Humor as Fat-shaming


Comedian Doug Stanhope has an un-cordial relationship with his sister-in-law. In one of his bits, for a Showtime Special, he characterized her as a “humorless ____” with the second word being a very rude term indeed. But she should not have been offended, Stanhope maintains, because for the TV show he made a special effort to be kind. When he told the joke in clubs, what he called his sister-in-law was even worse.

I usually said “fat girl” and I knew that if she ever heard it, “fat” would hurt more than “humorless ____.”

“Yo mama” jokes are a traditional form of American folk entertainment that can’t be attributed to any author. Here are a few punchlines that all begin, “Yo mama so fat….”

…she fell out of both sides of the bed.
…she’s got her own area code.
…just the shadow of her behind weights 100 pounds.
…she gets group insurance.
…at the zoo, elephants throw her peanuts.
…she’s on both sides of the family.
…in the restaurant, she looks at the menu and says “Okay!”
…the sign on the restaurant wall says “Maximum Occupancy – 200, or yo mama.”

The great George Carlin (salty language alert) attributed the fad for carrying backpacks to the fact that Americans need to keep our hands free at all times to hold food. He described us as “fatally attracted to the slow death of fast food.” And we love going to the mall because there we can satisfy our two biggest addictions, shopping and eating, at the same time:

Huge piles of redundant protoplasm lumbering through the malls like a fleet of interstate buses.

Is all humor about obesity fat-shaming? Can fat-shaming be humorous? These and other related questions matter, because in the context of this society, obesity is widely seen as “fair game” for ridicule.

The journal Psychology of Popular Media Culture published an article titled “Weight-Related Humor in the Media: Appreciation, Distaste and Anti-Fat Attitudes.” Written by Dr. Robert Carels and Jacob Burmeister, of Bowling Green State University, it described the research they conducted to learn about the relationship between anti-fat attitudes in general and a person’s appreciation or distaste for fat humor.

The researchers collected seven video clips, excerpted from movies and TV shows, that embodied the most widely-held stereotypes about overweight people, humorously depicting them as lazy, unintelligent, unattractive, etc. They showed these to 500 participants, who…

…rated each clip on a number of factors, including how funny, mean, offensive, motivating and harmful they found each one… They also rated how sad, upset, angry and happy the videos made them.

The subjects also answered questions about their personal attitudes and beliefs about obesity.

Did they dislike overweight people? Did they believe that weight is always under an individual’s control? What other beliefs about obese people did they hold?

Not surprisingly, the participants’ dislike for obese persons and their belief in disparaging stereotypes about obesity were associated with higher levels of appreciation for weight-related humor. The more strongly people believed that obesity was a controllable condition, the less aversion they had for the humor.

Apparently, people are more comfortable about blaming others for their obesity, and since (unlike, for instance, a speech impediment) obesity is perceived as a choice, it is acceptable to laugh at fat jokes and not be offended.

Of course, humor is not always delivered with cruel intent. Sometimes it can be accepting and loving. The New Yorker mentioned spoken-word artist Jamaal St. John’s “ode to curvy women”:

Stop asking me if those jeans make your butt look big. No. Your butt makes your butt look big! And I love every inch of it.

Your responses and feedback are welcome!

Source: “George Carlin on Fat People.”, 11/04/09
Source: “Fat jokes, belief in obese stereotypes linked,”, 07/30/14
Source: “The Plus Side,”, 09/22/14
Image by fly


Everything You Know About When to Eat Is Wrong

Street Snacks

Everyone eats breakfast every day, at least in the literal sense. The first meal, no matter what time it is consumed, breaks the fast, or period of abstention from eating that includes sleep. But conventionally, breakfast takes place in the morning, when a person first wakes up or soon thereafter. There is also an expectation that two more meals will follow, at noon and in the evening.

There are many different ways to skip breakfast. It might be missed because of time constraints, other priorities, or unavailability of food. A person can simply eradicate breakfast from the day, without trying to “make up for it” at lunch, and enjoy the satisfaction of taking in fewer calories. A person might skip breakfast but eat an early lunch, effectively combining the two meals. Restaurant brunch, as a social event, encourages overeating and overdrinking. These conditions rarely lead to weight loss even if the diner did, technically, skip breakfast.

