More Advice from the Formerly Fat

[Woman looks at tall stack of donuts. Accompanying quote: 'Food is the most widely abused anti-anxiety drug in America, and exercise is the most potent yet underutilized antidepressant. ' --Bill Philips]

Dr. Pretlow has always emphasized the importance of identifying problem foods, and there is a very good reason for that recommendation. Many formerly obese patients, when faced with the seemingly overwhelming task of cutting down on food, have found an incredible advantage in narrowing the range by pinpointing the worst food villains. To work on eliminating them first gives a person an incredible head start toward achieving and maintaining a healthy weight.

This excerpt is from exercise physiologist Dean Kriellaars, who playfully characterizes a person’s problem food as a “Miss Vickie,” because that brand of potato chips used to be his particular downfall. He told a reporter:

She’s a lovely woman. She never says no to me. She smells great. But I had to kick her out. I broke up with her. Everybody’s got a Miss Vickie.

From what Kriellaars told a reporter about one of his former clients, another fallacy becomes obvious, and that is the human ability to fool oneself with words. This person’s “Miss Vickie” was something called a “skinny latte.” One of those concoctions only has 300 calories — what could go wrong? Turns out, drinking four of them every day removes any potential for “skinny.” Once that problem was identified, the client was able to shed nearly 90 pounds.

The website Reddit reliably supplies real-life anecdotes from real people like the formerly obese “roccala,” who used to weigh 300 pounds but got down to 175 and has maintained that weight for three years. This person made the bold choice to continue eating the same volume of food — “as much as I wanted” — but only if it was fresh and chemical-free. Within those parameters, a moment’s reflection will confirm how astonishingly few dining possibilities remain.

“Roccala” also concluded that sugar makes a lousy anti-depressant and began using exercise, instead of sweets, to banish the stress of daily life. Another suggestion is to chew more thoroughly because digestion is supposed to start in the mouth, as the beginning of a process that uses nutrients more efficiently. Of course, we all need to remember that the brain doesn’t immediately receive the “enough” message, and it’s always a good idea to finish a meal slightly hungry because the satiated feeling will arrive within 15 or 20 minutes.

This formerly obese person also counsels stomach shrinkage, a natural process that takes place over time, once you change habits and eat smaller amounts. Also, “Water — make it your best friend.” That is excellent advice for anyone, whether their “Miss Vickie” is soda or sweetened coffee or tea. Plain water is always a superior refreshment to any other fluid.

Not 100% on board

“Roccala” makes one sketchy suggestion, to have a cheat day on which you can eat anything you want. Granted, this does seem to work for some people. But Dr. Pretlow does not advise incorporating a cheat day into the program. If a problem food is truly an addictive substance, comparable to a drug, abstinence is the only way out. Recovering alcoholics don’t get to drink on one day a week, because it absolutely doesn’t work.

Adopting a consistently healthful diet does have the advantage of making a person lose the cravings that previously existed. Many formerly obese people are very enthusiastic about the “ketogenic diet,” which was originally developed to treat childhood epilepsy, testifying that it removes the craving for carbohydrates and sweets.

Many formerly obese people swear by the technique of calculating the cost, which can now be done with technological means. What price will you pay for indulging in an eclair? How many calories does that attractive nuisance contain, and how many minutes will you have to run to erase those calories? Does this sound like a good deal? Really?

Your responses and feedback are welcome!

