junk food — is challenging but feasible. It may seem unreasonable to advise a client to completely abstain from a food, even junk food. However, if clients are allergic to the food, they would need to avoid that food, perhaps forever. Obesity is really no different. People don’t become addicted to broccoli or dry toast. Nutritionists can help clients sort out the foods to which they are addicted and substitute with non-addictive foods. Nutritionists also can help clients reduce their stress level and find non-food ways to cope.

    Substituting low-calorie foods as “coping” foods may not be a good idea, as food is still used for emotional reasons, and the client may become addicted even to 100-calorie packs. Nutritionists should help clients establish a “nutritional” relationship with food, rather than using food for comfort, coping, and entertainment, which can lead to dependence. This is not advanced psychology and is well within the domain of nutritionists. Furthermore, there is no stigma associated with seeing a nutritionist, whereas seeing a psychologist or psychiatrist may imply “mental” problem.

    A Food Addiction Road Map 

    Nutritionists may first want to ask the following five questions when evaluating overweight/obese clients:

    1. Do you ever feel stressed, sad, or bored?
    2. Do you find yourself eating to make yourself feel better (maybe, mindless eating)?
    3. Do you struggle to resist cravings or urges for rich food, like junk food or fast food, knowing full well that you don’t want to gain any more weight?
    4. Do you feel that your eating is out of control?
    5. Do you find yourself eating to comfort the distress of being so heavy?

    As I manage my overweight patients with comfort-eating patterns, I’ve shifted my focus from portion control to stress control. Here is my written prescription for my patients. I hope it works for your clients as well.

    Prescription for overweight clients:

    1. Write down your reasons to not overeat, such as: so I won’t be out of breath; so I won’t be teased; so I can fit into cool clothes; so I can get dates; so I can play sports; and for my health.
    2. Do three things to reduce your stress each day, such as relaxation, deep breathing, meditation, taking a walk, practicing a hobby, shooting hoops, or playing a musical instrument.
    3. Write down a list with a description of each of your problems, leaving space underneath each, such as: “I just can’t understand algebra” and “My mom bugs me about my weight.” Underneath each problem write a plan, such as, “Ask the school for a math tutor” and “Write a letter to my mom saying that her nagging makes me eat more. Ask my minister to help me with my mom.”
    4. Talk about your problems with your parents, friends, doctor, religious leader, or counselor.
    5. Avoid junk food and fast food, including sugar-sweetened drinks. Ask your parents to not have them in the house.
    6. To get unhooked from problem foods, try to stay completely away from the one food that is most problematic. Your cravings for that food should improve in 1 to 2 weeks. Don’t abuse a new food once you get off the most problematic one. Do this withdrawal process with as many problem foods as you can, one at a time.
    7. Find sources of comfort other than food, such as pets, volunteer work, books, hobbies, and clubs.

    The website in this report, http://www.weigh2rock.com, is owned by eHealth International, Inc., Pretlow’s company, as is his book, Overweight: What Kids Say.

    – Robert Pretlow, MD, MSEE, FAAP, the founder and director of Weigh2Rock, an online weight loss system for teens and preteens, is board-certified in pediatrics and is a fellow of the American Academy of Pediatrics. For more information, Pretlow may be contacted at: director@weigh2rock.com or 206-448-4414. 

    Originally published 6/27/10 at TherapyTimes.com.
    Reprinted with permission.

    Image by Tobyotter (Tony Alter).

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    Food Addiction and Childhood Obesity: Now What Do We Do?

    April 28th, 2011

    (Part Two of a Two-Part Post — View Part One)

    The first part of this post had to do with the fact that the “healthy eating and exercise” approach for ending the childhood obesity epidemic just isn’t working. Compelling new evidence now points to actual addiction to highly-pleasurable comfort foods, like junk food and fast food, as the predominent cause of childhood obesity. Based on this knowledge, if we are to turn the tide of this horrific epidemic, a major paradigm shift is needed. We must attack childhood obesity in the same manner as we do other addictions. A 13-year-old girl (5’, 128 lb.) responded to a poll asking if junk food access by children should be restricted:

    OMG THIS WOULD HELP SO MUCH!! … i find myself at the deli buying candy behind my moms back ugh.

    Proposed Action Items

    Some of the following action items may be considered too radical. Even so, their implementation might render a reality First Lady Michelle Obama’s dream of eradicating the childhood obesity epidemic within a generation:

    • Substance dependence methods should be incorporated into overweight intervention programs for youth. For example, obese kids will need to go through a withdrawal process to get off highly pleasurable foods, as this 15-year-old girl (5’10”, 209 lb.) describes:

    if u can have enough self control and stay off the sugar for two weeks you stop craving sugar completely..