After a show, club musicians eat huge piles of bacon, eggs, and toast in the middle of the night and then sleep until mid-afternoon. Night shift factory hands, nurses, roughnecks on oil rigs, and many other workers have such crazy schedules that an attempt to correlate their weight to their breakfast habits would be a very frustrating project.

Childhood Obesity News recently looked at the pros and cons of breakfast. As with so many other aspects of life, evidence leans in the direction of content over form. A meta-analysis of scientific materials concerning breakfast suggests that what we eat is more important than when we eat it.

Eating After Dark

The night eating question is so reminiscent of the breakfast debate, the two overlap. An article titled “The Obesity Era,” by David Berreby, illuminates many aspects of current scientific progress. He quotes an Ohio State University study in which one group of mice was kept in full light or dim light all the time. They never knew when it was night, and gained almost 50 percent more weight than the control mice who experienced normal light and darkness cycles. Berreby theorizes:

It’s possible that widespread electrification is promoting obesity by making humans eat at night, when our ancestors were asleep.

Registered Dietician Keri Gans finds that patients pursuing weight loss often ask how bad it is to eat after 6 p.m. or 8 p.m. or some other arbitrary deadline. Her feeling is that when people put off dining until late, they have more opportunity to work up an appetite or even to just start feeling peckish for no reason, and they are more prone to overeating. She suggests that a person should query herself according to the HALT acronym: “Am I Hungry? Am I Angry? Am I Lonely? Am I Tired?” There is a strong implication that emotional eating is more likely to get a foothold at night when we are too worn out to resist it.

If late-night munching is inevitable, Gans suggests a piece of fruit or a cup of berries; raw vegetables; a little low-fat pudding or yogurt; 3 cups of popcorn (air-popped, of course), or a sugar-free frozen fruit pop. She writes,

Eating late at night doesn’t cause you to gain weight, but eating too much late at night will…Going to bed on a full stomach for many people is a detriment and interferes with their beauty rest. And unfortunately if you don’t sleep well, there is an increased chance that in the morning when you are exhausted you will make poor breakfast decisions. But the best solution of all is to go to bed earlier—you can’t eat when you are sleeping.

Your responses and feedback are welcome!

Source: “Myths, Presumptions, and Facts about Obesity,”, 2013
Source: “The Obesity Era,” AeonMagazine, 06/19/13
Source: “Will Eating Late at Night Make You Fat?, 08/02/13
Image by Jakob Montrasio

The Most Problematic Meal – Breakfast

Breakfast in Cebu

It often seems like there’s very little solid ground anywhere in the world of obesity. Breakfast, for those lucky enough to have food available, is a subject that never ceases to enthrall people concerned with weight loss. For instance, do the results of research conducted among lean subjects also apply to obese people? All the votes are not in. The Cleveland Clinic’s Wellness Team wrote about a British study in which non-obese people were randomly assigned to either eat breakfast or not.

Six weeks later, there was no significant difference in metabolic rate and other related factors, including overeating throughout the day. People who skipped breakfast were, however, more likely to be lethargic and less active in the morning.

Kristin Kirkpatrick of the Cleveland Clinic Wellness Institute calls such studies “interesting conversation starters,” reminiscent of Prof. Patricia McKinney’s  summing-up of a study in her field:

This is a technically sound hypothesis-generating paper and, viewed as such, is interesting. It doesn’t tell us much, other than pointing towards some further investigation.

There seem to be more and more opportunities these days for a healthy admission of ignorance, and researchers and academics should be congratulated for making such honest statements. Kirkpatrick also points to statistics kept by the National Weight Control Registry, showing that 70 percent of successful long-term weight losers do eat breakfast. And of course a great deal depends on what is eaten. She suggests a lean protein, like eggs, and at least one serving of fruits or vegetables.

At least one study has established that a high-protein breakfast cuts down on the production of ghrelin, the hunger hormone, and “increases cholecystokinin (CCK) that tells your brain you’re full.”

Some of the meal’s biggest proponents are, of course, cereal companies. Breakfast may or may not be “the most important meal of the day,” but processed grain coated with sugar is almost certainly not the best choice. And it should go without saying that anyone afflicted with a condition such as diabetes will follow closely the best practices associated with its management.