Source: “Tips for trimming the fat,”, 08/24/2013
Source: “Hello! HamPlanet Boogie2988 here sitting down the fried chicken long enough to answer your questions,”, 10/28/13
Image by

Advice from the Formerly Fat

[montage of junk food]

The Pleasures of Life

The website Reddit is a font of crowd-sourced wisdom, where many people pass along the lessons they learned the hard way. In the “fat people stories” sections, the obese refer to themselves by the ruefully humorous term “hamplanet,” and this tip comes from a page called “You might be a hamplanet if…” It advises careful self-scrutiny and the honesty to acknowledge that a problem probably exists if:

• you have a medical ‘condition’ that isn’t backed by an actual doctor
• you’ve eaten someone else’s food without asking
• it takes you 12 hours to complete a 26 mile marathon, but still consider yourself an athlete
• you chew with your mouth open
• you have used a scooter in a store because you were tired of walking
• you have to weigh the option of bending over for something

Many formerly obese people come to recognize the lies they used to tell themselves. They grasp the truth rather than clinging to fallacies. They let go of the idea that by working to gain a healthy weight, a person is depriving herself or himself of the good things in life, like cheeseburgers, cupcakes, and sugar-sweetened beverages. They learn a secret, namely that the seeming deprivation opens the door to rewards much more comprehensive and satisfying than the momentary pleasure of scarfing down a treat.

Some people consider themselves lucky because their definition of a treat is so specialized. If you’re an ordinary person struggling to pay the bills, and a rare cheese or a gourmet brand of chocolate is your idea of gustatory heaven, the monetary cost will automatically limit your ability to indulge. Consider yourself fortunate to have such expensive tastes, some say, because that pickiness can save you from ruin.

A reinvented self

Theresa Bowick is a registered nurse, motivational speaker, neighborhood health activity organizer, wellness enthusiast, talk show host, and author of the book Collard Green Curves – A Fat Girl’s Journey from Childhood Obesity to Healthy Living.

For a while she followed an unpromising path, dropping out of college to have a child, and letting her body grow to uncomfortable and unhealthy proportions. At 5’7”, Bowick weighed 236 pounds, but what really motivated change was not her own bulk but the occasion of her overweight daughter’s 16th birthday party. She realized that by setting a better example, she might change both their lives.

The Weight Watchers program helped her to lose 75 pounds and, more importantly, to maintain the loss for years. As a bonus, being in control of her weight showed her that other areas of her life were amenable to change. That’s when she went back to school and got a nursing degree, started a fitness movement in her town, and eventually was recognized by the President’s Council on Fitness, Sports & Nutrition with a community leadership award.

Your responses and feedback are welcome!

Source: “you might be a hamplanet if…”, 03/10/14
Source: “Going From Fat to Phat! ‘Collard Green Curves’ Author Dishes on Diet and Exercise,”, 07/09/13
Image by Tumblr


Therapy and the Formerly Obese

[boy looks askance at woman, with caption 'So you're telling me ... people pay people to tell them to eat less?]

Depression can be caused by interpersonal difficulties, and can in turn can cause further difficulties in getting along with other people. For people prone to overeating, this can result in a vicious cycle where social malaise causes unhealthy eating patterns, which in turn lead to more problematic social interactions.

Any childhood obesity intervention needs to take social relationships into account. Childhood Obesity News suggested that while boredom can lead to bad habits like recreational eating, an overscheduled life filled with high expectations can be just as dangerous. When people try to fix life situations, they often go too far the other way. The formerly obese seem almost of a single voice when urging a sufferer to hook up with therapy and/or a support group, especially if their problems include a gnarly issue like being an abuse survivor.

On a webpage that unfortunately can’t be located anymore, a formerly obese person praised the virtues of The Self-Esteem Workbook, a self-directed program that his therapist had recommended. Put together by Glenn Schiraldi, a psychologist and health educator, it offers “twenty essential skill-building activities, each focused on developing a crucial component of healthy self-esteem.” One exercise is to list all the behaviors that are not helping a person’s self-esteem, such as negative self-talk and mirror avoidance, so they can be consciously considered and worked on.

On that same lost page, a formerly obese person recommended Dialectical Behavioral Therapy to “everyone.” The endorsement read, “It’s been studied and peer reviewed and proven effective at helping people with all kinds of emotional issues.” DBT is a specific variety of cognitive-behavioral psychotherapy that helps the patient identify the thoughts, beliefs, and assumptions that are putting up roadblocks. One description says:

In DBT people are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset.