    • Current childhood obesity initiatives and interventions should all be examined through a “psychological food dependence – addiction lens.” Do such programs help psychological food dependence – addiction? If not, kids may become discouraged when the programs fail to help them lose weight or maintain their weight. Discouraged kids may comfort-eat more and seek help less, a vicious cycle. Nevertheless, parts of current programs may serendipitously help food addiction. For example, fun physical activities relieve stress and depression, the underlying causes of food addiction, although striving to eat 5 servings of fruits and vegetables or walk 10,000 steps a day may not.
    • Campaigns and interventions that promote healthy eating and exercise may thus be counterproductive. Those programs should instead educate kids as to why they overeat; how to reduce their stress, loneliness, and depression; and how to cope with life without turning to food.
    • Obese kids need major support to break their addiction to highly pleasurable foods and avoid relapse. Interventions should include such support via mentors and peers. Counseling should be provided for kids in need of it.
    • Factors that produce stress, loneliness, and depression in kids should be addressed, as such are the underlying cause of comfort and stress eating and resulting food addiction. Fun activities with other kids should be provided after school and on weekends in order to combat social isolation, a main factor. The inability of many heavy kids to participate in sports should be accommodated with activities such as hobbies, non-strenuous games, learning to play musical instruments, etc.
    • Insurance should cover treatment of morbidly obese kids in residential centers, rather than paying for bariatric surgery. This should include coverage for follow-up after discharge and “halfway houses,” to gradually reintroduce the kids to the temptations of comforting, highly pleasurable foods in the real world and to develop coping skills that don’t involve eating. Follow-up should continue indefinitely once the kids return to their home environment.
    • Junk food and fast food should be banned in schools, as well as such outlets in the vicinity of schools.
    • Foods that kids say they have the most problem resisting should be taxed, in the same manner that taxation of tobacco products has shown success in decreasing tobacco use.
    • Ideally, sales of junk food (including sugar-sweetened beverages) and fast food should be restricted to minors, similar to restrictions with tobacco.
    • Childhood obesity campaigns should promote overeating as “not cool” and junk food as “yuck!” Celebrities such as rock stars and athletes could help tremendously.
    • Parents should be educated not to use food to soothe, comfort, or reward their children. Parents should likewise be made aware of the signs of comfort eating and food addiction.
    • New terms should be coined to describe foods or food-like substances which may be addictive. Terms such as “addictafoods” or an acronym like “PDFs” (psychological dependence foods) might be appropriate.
    • An indicator of food addiction potential should be required on food labels, for example a scale of 1 to 3. The most addictive foods (level 3) should also have a warning label similar to cigarettes: “Warning: This food may be addictive and cause obesity.”
    • Federal corn subsidies, which lower the price of high-fructose corn syrup, should be ceased. High-fructose corn syrup is used to sweeten a multitude of food products, rendering them more pleasurable, comforting, and addictive.
    • The Code of Food and Beverage Advertising to Children (Code PABI) in Mexico should be emulated in the U.S. and other countries. This code, which currently is self-policed, will soon become government-enforced.
    • Ideally, all food advertising directed at children should be banned. Food advertising directed at children is, in truth, enticement rather than advertising. Only highly pleasurable foods are advertised, which may get children hooked. Food companies are no dopes: an addicted kid is a customer for life. Could that be why apples are not advertised?

    Overweight and obese kids are hapless victims of stress, loneliness, and depression in a readily available, addicting, comfort food environment. Food addiction and resulting weight gain devastates their lives. These kids are in real pain. They desperately need for the medical profession, parents, and policy makers to do something about this deplorable problem. If one third of our kids were suffering from asthma due to air pollution, we’d take draconian measures. Why is childhood obesity different?

    Your responses and feedback are welcome!

    (View Part One of This Post)

    Image purchased from iStockPhoto.

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    Ending Childhood Obesity Through Healthy Eating & Exercise?

    April 27th, 2011

    I recently witnessed two teenagers in a group, one advising the other how to lose weight. The first teen glibly proclaimed,

    All you gotta do is eat healthy and exercise!

    Whereupon, the second teen indignantly retorted,

    That is sooo not it!!! I know what to eat, I just can’t resist bad food!! And exercise is, like, impossible!!! I get so outta breath and my feet and knees hurt!

    At 13, she weighed in at 5’5”, 257 lb.