The Big Obesity Study

Several times, Childhood Obesity News has referenced a multi-author study from the University of Alabama (senior author, Dr. David Allison) that sifted through both scientific and secular media to assess the myths and presumptions about obesity. One area of inquiry was the value of breakfast. The American Journal of Clinical Nutrition included these words from the authors:

A recommendation to eat or skip breakfast for weight loss was effective at changing self-reported breakfast eating habits, but contrary to widely espoused views this had no discernible effect on weight loss in free-living adults who were attempting to lose weight.

To return to the uncertainty of knowledge, we note that in the course of its massive research, the UAB team identified four different forms of biased reporting:

Biased interpretation of one’s own results
Improperly describing causality in one’s own results
Misleading citations of others’ results
Improperly describing causality in others’ results

Your responses and feedback are welcome!

Source: “Is Breakfast the Most Important Meal for Weight Loss?,”, 09/02/14
Source: “Why frequent small meals can stall fast, lasting fat loss,”, 06/25/14
Source: “Myths, Presumptions, and Facts about Obesity,”, 2013
Source: “The effectiveness of breakfast recommendations on weight loss: a randomized controlled trial,”, 2014
Source: “Skipping Breakfast: Evidence, Beliefs, and Bias,”, undated
Image by Global X

Everything You Know About How to Eat is Wrong

Water Glass

“Weight cycling” is a classier term for yo-yo dieting. Linda Bacon, Ph.D., is typical of the experts who say that yo-yo weight cycles are common to dieters and do harm to health. In the opposite corner is a New England Journal of Medicine article that argues:

Although observational epidemiologic studies show that weight instability or cycling is associated with increased mortality, such findings are probably due to confounding by health status. Studies of animal models do not support this epidemiologic association.

That same publication also exposed as a myth the commonly accepted belief that a large and rapid amount of weight loss is inevitably associated with a poor long-term weight loss outcome. Both medical professionals and the public at large have been taught that slow, gradual weight loss is the only kind that will stick. But this 20-author study found:

Although it is not clear why some obese persons have a greater initial weight loss than others do, a recommendation to lose weight more slowly might interfere with the ultimate success of weight-loss efforts.

Chewing for Life

Followers of Childhood Obesity News know all about the benefits of thoroughly chewing food, as advocated by Horace Fletcher as far back as the early 1900s. Even today, many health-conscious people swear by the Fletcher system because it makes nutrients more bio-available and because thorough chewing prevents “leaky gut syndrome” and other dire consequences.

In 2011, Harbin Medical University (in China) reported that taking longer to chew food resulted in the consumption of about 12 percent fewer calories, and this was true of both healthy-weight and obese men. Researcher Jie Li theorized that “mastication apparently plays a role in the gut hormone profile, which consequently influences energy intake.” Journalist Katherine Harmon Courage elaborated on this:

Hunger is largely controlled by hormonal signals, including that from ghrelin, which spurs the feeling of hunger. The team found that when study participants chewed more, their ghrelin levels were consistently lower post-mealtime. It might be that the longer the body senses food in the mouth, the more ghrelin is released.

Two years later, a story from Texas Christian University reported that both lean and obese people who took the time to chew would feel less hungry at the end of a meal. But this finding was announced with two different spins by two media outlets. The Reuters headline was, “Eating slowly may cut meal size,”
which suggests that a person might do well to go ahead and try it. The Stone Hearth News headline read, “Eating slowly does not cut intake for overweight people,” which implies that it’s not worth the effort.

Normal-weight subjects took in 88 fewer calories during the course of a slow meal with attention given to chewing. Overweight and obese participants also ate slowly and chewed carefully, and while it is true that they too consumed fewer calories, research leader Meenah Shah is not sure whether any conclusions can be drawn. The Stone Hearth News take on it was that:

Research suggests that the ability to control energy intake may be affected by the speed at which we eat, and a high eating rate may impair the relationship between the sensory signals and processes that regulate how much we eat.

However, since both lean and overweight subjects drank more water while eating slowly, Dr. Shah felt that the sensation of fullness might be accounted for by mere mechanical stomach distention. The troubling detail here is that participants in both group drank more water, an activity best reserved for between meals. Many experts deplore the washing down of food with beverages during meals, because the necessary stomach acids are diluted and cannot do their job well. Again and again, in the realm of food and eating, the interested person feels that the universe is saying “Everything you know is wrong.”

Your responses and feedback are welcome!