With Cognitive Behavioral Therapy (CBT) the person learns techniques to monitor and change eating habits, and to change his or her ways of reacting to stress and difficult life situations. Ashley Gearhardt, a clinical psychology doctoral student who studies food addiction at the Yale Rudd Center for Food Policy and Obesity, says that support programs, particularly 12-step ones patterned after Alcoholics Anonymous, coupled with CBT can help people cope with food addiction.

In the view of Dr. Ian Campbell, chair of Britain’s National Obesity Forum, very few obese people are actually addicts in the classic sense, but for the few who are, CBT is their best hope. Also via the United Kingdom’s National Obesity Observatory, we learn from the publication Obesity and Mental Health that…

A comprehensive review of psychological interventions for overweight or obesity concluded that behavioural and cognitive behavioural therapies make a significant difference to the success of weight management interventions, especially when combined with diet and physical activity.

It’s always important to get rid of negative self-talk. For instance, a person in the habit of scolding herself or himself by thinking, “You fat pig, you did it again,” is taught to give that up and adopt positive self-talk instead. Part of this involves telling yourself how wonderful you are. Proponents advocate starting each morning with affirmations about the awesomeness of both oneself and the upcoming day. Some feel that “I’m awesome!” is too generic, and recommend choosing a different trait every time. Wake up, look in the mirror, and say “I like my eyebrows,” or “I like my curiosity about how things work,” or whatever.

A participant known as “Plingie” gives an example, making a positive quality from the fact that he necessarily has to work harder than slimmer people do, just to drag his bulk from place to place. His self-talk included the mantra “I AM STRONG because I’m carrying myself every day. I am carrying 400 lbs every day. I am STRONG.”

Your responses and feedback are welcome!

Source: “The Self-Esteem Workbook,”, undated
Source: “An Overview of Dialectical Behavior Therapy,” undated
Source: “Conquering Food Addiction,”, 01/18/11
Source: “Food addiction: know the facts,”, 01/05/2013
Source: “Obesity and Mental Health,”, March 2011
Source: “I’m a pe teacher who needs advice about a morbidly obese student,”, 01/28/14
Image: Internet meme

Another Fat-Shaming Accusation

[photo of Adam Richman on a restaurant wall]

Richman on a featured restaurant’s wall

A new TV show called Man Finds Food was set to premiere last week, but the Travel Channel has postponed it because the would-be host, Adam Richman, is in disgrace.

After earning a master’s degree in fine arts from Yale, Richman traveled the country working in many facets of the restaurant industry. He created episode after episode of Man v. Food, which became the network’s most popular show, and which has been called a cult culinary series and a cultural touchstone. He gained a huge fan base, and in 2009 was named one of Yahoo’s “Most Fascinating People.”

When Richman started doing television, he was normal-sized. But years of making these episodes, some of which apparently involved ingesting huge amounts of food, did the predictable damage and he ballooned up. Recently, after working hard to slim down, he showed off by sending out an Instagram picture of a bespoke suit he ordered and was measured for last year. Now the carefully tailored suit is too loose, a visual proof of successful weight loss. In one of the most disastrous instances of media mismanagement ever, he added a single hashtagged word — #thinspiration.

Richman may be a famous show biz personality, but he doesn’t know everything, and perhaps was not aware that “thinspiration” is a loaded word. Maybe he even thought he had made it up on the spur of the moment. As a portmanteau pun, it is pretty obvious. It is also a code word among supporters of the serious eating disorders anorexia and bulimia. A reader self-identified as a “fat activist who is fat” took umbrage and complained, encouraging her friends to add to the social media barrage. A typical response, reported by Ben Beaumont-Thomas, insisted that the term thinspiration “glorifies negative media self-imagery that being thin is better as opposed to any other body style.”