    In an online poll, most overweight kids report that they’re overdosed on healthy eating information. They’re deluged with it in school and it really doesn’t seem to help them. As one 13-year-old girl (5’4”, 240 lbs) noted:

    I took a poll at my school. 95% knew a lot about eating healthy but 99% said that they really didn’t do any of the stuff we learn about.

    This information comes from an interactive website for overweight kids called Weigh2Rock, moderated by medical professionals. It has tapped into a vast knowledge base: nearly 30,000 unique overweight teens and preteens have posted more than 135,000 messages on this site over the past 11 years.

    And, confirming what these kids say about exercise, a new report from the EarlyBird Diabetes Study suggests that physical activity has little, if any, role to play in the obesity epidemic among children. Plus, a recent review study confirms that healthy eating and exercise may not be the answer.

    Yet, healthy eating and physical activity comprise the very fabric of current childhood obesity interventions and initiatives, such as First Lady Michelle Obama’s laudable “Let’s Move” campaign. A 14-year-old girl (5’4, 230+ lb.) commented about Ms. Obama’s campaign in a website poll:

    There are actually alot of activities in my school, like intramural sports and i was in them, didn’t help a smidge. And there ARE healthy affordable foods where i live, it doesn’t mean that we buy them. I don’t think she has thought about the fact that there are multiple mcdonalds in every town. For years people have had programs and activities to help obese people and it hasn’t really helped. There are many holes in this plan.

    So… if the healthy eating and physical activity approach is not working for childhood obesity, what do we do now?

    About a third of the thousands of overweight kids, who’ve shared their struggles on the Weigh2Rock website, explicitly say that they turn to food to ease sadness, stress, anger, loneliness, fatigue, and boredom, as well as the pain of being obese itself. For most, this “comfort eating” appears to be unconscious, mindless. The disaster is that they become hooked on this behavior and unable to stop, even when distressingly overweight or obese because of it. Food companies understand this and market with slogans like “Comfort in Every Bar” (Milky Way candy). These kids say they hate being fat, yet they struggle to resist incessant thoughts and urges to eat food “that tastes good,” e.g., junk food and fast food, knowing full well that eating those foods will result in additional weight gain and further damage to their lives. Many say that their eating is “out of control.” A post from a 16-year-old boy (5’6″, 230 lb.) exemplifies this struggle:

    does anybody have any info on how to resis the urge 2 eat, knowing that later on you’ll regret…i need help bad!

    This compelling evidence points to a serious dependence on highly pleasurable comfort foods (i.e., addiction) as a major component of the childhood obesity epidemic, not unlike addictions to tobacco, alcohol, and even drugs. These research findings are summarized in an article in the upcoming edition of the peer-reviewed journal, Eating Disorders, Vol. 19, #4 (in press).

    What these kids say is confirmed by a brain scan study at Yale University published this month, which revealed that that the brains of adolescent compulsive eaters “light up” when shown the foods they crave, like milkshakes and donuts, the same way the brains of drug addicts “light up” when shown the drugs they are addicted to. Many kids — when stressed, depressed, or bored -– appear to use highly pleasurable food as a “drug of comfort,” which is more acceptable than tobacco, alcohol, or drugs of abuse, but nearly as addicting. Children have difficulty obtaining tobacco, alcohol, or drugs but have ready access to highly pleasurable foods.

    Kids even describe their addiction to comfort foods, for example a 15-year-old girl (5’1”, 335 lb.):

    HOW can I stop BEing ADDICTed to FOOD???? In SCHOOL I can’t even LISTEN because of how UNCOMFORTable it is to be SO HEAVY but ALL I want is to go HOME and have ICEcream or COOKies to feel BETTER

    Medical science is resisting the notion of food as an addictive substance. Why? One reason may be that much of obesity scientific research is funded by the food industry, which is deathly afraid that their products might be labeled as addictive substances. This likely would open up a liability nightmare, as well as extensive federal regulation of food. A second reason is that obesity researchers have substantial vested interests in areas such as nutrition, metabolism, and exercise. Plus, physicians generally are uncomfortable with a psychological approach to a physical problem. And, for nutritionists and dietitians, the term “food addiction” is inherently a non sequitur. One dietitian, Christy Harrison, a writer with the Slate Group, rejected this post as a “counterintuitive position.”

    Your responses and feedback are welcome!

    Read Part 2: Food Addiction and Childhood Obesity: Now What Do We Do?

    Image purchased from iStockPhoto.

    7 Comments "

    Childhood Obesity Conflicts of Interest

    December 20th, 2010

    Childhood Obesity Science Conflicts of Interest

    If a tobacco company were to fund an anti-smoking scientific journal, most people would point out the glaring conflict of interest. Yet, a new peer-reviewed, scientific journal, Childhood Obesity (Mary Ann Liebert, Inc.), was launched in September 2010 with a grant from the W.K. Kellogg Foundation. The Kellogg Foundation’s trust assets include $4.1 billon of Kellogg Company common stock (out of $6.4 billion total assets). That’s not independence.