Source: “Everyone Knows Obesity Is Hurting Us, But Is the Fight Against Obesity the Problem?,”, 03/07/12
Source: “Myths, Presumptions, and Facts about Obesity,” 01/31/13
Source: “Chew on This: More Mastication Cuts Calorie Intake by 12 Percent,”, 08/03/11
Source: “Eating slowly may cut meal size,”, 01/09/14
Source: “Eating slowly does not cut intake for overweight people,”, 12/30/13
Image by Didriks

Everything You Know About Mini-Meals Is Wrong

healthy snack

The topic of meal size versus meal frequency has not yet been exhausted. Neither has the thin or possibly nonexistent line between frequent small meals and snacks. Many authorities have opinions for or against snacking, and many researchers have garnered proof, one way or the other—a circumstance that throws into doubt the claim of “proof.” Some studies seem to indicate that eating frequent, small amounts does not make a measurable difference.

One expert suggestion for inveterate grazers is to nibble only on vegetables and fruits. The objection is the perceived high cost of fresh produce. The rebuttal to that objection was formulated by Economic Research Service researchers, who found that:

Contrary to popular perception, fruits and vegetables are comparable in price per portion to other snack foods, and both groups offer inexpensive as well as more expensive options….Americans on a 2,000-calorie diet could purchase the quantity and variety of both fruits and vegetables recommended in the 2010 Dietary Guidelines for Americans for between $2.00 and $2.50 per day.

According to this paradigm, if once a day a person will forego a customary unhealthful snack and substitute a healthful one, daily food consumption would be reduced by an average of 126 calories, and monthly consumption by an average of 3,780 calories. Theoretically, and all other factors being equal, this small habit could result in losing one pound per month. So don’t listen to those spoilsports who say that small cumulative changes make no difference. Some big changes, like having one’s innards excised or stapled together, don’t have a very impressive track record either.

The Other Side of Mini-Meals

One example of the opposite view is a study recently published in the journal Obesity, concerning 24-hour fat oxidation and subjective hunger ratings. It compared the effect of eating three meals versus the same number of calories spread out over six meals:

We conclude that increasing meal frequency from three to six per day has no significant effect on 24-h fat oxidation, but may increase hunger and the desire to eat.

Obesity researcher Nikhil Dhurandhar of Louisiana’s Pennington Biomedical Research Center has this to say:

Eating six meals a day can work for someone who has a lot of discipline. But for others, it’s like offering an alcoholic a glass of wine six times a day. Their willpower just can’t take it.

That is the big issue for a lot of obese people. Cross-addiction seems to be the rule rather than the exception, and a person in trouble with one substance is very likely to have more than one problem substance. Even someone who has severed a relationship with alcohol or a hard drug can hit a wall with food. It is possible to keep liquor out of the home, and to stay out of bars. It is possible (in most professions) to avoid hanging out with cocaine users. But food is not only everywhere, it is inescapable, because eating is inevitable.

Actor Jeff Garlin articulated a very relevant point about 12-step programs like Overeaters Anonymous. When interviewer Marc Maron asked whether he struggles with food every day, Garlin said:

Every day. I’m an addict, man…I even go to AA [Alcoholics Anonymous] meetings sometimes… Here’s the problem with OA meetings…A lot of the people at OA are very casual. They haven’t hit bottom, man. When you go to an AA meeting…nobody there is not taking it seriously.

Your responses and feedback are welcome!

Source: “Gobbling Up Snacks – Cause or Potential Cure for Childhood Obesity?,”, December 2012
Source: “6 Weight Loss Myths Debunked,”, 07/02/13
Source: “Episode 567 – Jeff Garlin,”, 01/12/15
Image by Kevin

Everything You Know About Snacking Is Wrong


Yes, no matter what your philosophy of snacking is, someone out there disagrees with you and can prove his point. Consumers are inundated with advice about what, when, where, why, and how to eat, along with other input promoting the exact opposite to all that advice. Snacking is one area where this happens a lot. According to its advocates, snacking can help a person eat less during meals because it stabilizes the blood sugar level and curbs the appetite.