An apology was demanded and, at first, refused. Harsh words were thrown around by both sides. Adam Richman did not comport himself well in the dispute, though his rudeness was mild relative to the language one sees in many popular forums and boards. Still, self-expression that is commonplace among anonymized adolescents will not do for a popular public figure. A lot of people freaked out, accusing the TV personality of fat-shaming and worse. One online commentator wrote:

The whole hypocrisy of this is on his show Man vs Food he glorified extreme eating contest and was extremely obese but now that he is thin is holier then thou.

Some social media users came to Richman’s defense, calling his chief opponent “morbidly obese yet massively defensive.” Others voiced more general objections, calling his program the food version of Jackass and wondering if anyone really learns anything from food show “gurus.”

This is all reminiscent of a similar Internet scandal that happened a year ago, when University of New Mexico professor Geoffrey Miller issued an infamous tweet warning obese PhD applicants that if they didn’t have the willpower to give up carbs, they would be incapable of completing a dissertation. That definitely didn’t sit well with the academic community or with Miller’s supervisor, and he complicated the situation by claiming that the ill-advised tweet was part of a nonexistent research project. Katie McCaskey sketched the tempest’s outlines:

The onslaught of angry voices asked, among other things:
• Why is obesity fair game as the last openly discriminatory characteristic?
• Has Miller vetted candidates at either university based on this discrimination?
• Why does Miller, a professor, think that this kind of update is acceptable — if he takes his role as a role model seriously?

The rest of McCaskey’s article offers excellent advice to celebrities involved in Twitter wars and Instagram insurrections. Too bad Adam Richman didn’t take that advice to heart.

Your responses and feedback are welcome!

Source: “Meet Adam Richman: Adam Richman Bio,”, undated
Source: “How ‘thinspiration’ became a dirty word,”, 07/02/14
Source: “How to Avoid a Big, Fat, Sloppy Social Media Mess,”, 06/07/13
Image by Kim

7 Ways to Not Be Fat

[cake decorated as American flag]

Happy July 4th! There’s no better way to say “Thanks!” to America than by doing a little something to end our obesity epidemic, starting with our own families. Here’s a collection of suggestions.

Reduce salt intake

An Australian study of 4,000 children found that the more salt they ate, the more sugary drinks they consumed. Cut down on the usual suspects like potato chips and fries, as well as less obvious harborers of sodium such as hot dogs, cold cuts, and cheese.

Replace the dishes

In Philadelphia, a study of first-graders showed that children going through the lunch line with big plates will serve themselves more food, amounting to twice as many calories, as the same children will dish out for themselves if provided with smaller plates.

Cornell University researchers make this suggestion:

Change your dishware to better accommodate your dining needs. If your goal is to eat less, select plates that have high contrast with what you plan to serve for dinner. Want to eat more greens? Try serving them on a green plate!

Other scientists are proponents of the red plate. Why?

The color red elicits avoidance motivation across contexts…. red functions as a subtle stop signal that works outside of focused awareness and thereby reduces incidental food and drink intake…. In line with our hypothesis, participants drank less from a red labeled cup than from a blue labeled cup, and ate less snack food from a red plate than from a blue or white plate.

Watch your language

Forget about the old “clean your plate” concept and concentrate on helping kids learn to take smaller portions and to be aware of when they’ve had enough. Remember that food shouldn’t be used as a reward, pacifier, or bribe. When discussing  the importance of good everyday habits with kids, frame it as a way of being healthy, not as the road to looking a certain way.

Be the change you want to see

One of the very most important things a parent can do is set a good example. The power of example is much stronger than any words. Find activities the family can do together — bike, hike, swim, walk — and encourage kids to explore the possibilities until they find a sport or activity that gets them joyously moving.

Live in an affluent neighborhood

For most of us, file this under “long-term goal.” University of Washington researchers found that neighborhood property values predict local obesity rates better than income or education. Data collected in Seattle showed that fancy real estate implies about a 5% obesity rate, while impoverished neighborhoods have an obesity rate around 30%.

Back a winning team

French researchers studied Americans living in cities with National Football League teams, and found that we consume more saturated fat and more total calories on the day after a home team loss. Never mind football, this simple tip can help for July 4: “Make chili with ground turkey or substitute Greek yogurt for sour cream and queso in dips.”