    In effect, a major food company is funding a childhood obesity scientific journal. Will childhood obesity researchers and professionals thus tend to look more kindly at the Kellogg Company and its food products? Kellogg’s products include sugary kids’ cereals, such as Fruit Loops, Honey Smacks, and Cocoa Puffs, and pastries such as Pop Tarts. Kellogg’s Pop Tarts are marketed as entertainment for kids with the slogan, “Made for Fun.”

    Furthermore, the Vice President for Programs of the Kellogg Foundation, Gail C. Christopher, DN, is on Childhood Obesity’s editorial board. Dr. Christopher is a naturopath and wrote the “Welcome” article in the inaugural issue of the journal. Why would a naturopath, much less a vice president of a food giant’s foundation, be selected for the editorial board of a medical childhood obesity journal? Might the Kellogg Company wish to influence the journal’s choice of articles?

    Emerging new evidence indicates that sugar may be addicting and thus a possible cause of the childhood obesity epidemic. Exposure to sugary kids’ cereals might induce sugar addiction in children. The Kellogg Company may not want articles on food addiction to appear in Childhood Obesity. By way of disclosure, my article, entitled “Food Addiction in Children,” was rejected by Childhood Obesity but was accepted by the journal, Eating Disorders. Researchers at Yale University recently remarked (PDF) on the effect of food-addiction evidence on the food industry:

    But for such a sensitive issue, and one with potentially important legal implications, one can imagine how threatening even the implication of addiction would be to the [food] industry, as it was with tobacco.

    The Kellogg Foundation also has provided funding in 2010 for HealthCorps, with the stated purpose:

    [...To] prevent childhood obesity by encouraging students to take personal responsibility for their health and wellness.

    “Personal responsibility” is the food industry’s typical solution for the obesity epidemic. The American Personal Responsibility in Food Consumption Act, also known as the Cheeseburger Bill, sought to protect producers and retailers of foods — such as McDonald’s Corporation — from an increasing number of suits and class action suits by obese consumers. The Act was passed by the U.S. House of Representatives in March 2004, but did not receive a Senate vote. The Bill was reintroduced in 2005 by Florida Republican Congressman Ric Keller and re-passed by the House but still not by the Senate.

    How much personal responsibility is a five-year-old able to exercise when he discovers a box of Fruit Loops or Pop Tarts in the pantry? If the Kellogg Foundation is to fund efforts to prevent childhood obesity, as well as childhood obesity research, shouldn’t the Foundation completely divest itself of all assets in the Kellogg Company food giant? Otherwise, a conflict of interest will continue to exist.

    As noted in the “Medical Science and Food Addiction” post on our Childhood Obesity News blog, the high fructose corn syrup industry was a sponsor of the Obesity Society 2008 scientific meeting. At the Obesity Society 2010 scientific meeting, the word “addiction” was censored from presentation titles in the preliminary vs. final program.

    Pepsico is funding obesity research at Yale, and The American Dietetic Association recently announced that it has inked a partnership with the Hershey Company. McDonald’s has a Global Advisory Council consisting of childhood obesity and nutrition professionals.

    I talked with Dr. Tom Baranowski, an eminent childhood obesity researcher and one of the Council’s members, at a child obesity conference. He revealed that he has received money from McDonald’s for his Council services but would not reveal the amount. With all due respect to Dr. Baranowski and the other distinguished members of McDonald’s Global Advisory Council, if someone pays you money, it’s impossible to be objective.

    Childhood Obesity Initiative Conflicts of Interest

    The November 2010 issue of the journal Pediatrics included a special supplement about the Shaping America’s Youth (SAY) initiative to combat childhood obesity. SAY recently held town meetings all across the U.S. to promote healthy nutrition and physical activity in children, with the goal of eradicating the childhood obesity epidemic. The source of funding for these town meetings included Conagra Foods, QTC Group (a division of Pepsico), Cadbury Schweppes (a division of Kraft Foods), and Dr. Pepper Snapple Group (Dr. Pepper, 7UP, Canada Dry, RC Cola). Food companies appear to be trying to divert attention away from evidence of food addiction by portraying childhood obesity as nutritional ignorance and a sedentary lifestyle problem.