A typical example of the frequency school of thought can be found at ABC News, which reported that “eating six small meals is best for weight loss” and, according to the British Journal of Nutrition, there is “no weight-loss difference between dieters who ate their calories in three meals versus six daily meals.” Remember that study with the 20 authors, that Childhood Obesity News mentioned in relation to the notion that small changes can make a difference? Those authors sifted through both the scientific literature and the popular media, for the purpose of either verifying or disproving myths about obesity, especially the ones that have society-wide implications. One proposition they looked into is the idea that, “Snacking contributes to weight gain and obesity.” Their answer? No. They say:

Randomized, controlled trials do not support this presumption. Even observational studies have not shown a consistent association between snacking and obesity or increased BMI.

That is a bold statement, and one that upsets a lot of applecarts. It gets worse, as at least one authority goes even further, and characterizes snacking as not just value-neutral, but actually positive. Here is the pitch:

Dr. Sanford Siegal knows that the best way to lose weight is not by starving but by eating—often! How often? Every two hours between wake-up and bedtime, to include nine small snacks and one generous meal. Why? Because less time without food means less time to get hungry.

Of course, every snack consists of the same thing—a 60-calorie cookie of Dr. Siegal’s invention, available from his website. There is even a shake mix that replaces two of the cookies. Another vote for snacking, if the snack consists of the right stuff, comes from four researchers from the U.S. Department of Agriculture. Their feeling seems to be that kids are going to graze anyway, as shown by studies establishing that American children snack between two and three times a day, taking in as many as 200 extra calories. But this problem could be somewhat ameliorated by substitution:

Despite its likely role in childhood obesity, snacking may provide a mechanism for addressing this obesity problem and improving diet quality. Replacing one energy-dense snack each day with a fruit or vegetable could reduce caloric intake and decrease the prevalence of overweight and obesity…If done on a daily basis, all else equal, this simple behavior could result in about half a pound less of body weight at the end of a month.

But then, on the other hand, others have proven to their own satisfaction that small changes fail to make an overall difference. Maybe there is a correct snacking method— and probably some people who follow it with no bad consequences. If every snack or frequent meal or mini-meal consists of a carrot or a hunk of raw cauliflower, how bad can that be? Ah, if only.

The anti-snack camp has its own collection of studies to rely upon, such as the one published in the journal Hepatology, showing that small meals plus snacking can contribute to increased fat storage in the abdomen and liver. Also significant is a study published in the British Journal of Nutrition, where participants took in the same number of calories, but one group ate them divided into three meals. The other group had three smaller meals plus three snacks, and the more frequent eating offered no fat loss advantage.

Dr. Pretlow falls into the anti-snack camp, and the W8Loss2Go smartphone app is designed to help kids switch over to a snack-free existence.


Dr. Pretlow’s paper, “Treatment of child/adolescent obesity using the addiction model: A smartphone app pilot study,” will soon be published by the journal Childhood Obesity (and also online, of course.)
Watch this space!

Your responses and feedback are welcome!

Source: “6 Weight Loss Myths Debunked,”, 07/02/13
Source: “Myths, Presumptions, and Facts about Obesity,”, 01/31/13
Source: “Dr. Siegal’s Cookie Diet,”, undated
Source: “Gobbling Up Snacks – Cause or Potential Cure for Childhood Obesity?,”, December 2012
Source: “Why frequent small meals can stall fast, lasting fat loss,”, 06/25/14
Image by Donald Lee Pardue

A New Nosology, the RDoC


A nosology is a system of disease classification, and the National Institute of Mental Health (NIMH) is promoting a new one, the Research Domain Criteria (RDoC). Yesterday, Childhood Obesity News outlined the basic characteristics of the systems already in place, the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases and Related Health Problems (ICD). Karen Franklin, Ph.D., forensic psychologist and adjunct professor at Alliant University in Northern California, says:

Mental health professionals know not to take the DSM (or the ICD, for that matter) too seriously. It’s just convenient fiction, or at best “useful constructs,” mainly used to attain insurance reimbursement….

We also touched on case formulation, the preferred diagnostic approach of some healers. The illustration on this page is a chart from Dr. Adam Blatner’s “The Art of Case Formulation,” which serves to remind us of just how many different things might play a part in any given illness. Unfortunately, being such an art, case formulation is not eminently suited to the modern need for speedy and concise information delivery. NIMH realizes that diagnostic science is not keeping up. Because mental function depends on multi-layered systems, new ways are needed to classify mental disorders based on both observable behavior and neurobiological test results. Dr. Franklin reminds us:

Remember when they first announced work on the new DSM? It was going to be a revolutionary “paradigm shift,” aligning diagnoses with modern science. Disorders were going to be dimensional rather than categorical…

But it didn’t happen. To give an example of the difficulties that impact childhood obesity, here is a problem that did not disappear with the new DSM revision:

While the DSM-IV uses a categorical classification system of mutually-exclusive diagnoses, patients with eating disorders often develop symptoms consistent with more than one diagnosis over the course of their illness, demonstrating shifts between diagnoses known as diagnostic crossover.