Don’t drown in remorse

And if the holiday celebration gets out of hand, don’t stress about it, recommends the Louisiana State University Health Sciences Center. But do make it a high priority to form — and stick to — good eating habits as part of the everyday routine.

Your responses and feedback are welcome!

Source: “Childhood Obesity: Kids Crave Salt and Sugary Drinks,”, 03/12/13
Source: “A Simple Way to Fight Childhood Obesity,”, 04/12/13
Source: “What’s With the Color of Your Plate?”, 2012
Source: “Want to eat less snack food? Use a red plate,”, 09/16/13
Source: “Tips to Combat Childhood Obesity,”, 04/20/13
Source: “ZIP Codes And Property Values Predict Obesity Rates,”, 08/30/07
Source: “Study: NFL Fans Binge Eat if Team Loses,”, 01/31/14
Source: “Rules of thumb: Three simple ideas for overcoming childhood obesity,”, 05/01/14

Image by lizwest

School Food Rules — Sensible or ‘Draconian’?

[before-and-after chart of new USDA standards]

USDA Standards

In 2012, the journal Pediatrics published the results of a study of the effect of “competitive foods” in schools. Those are snacks and drinks available from vending machines and snack bars, which compete with the meals provided by the school’s food service department. For the New York Times, Sabrina Tavernise described how researchers compared the progress of kids in states that had no regulations against competitive foods with states where weak laws were in effect, as well as states with strong laws.

The study tracked weight changes for 6,300 students in 40 states between 2004 and 2007, following them from fifth to eighth grade…. Students who lived in states with strong laws throughout the entire three-year period gained an average of 0.44 fewer body mass index units, or roughly 2.25 fewer pounds for a 5-foot-tall child, than adolescents in states with no policies….

The study also found that obese fifth graders who lived in states with stronger laws were more likely to reach a healthy weight by the eighth grade than those living in states with no laws.

Another thing they learned was that weak laws are the same as no laws at all. Other studies showed similar results, and strict regulation appeared to be the only answer. Since then, the federal government has decided to be a strict regulator.

Starting in July when the rules change, “competitive” products can still be stocked by vending machines and school snack shops, but they will not have the same allure. Items that qualify as entrees will be limited to 350 calories and snacks to 200 calories, and they must consist of acceptably healthful foods like fruits, vegetables, whole grains, dairy products, or lean protein.

Any item sold on the school grounds will have to be free of trans fats and derive no more than 35% of its calories from fat. A sweet item can only be 35% sugar, and sugar-sweetened beverages will be excluded. The only permitted beverages will be water, fat-free or low-fat milk, and 100% fruit or vegetable juice. CNS News reporter Barbara Boland calls these rules “draconian.”

Really? “Draconian” means drastic, stringent, harsh, extreme, severe, and cruel. The Greek lawmaker Draco decreed that a person could be sold into slavery for owing money, or be sentenced to death for stealing a cabbage. The worst that will happen to a school violating the new food rules is loss of federal funding, which by all accounts is shrinking into near-invisibility anyway.

Your responses and feedback are welcome!

Source: “Study Links Healthier Weight in Children With Strict Laws on School Snacks,”, 08/13/12
Source: “USDA Bans Junk Food in Schools – Will Salty Snacks Move to Black Market?”, 04/14/14
Image by USDA

‘Pouring Rights’: Pay One Way or Another

[graphic of Coke bottles and sillouettes of a man getting wider]]

Tom Philpott reported for Mother Jones on how, since the early 1990s, public schools have been selling “pouring rights” to corporations, with Pepsi and Coke being the biggest players. In this arrangement, the company in question buys the exclusive right to sell beverages in the schools’ vending machines, snack bars, and stores (and, of course, at sporting events). He quoted a typical pouring-rights agreement, made with the school district in Rockford, Ill. — a 10-year contract for which Coca-Cola initially ponied up $4 million, and promised an additional $350,000 per year.