    McDonald’s was a supporter of the National Childhood Obesity Awareness Month, as part of an esteemed group which included the American Academy of Pediatrics, the CDC, the National League of Cities, and the YMCA. Does anyone really believe that McDonald’s will do what is necessary to combat the childhood obesity epidemic?

    Your responses and feedback are welcome!

    Source: “Premier Issue of New Childhood Obesity Journal Launched by Mary Ann Liebert, Inc., publishers,” Mary Ann Liebert, Inc. Publishers PR release, 09/07/10
    Source: “Pop Tarts Dancer,” YouTube
    Source: “Combined Statements of Financial Position With Supplemental Combining Information,” W.K. Kellogg Foundation Annual Report, 2009
    Source: “Study Suggests Sugar May Be Addictive,” HealthDay, 12/10/10
    Source: “The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food?” (PDF), Rudd Center for Food Policy and Obesity, Yale University, 2009
    Source: “Should PepsiCo be Funding Obesity Research at Yale?” Fooducate blog, 04/07/10
    Source: “Only in America: Candy Maker to Sponsor Our Dietary Advice [Thanks Hershey!],” Fooducate blog, 07/20/10
    Source: “Making the Case!” (video), Healthier Kids, Brighter Futures, 09/10
    Image: Cover of Childhood Obesity, used under Fair Use: Reporting.

    7 Comments "

    Medical Science and Food Addiction – Part 2

    July 20th, 2010
    fueluptoplay60

    The "Fuel Up To Play 60" Campaign is sponsored by Domino's Pizza, among others.

    (Part Two of a Two-Part Post)(View Part One)

    by Robert A. Pretlow, M.D.

    My last post had to do with the difficulty of medical science in accepting food addiction as a cause of the obesity epidemic. This post presents how the evidence for food addiction is being downplayed.

    Anecdotal Data

    I recently talked with Robert Lustig, a pediatric endocrinologist and eminent childhood obesity researcher at the University of California, San Francisco, about my paper on “Food Addiction in Children,” which was rejected by the Childhood Obesity journal. Dr. Lustig declared, “The kids’ posts in your study are merely anecdotal and not acceptable for a peer reviewed journal.” Nevertheless, the medical definition of anecdotal is, “a single case report not yet substantiated by studies using large numbers of people.”

    There are 134,000 posts on our site, written by 29,000 kids — that’s not anecdotal data. How many kids are in university studies? Typically, a hundred to a couple thousand. Furthermore, the type of data on our website is not obtainable by conventional face-to-face research. A certain degree of anonymity is necessary for kids to open up, which is possible only on the Internet. We used important safeguards to improve the value of the research: The boards were monitored by health care professionals, who removed any blatantly misleading or outlandish posts. This is vetted research, not just unfiltered spam.

    Dr. Lustig also claims that, as I’m not a university-based researcher, getting the information accepted by a scientific medical journal would be difficult. Even so, university research committees, legal departments, and human-subjects review boards likely would not allow “World Wide Web” research on kids, particularly without identity validation and parental permission. The kids want to remain anonymous. Only an “outsider” is able to conduct such research.

    Scientific Evidence

    There are human-brain scan studies, as well as animal model studies, that provide the “scientific” evidence to support the user-generated research. Neuroimaging studies (PDF) reveal that low dopamine D2 receptor levels in the striatum of the brain are strikingly similar in obese and drug-addicted individuals.

    Further, a recent study in rats found that fatty, sugary foods such as bacon and frosting can cause cocaine-like addiction. Once rats became obese from eating those foods, they would endure even an electric shock to get to the foods, whereas normal rats would not. The obese rats’ brains showed the same low dopamine receptor changes as in the human studies, and the same changes as in the brains of rats allowed unlimited access to cocaine or heroin. Additional brain-imaging studies demonstrate that obese people react much more hedonistically to sweet, fat-laden food in the pleasure and reward circuits of the brain than healthy-weight people do, which overrides their normal hunger and fullness eating-control mechanisms.

    Food Industry Trying to Downplay Overeating Problem in Kids

    The food industry is trying to promote the idea that kids can eat as much and whatever they want, and simply work it off with exercise. An example is the “Fuel Up To Play 60″ campaign, sponsored by the National Dairy Council in conjunction with the National Football League, and other food companies, including Domino’s Pizza. This campaign overlooks the fact that kids really can’t exercise enough to work off the massive numbers of calories consumed by many kids. Kids simply are not professional athletes. And, the ultimate irony, even the NFL now has obesity problems. Plus, a new study suggests that physical activity has little if any role to play in the obesity epidemic among children: “The focus has to be on what — and how much — children consume.”

    Medical Science Slow to Adopt New Approaches

    Historically, medical science has been highly conservative and extremely slow to change. Take handwashing, for example. It is something we take for granted when it comes to healthcare personnel, but such was not always the case. In the first half of the 19th century, seven percent of women died in childbirth in hospitals because doctors did not wash their hands and spread infection from one patient to another. Even though there was very compelling evidence of the benefits, handwashing by doctors took years to be adopted.

    Another example of slow adoption of new approaches in medicine is what The London Times said about the stethoscope in 1834: “That it will ever come into general use, notwithstanding its value, is extremely doubtful; because its beneficial application requires much time and gives a good bit of trouble both to the patient and the practitioner; because its hue and character are foreign and opposed to all our habits and associations.”

    True to its conservative nature, mainstream medicine has not yet accepted the Internet as a means of care or research. Only a small percentage of physicians use email with their patients, and even fewer utilize home monitoring. There were only two Internet research papers presented at the 2010 American Telemedicine Association meeting, one of those mine.

    In view of what tens of thousands of overweight and obese kids post anonymously on the Internet, and not merely on our site (e.g. SparkTeens), there seems to be little doubt that comfort eating and resulting addiction to highly pleasurable foods plays a significant role in the childhood obesity epidemic. It’s tragic for kids that medical science won’t look at this. Obese kids are not invited to speak at scientific conferences. If researchers and reviewers would simply listen to the kids, they would figure it out.

    Source: “Similarity Between Obesity and Drug Addiction as Assessed by Neurofunctional Imaging: A Concept Review” (PDF), Haworth Press
    Source: “Junk food turns rats into addicts,” Science News, 11/01/09
    Source: “Eating to Live or Living to Eat?,” The Wall Street Journal, 07/13/10
    Source: “Obesity Rampant in NFL, Study Says,” Fox News, 03/01/05
    Source: “Inactivity ‘No Contributor’ to Childhood Obesity Epidemic, New Report Suggests,” Science Daily, 06/08/10
    Source: “Ignaz Semmelweis,” Wikipedia
    Image: “Fuel Up To Play 60″ campaign screen pic, used under Fair Use: Reporting.


    Robert Pretlow is a pediatrician and founder/director of Weigh2Rock.com, an online weight loss system for teens and tweens, used by clinics, hospitals, schools, private practitioners, community centers and health clubs worldwide. He lectures frequently on childhood obesity, both nationally and internationally, and is author of the new book, “OVERWEIGHT: What Kids Say: What’s Really Causing the Childhood Obesity Epidemic?”

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    Medical Science and Food Addiction

    July 19th, 2010
    obesity society

    HFCS lobby was a sponsor of the Obesity Society 2008 scientific meeting.

    (Part One of a Two-Part Post)(View Part Two)

    by Robert A. Pretlow, M.D.

    Why Does The Obesity Community Reject Addiction?

    In September 2009, I conducted a plenary session presentation at the European Childhood Obesity Group (ECOG) scientific meeting in Dublin, Ireland, in which I proposed that comfort eating and resulting addiction to highly pleasurable foods is what’s causing the childhood obesity epidemic, based on the anonymous posts of thousands of overweight and obese kids on my open-access website over the past 10 years. After my talk, it was notable that hardly anyone asked questions. The conference chair, Grace O’Malley, confided to me, “The attendees were stunned by what the kids said in your presentation.”

    At that same conference, a research paper was presented by a pediatrician from Austria, which “proved the relevance of food craving/addiction in childhood obesity” (Abstract, PDF). In the summary session at end of the conference, an attendee remarked that my plenary presentation and the addiction research paper were “new information.” He proposed that ECOG issue a statement on “addiction and childhood obesity.”

    The response of the president of ECOG, Margherita Caroli, was, “Well, we don’t know what we’d say!” The proposal went no further. The response of the ECOG president, as well as that of the stunned attendees, illustrates a point: Medical science is having difficulty fathoming the idea of food as an addictive substance.

    I recently submitted a paper to the new journal, Childhood Obesity, entitled, “Food Addiction in Children,” based on 134,000 posts from 29,000 overweight and obese kids. My article was rejected. The reviewers legitimately pointed out flaws in my paper, however, their comments included: “overly provocative title”, “sensationalistic language”, “inflammatory conclusions,” and a declaration that the compelling posts of the kids “read like a laundry list.” The kids’ posts speak for themselves. The kids speak for themselves.

    Why is Medical Science So Foreign to the Idea of Food Addiction?