Along with actual product sales, such contracts extend the right to advertise profusely, which adds another level to the distress felt by critics of these arrangements. But the income makes possible the purchase of gym uniforms, field trips, and such classroom aids as the SMART Board, a combination of whiteboard and computer.

What’s not to like?

But wait. What happens if, for instance, all sugary drinks are banned from schools by federal law? Are the 10-year contracts grandfathered in, so that some school districts legally keep soda available while in others it is forbidden? Is that why a long-term agreement was engineered in the first place, to sidestep such a contingency? Or would the school, if halfway through such a contract, have to stop allowing the sale of sugar-sweetened beverages and refund some or all of the payment?

Last time, Childhood Obesity News looked at the situation in Seattle, where for years transportation, school publications, social events, and athletic uniforms had been paid for by the profits from vending machines. In 2004, the city’s schools adopted food health standards that were even stricter than any state or federal law at the time. This had a catastrophic effect on the budget of the Associated Student Body organizations. The school board promised to make up the difference, but it didn’t have any money either. Seattle Times education reporter Brian M. Rosenthal wrote:

Board members apologized to the students for failing to live up to their promise of refunding lost revenue. They said their tight budget makes it impossible to repay the money now, but they pledged to explore revising the ban.

How large a difference did the Seattle ban make? Back in 2001, the schools took in $214,000 from vending-machine sales. In 2011, after several years of strict rules, the vending-machine profit for the entire city’s school system had shrunk to $17,000. That should be good news! The difference represents $197,000 worth of junk food that wasn’t eaten. We should rejoice over all the obesity that was prevented by the city’s introduction of strict rules.

But as Rosenthal pointed out, just because it wasn’t available in the vending machines does not mean all that junk food remained uneaten. Many schools don’t require students to stay on campus all day, and they can easily walk to nearby convenience stores and gas stations where the full array of junk food is available. Tons of unhealthful food and drink are still consumed, and a lot of money is still being spent, but the income goes to those businesses rather than to the student organizations.

Is there a net gain in obesity avoidance? What about all the kids who stayed off sports teams because they couldn’t afford the gear? Didn’t they get fatter? What about the kids who didn’t have enrichment classes and after-school activities to provide them with intellectual stimulation and group fun? Probably a lot of them spent their time playing video games, feeding their faces, and getting fat. That’s the curse of unintended consequences.

Your responses and feedback are welcome!

Source: “80 Percent of Public Schools Have Contracts With Coke or Pepsi,”, 08/15/12
Source: “School board may ease ban on junk food,”, 12/11/11
Image by Mike Licht

School Food Interventions

[children reaching for salads at school cafeteria]

In many places, there are strong movements to improve school cafeteria meals; to restrict vending machines to healthful items or even ban vending machines altogether; and even to extend the junk food ban to nearby retail establishments. Dr. Pretlow says:

If schools had cigarette vending machines in the halls, obviously kids would get hooked on smoking. Highly pleasurable fast food in school lunches is really no different. We’ve got to stop exposing kids to foods that they can get hooked on.

That’s unarguable, but many questions have arisen in connection with these efforts to reduce obesity by making strict rules for school food, whether it is available in the cafeteria, in vending machines, or both. The fact that kids spend so much time in the school environment is on everyone’s minds, but the implications of any proposed intervention are not so clear.

If someone proposed to install cigarette vending machines in schools, the uproar would be deafening. So why is there not the same level of objection to harmful food with low nutritional value or none at all? Why are so many Americans okay with the availability, in the educational setting, of food that contains harmful fats, additives, sugar, salt, and other undesirable ingredients?

On the theory that “you don’t miss what you never had,” the big mistake was to allow unhealthful foods in the first place. Their availability became taken for granted, and the notion of their acceptability gained a foothold. Worthless and harmful foods were permitted to become part of the culture, and especially of the financial underpinning of the educational system. The unintended consequences of that decision have been enormous, and as we will see, the unintended consequences of trying to revoke that decision are also momentous.