    For one thing, mainstream medicine lacks a framework with which to understand food addiction. Comfort eating and addictive dependence are “touchy feely,” and my physician colleagues deride “touchy feely” medicine. Medical science is based on measureable physiology. Comfort eating and food addiction are difficult to quantify, much less statistically validate. I heard a commentary on NPR the other day referring to the fact that medical people have a tough time with any conditions related to the mind-body connection, e.g. habits of mind that determine behaviors. Even the psychiatric royalty is waffling over whether to designate obesity as a mental disorder in the new DSM-V diagnostic manual.

    Conflicts and Vested Interests

    The food industry doesn’t want the FDA to regulate food, which would likely happen if food addiction is scientifically established as causing obesity. Obesity medical science is supported by the food industry. For instance, here’s an article: “Should Pepsico fund obesity research at Yale?” Another example is that the high fructose corn syrup industry was a sponsor of the 2008 Obesity Society scientific meeting (see image, above). That same year, David Ellison, president-elect of the Obesity Society was forced to resign because of an article in The New York Times exposing his financial relationship with the fast food industry.

    Ironically, some obesity researchers (and journal reviewers) are overweight or obese themselves. Kids note the hypocrisy of overweight health professionals promoting obesity treatment and research. Do such overweight or obese researchers have vested interests or hidden agendas? An obese physician at a university children’s hospital obesity clinic wrote, “Our nutritionists are opposed to such a weight-loss emphasis in a program… [W]eight loss diet programs in teens show little evidence of long-term success and indeed can at times turn into eating disorders.” At the 2007 National Childhood Obesity Congress an obese member of the Expert Committee on Childhood Obesity proclaimed in a presentation, “If McDonald’s closed every one of its restaurants, it wouldn’t affect the childhood obesity epidemic.”

    Furthermore, there are enormous vested interests of researchers and journal reviewers in other obesity medicine research areas, such as genetics, metabolism, nutrition, exercise physiology, and the “built environment.” The premise that obesity may be due to food addiction threatens these vested interests. The Obesity Society scientific meeting (PDF) has no track on psychology, let alone food addiction.

    Food Is Necessary for Life and Can’t Be Abstained From

    There is the argument that the addiction model won’t work for obesity because “food is necessary for life and cannot be abstained from,” which was the response to a letter I wrote (PDF) that was published in the Pediatrics journal in 2008. However, medical science fails to realize that it’s not every food that kids are addicted to but only highly pleasurable foods, like junk food and fast food.

    At the 2008 Obesity Society scientific meeting there was a session on “Assessment and Intervention for Food Cravings,” in which the speaker, Corby Martin, noted that chocolate is the “most craved food.” In the Q&A following his talk, I stood up and asked about treating food cravings with the substance-dependence model. Dr. Martin responded with the classic, “food is necessary for life” argument. I then asked, “Is chocolate necessary for life?” He did not reply. I detected darts from the eyes of many in the audience.

    The problem is tricky, in that foods which are addictive are intermingled with foods needed for life. Food is not a substance from which children can abstain, but what is overlooked is that chocolate, chips, fast food and candy — the foods kids say they have the biggest problems with — are not necessary for life and can be abstained from. It’s difficult, but possible. Still, our culture has these everywhere, and there’s the rub.

    Part Two →

    Source: “What’s Really Causing the Childhood Obesity Epidemic? What Kids Say,” Weigh2Rock.com
    Source: “Issues for DSM-V: Should Obesity Be Included as a Brain Disorder?,” The American Journal of Psychiatry, 05/07/1-
    Source: “Should PepsiCo be Funding Obesity Research at Yale?,” Fooducate Blog, 04/07/10
    Source: “Menu Fight Over Calories Leads Doctor to Reject Post,” The New York Times, 03/04/08
    Source: “How do you feel about overweight doctors…?,” BlubberBuster.com poll
    Source: “What food do you have the most problem with?,” BlubberBuster.com poll
    Source: “Overweight and Obesity in Children” (PDF), Pediatrics, 2008
    Image: Obesity Society meeting board, used under Fair Use: Reporting.


    Robert Pretlow is a pediatrician and founder/director of Weigh2Rock.com, an online weight loss system for teens and tweens, used by clinics, hospitals, schools, private practitioners, community centers and health clubs worldwide. He lectures frequently on childhood obesity, both nationally and internationally, and is author of the new book, “OVERWEIGHT: What Kids Say: What’s Really Causing the Childhood Obesity Epidemic?”