In 2010, the U.S. Department of Agriculture had already banned many foods from schools, but kids could still buy soda, chips, cookies, and candy. The University of Nebraska released news of a study conducted among kids in grades 7-12 at eight schools in the Midwest. The researchers also consulted school administrators and included several other factors in their deliberations. Here is what they learned:

The findings suggest that a single policy shift — banning all junk food from a la carte lines during school lunch hours — would result in an 18 percent reduction in overweight or obese students.

The study suggests expanding the USDA’s current ban on selling so-called Foods of Limited Nutritional Value during school meal times to include all junk food a la carte selections.

The following year, Brian M. Rosenthal reported for the Seattle Times that student governments were besieging the school board with complaints about strict school food rules. Seattle had been an early adopter, with years of enlightened awareness about the harmfulness of junk food and snacks, and rules that matched. Rosenthal wrote:

The policy, approved in 2004 — before any state or federal regulations on school nutrition had been established — put Seattle on the cutting edge of the fight against childhood obesity…. The restrictions, which are more strict than the now-crafted state and federal nutrition guidelines, allow only products such as milk, natural fruit juice, baked chips and oat-based granola bars.

Sadly, the chief reason for the rebellion was financial. The profits from vending machines on school property went to ASB (associated student body) organizations throughout the city. The income pays for the school yearbooks and newspapers, dances, clubs, transportation, and athletic uniforms and equipment. In 2001, the combined ASBs of Seattle had made $214,000. Ten years later, that number was down to $17,000.

Next: More consequences.

Your responses and feedback are welcome!

Source: “UNL study: Schools that ban junk food at mealtime are 18% lighter,”, 10/28/2010
Source: “School board may ease ban on junk food.”, 12/11/11
Image by U.S. Department of Agriculture

PATHS, Pathways and Peer Pressure

[two small boys playing in a backyard]

Childhood Obesity News has been looking at the school-based intervention program Pathways to Health, which grew out of the risk-behavior reduction program known as PATHS. Pathways to Health is all about sharpening and strengthening Executive Cognitive Function (ECF). The object is to avoid and prevent obesity by learning impulse control, emotional regulation, and other related coping skills.

For each grade, kindergarten through sixth, different PATHS curricula have been designed and adapted. The third-grade program, for instance, comprises 46 lessons, of which 10 are introductory, 16 are concerned with feelings and relationships, 17 teach cognitive problem-solving, and three cover relationships and social competence.

The literature traces the process of adaptation for elementary school use. The abundant material that makes up PATHS had to be trimmed down for Pathways to Health.

The PATHS program teaches youth to recognize ∼55 affective states in addition to varying degrees of those states (e.g. angry, upset, furious). Labeling of affective states is a fundamental component of PATHS; thus, many of the earlier lessons are dedicated to recognition and labeling….

For Pathways, the content and mode of delivery had to be changed dramatically to accommodate time constraints. The number of affect states was limited to 39 of those that could be directly linked to physical activity or dysregulated eating behaviors (e.g. angry, bored, guilty, happy, humiliated, rejected, satisfied, tired, uncomfortable, worried)….

This decision was based, in part, on literature that identified categories of emotional eating or provided evidence of a relationship between specific emotional states and dysregulated eating.

For the endocrinological website, H.S. Shin explained a Pathways to Health trial study, showing how peer pressure contributes to behaviors that are called high-risk, including obesogenic behaviors. This was:

…an ongoing longitudinal, multicomponent study that included a childhood obesity prevention program, to determine whether peer influence moderated obesity or had any effects on obesity-related behavior.

Oxford Journals presented a table titled “PATHS lessons with application to obesity,” illustrating 30 points of similarity between an ECF-based drug abuse prevention program, and an obesity prevention program. The idea is fascinating — that the PATHS approach to treating both substance abuse and violence can be repurposed for such a seemingly different problem.