    8 Comments "

    Using the Psychological Food Dependence-Addiction Lens

    July 10th, 2010

    Food addiction lensA recent comment to “The Childhood Obesity Perfect Storm, Part 6″ post on the Childhood Obesity News blog describes the “Go, Slow, Whoa!” widget tool created by the We Can! Program of NHLBI, NIH. The widget’s purpose is to impact childhood obesity. It differentiates foods according to their nutritional value, in order to help kids make healthier food choices. The tool’s categories are as follows:

    * Go foods (eat almost anytime),
    * Slow foods (eat sometimes, or less often), and
    * Whoa foods (eat only once in a while, or on special occasions).

    The Go, Slow, Whoa! widget tool is similar to Nationwide Children’s Hospital’s “Snackwise®” tool, which differentiates specifically snack foods according to their nutritional value. The goal of the Snackwise system is to help parents and schools make better choices about which snacks to place in school vending machines.

    There are many worthwhile childhood obesity programs and tools like the WeCan! program, the GoSlowWhoa! widget tool, and the Snackwise tool. However, emerging new evidence points to a serious dependence (addiction) on highly pleasurable foods as a significant cause of the childhood obesity epidemic. Perhaps such childhood obesity programs and tools should thus be examined through a “psychological food dependence-addiction lens” (above). The question should be asked: “Do such programs and tools help psychological food dependence – addiction?” If not, kids may become discouraged when such programs/tools fail to help them lose weight or maintain their weight. Discouraged kids may comfort-eat more and seek help less, another vicious cycle.

    The GoSlowWhoa! widget tool, for example, is technologically impressive and on the right track, in terms of the psychological food dependence-addiction lens test. Nevertheless, what is really needed is a tool to differentiate foods according to their addiction potential. Highly pleasurable, addictive comfort foods generally have low nutritional value, but not necessarily so. Ice cream, for example, is one of the most comforting of foods, yet has at least fair nutritional value. Ice cream contains protein, calcium, and vitamins, as well as carbohydrate and fat energy sources. Still, some kids say ice cream is addicting:

    From Sabina, Age 16 — 10/28/06
    Ht. 5’6, Wt. 157 — i was so bad today. I had been really good for almost two weeks then my mom bought … ice cream. .. the damn icecream was what nearly killed me. I have the worst addiction to strawberry icecream

    From Claire, Age 18 — 5/29/07
    Ht. 5’4″, Start: 210 lb, Current: 162 lb, Goal: 130 lb — … I put a little ice-cream (about 2 scoops) in a small bowl and then after that I began craving more and I tried to stop myself but I just found myself going back to the freezer and puting in 2 more scoops this time bigger. I mean what the freak is my problem? I hate how sugar is so addictive…

    Furthermore, food companies tend to embellish nutritious foods with sugar, salt, and fat to render them irresistible, so they sell more. Those foods may still be marketed as “health foods” and may not fall out with a tool such as the GoSlowWhoa! widget. Fiber One bars are an example, laden with chocolate, sugar, and salt. One bar provides 35% of daily fiber requirements, but each bar contains 140 calories. Moreover, chocolate is the second top listed ingredient, behind chicory root extract (fiber). Sugar is listed twice, along with high maltose corn syrup and maltodextrin, a sugar with a particularly high glycemic index level, as well as fructose.

    If the GoSlowWhoa! widget tool were redesigned as an addictive-food differentiation tool, the categories might be relabeled as follows:

    * Go foods – not addictive (eat almost anytime, as much as you want),
    * Slow foods – slightly addictive (eat less often, and in moderation), and
    * Whoa foods – moderately to highly addictive (eat rarely, only at special events, and only in small amounts).

    Then there is the Stop Light Diet developed by Dr. Leonard Epstein, which divides foods by the colors of a traffic signal according to caloric value: green for low-calorie foods that can be eaten freely; yellow for moderate-calorie foods that can be eaten occasionally; and red for high-calorie foods that should be eaten rarely. The Stop Light Diet could likewise be adapted according to dependence risk of foods. “Red” foods would be the most addictive foods. “Green” would be the least addictive foods. “Yellow” would be foods in between. This system could be used both as a guide for treatment of overweight kids and for government regulation of addictive foods, taxation, and access by children. Red, green, or yellow labels could be required by law on all food packages and menu items.

    You might say, “Well, how the heck are we going to determine which foods are addictive in order to implement such an addictive-food differentiation tool?” Just ask kids. Which foods do overweight kids have the most problem with?  You’ve probably guessed that broccoli is not on the list.

    Your responses and feedback are welcome!

    Source: “We Can! Mini Widget,” Widgetbox, 06/21/10
    Source: “Maltodextrin, Splenda, and the Glycemic Index,” Big Daddy D’s LowCarbohydrate blog, 08/29/07
    Image of “Focus on Healthy Lifestyle” is from Pediatric News, used under Fair Use: Reporting.

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