For fourth- and fifth-grade lessons, peer relationships are mentioned five times in the Focus column, under the categories of “Class rules,” “PATHS kid,” “PATHS jeopardy review,” “Feelings review,” and “Making good decisions 1 — self-control resisting peer pressure.” In the area of Applications to Obesity, peer relationships are mentioned four times, including the category “Getting Help from Others.”

Your responses and feedback are welcome!

Source: “Translating evidence based violence and drug use prevention to obesity prevention: development and construction of the Pathways program,”, 10/10/11
Source: “Childhood eating habits influenced by peers,”, 2014
Source: “Translating evidence based violence and drug use prevention to obesity prevention: development and construction of the Pathways program,”, 10/10/11
Image byeyeliam

PATHS and Pathways to Health

[children dancing]

The school-based program called Pathways to Health, which is concerned with obesity prevention, developed out of an earlier program called PATHS that was designed to prevent violence and substance abuse. While they may appear to be very different problems, at the most elemental level violence, substance abuse, and obesity all qualify as risk behavior, and they all are rooted in Executive Cognitive Function (ECF).

Poor ECF, plus a dysregulation of emotion, contribute to undesirable behavior patterns. In obesity, the behavior patterns have to do with eating and physical activity, which at first blush don’t seem similar to drug abuse or violence. But drugs and hyperpalatable foods both affect the brain’s reward circuitry. Aggression and overeating are both connected with poor impulse control and other inadequately regulated emotions. According to this paradigm, they all come from the same place. This Oxford Journals article explains:

PATHS was based on the principles of emotion theory but more specifically the Affective–Behavioral–Cognitive–Dynamic (ABCD) model of development The ABCD model places primary importance on the developmental integration of affect, behavior, cognition and emotion language.

PATHS addresses impulse control, emotional regulation, and executive cognitive function. But it goes even deeper. The Pathways program also draws from STAR, a program said to successfully prevent substance abuse, which is described as follows:

A number of STAR constructs were applicable to Pathways, including resistance skills in response to peer pressure, self-efficacy, counteracting perceived social norms, healthy decision making based on perceived consequences of behavior and lessons involving parents (prevention communication, rule setting, leisure and family physical activity).

Decision-making and self-regulation count as “important modifiable risk factors,” which is another way of saying that people can change. When goal achievement is itself a goal, where does the ability to regulate behavior and make decisions come from? ECF covers the territory of working memory, planning, organization, emotional control, and inhibitory control. While the process may be lengthy and painstaking, all those skills can be taught and learned.

In obesity prevention, inhibitory control is obviously vital, especially for contemporary children whose environment is filled with cues for the overconsumption of hyperpalatable and obesogenic foods. These cues include advertising, cultural mores, social expectations, and the almost constant availability of food every moment of the day.

Those prompts come from the outside, but emotional control is equally necessary to quell the cues that come from inside — feelings of boredom, discomfort, rejection, emptiness, and all the other sources of strong affect and behavioral impulses that need to be cognitively managed if obesity is to be avoided. The literature describes a specific Pathways example in which students are asked to imagine a specific scenario:

…a vignette describing a Thanksgiving dinner, a student stuffed full of food and then a beloved grandmother bringing out her dessert in which she insists everyone must partake. Teachers prompt students for their internal feeling states, how others might feel, a behavioral choice students could make and the consequences as a result of that choice.

It’s like a dress rehearsal for a situation that could very easily arise in a child’s life. To sum up, Pathways to Health is an obesity prevention program whose intent is not to teach the principles of nutrition or exercise, but to help children develop the inner resources to know what to do about nutrition and exercise. The concept is for each person to create the mental and emotional tools to control the behaviors that lead to poor nutrition and cultivate the behaviors that lead to engaging in plenty of physical activity, and so on.

Your responses and feedback are welcome!

Source: “Translating evidence based violence and drug use prevention to obesity prevention: development and construction of the Pathways program,”, 03/13/12
Image by David Robert Bliwas

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