According to those who want change, DSM and ICD are perceived as too rigid. In the legal system, which clings to the DSM with fervor, Dr. Franklin points out that “the consequences of error can be grave.” But the real burr under the saddle is that, in the United States, the DSM has a stranglehold on the research grant application process. Dr. Bruce Cuthbert says, “The whole machinery of science is governed by the DSM.” The call for change, then, is a demand for more useful research standards and criteria.

To educate mental health professionals about RDoC, the federal mental health agency set up a webinar to explain its preferred new way of categorizing mental disorders. The initiative is led by Dr. Cuthbert, who introduces, “the guiding principles… the role of the new RDoC unit, and frequent questions researchers have….” Here is the best part—the 47-minute presentation is viewable by the public!

The new RDoC is touted as a flexible tool capable of achieving a happy medium. At first blush, it does sound as if RDoC is more conscious of all the possibilities listed in Dr. Blatner’s chart of physiological and psychosocial factors. But there is another point of view, capably represented by Dr. Franklin, who opines that:

Switching to its biology-worshipping Research Domain Criteria is like jumping from the frying pan to the fire.

Your responses and feedback are welcome!

Source: “DSM-5: Forensic applications (Part II of II),”, 05/30/13
Source: “The Art of Case Formulation.”, 09/15/06
Source: “NIMH Webinar Explains New Way of Categorizing Mental Disorders,”, 12/06/14
Source: “DSM-5: Much ado about nothing? (Part I of II),”, 05/29/13
Source: “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents,”, 04/01/12
Image by Adam Blatner, MD

Meet the Research Domain Criteria

The Pigeonhole Principals

Not long ago, Childhood Obesity News considered two of the major structures under which medical professionals sort diseases. Many healers are not totally on board with either of these taxonomical schemes, but insurance companies and other bureaucracies insist upon them. Worldwide, 60 percent of psychologists use a diagnostic classification system. As we noted, the hallmarks of a good one are simplicity, reliability, and ease of use. The professional who uses the system makes important decisions about the management and treatment of patients’ health problems. A system with fewer categories is preferred—if they are the right ones.

Sections of the Diagnostic and Statistical Manual of Mental Disorders  were vigorously disputed during revisions for the current edition, DSM-5. We are, of course, particularly interested in the parts that cover eating disorders and other conditions impacting childhood obesity. The National Institute of Mental Health (NIMH) believes that the DSM-5 diagnoses are inadequate because they are “based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.” If NIMH has its way, the Diagnostic and Statistical Manual will no longer be the “gold standard.” The agency has announced its intention to no longer support DSM-based research.

It has been determined that fewer than half of the psychologists are in the DSM camp. However, 60 percent of them are said to routinely consult the International Classification of Diseases and Related Health Problems (ICD). Both publications have been referred to as bibles, but really the term should apply to a book that has a fair claim to being the only one in its class.

Other Contenders

Also there is the Research Domain Criteria (RDoC) project, a new government-approved research framework that incorporates genetics, imaging, and cognitive science. NIMH director Dr. Thomas Insel explains:

Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior… Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment…RDoC is nothing less than a plan to transform clinical practice by bringing a new generation of research to inform how we diagnose and treat mental disorders.

Some mental health specialists prefer a very un-system-like system called case formulation, in which each patient suffers from a unique condition. Dr. Adam Blatner says,

A good formulation should be a kind of story, weaving together many threads…The organization of a formulation would depend on whether the patient is suffering from chronic or acute symptoms, or both. Similarly, is the patient involved in complex family interactions or do the symptoms seem to be confined primarily only to the individual? Are there significant associated medical conditions or dysfunctions at the level of cortical neurotransmitters? Are the stressors obvious and significant or minimal and elusive?


Dr. Pretlow’s paper, “Treatment of child/adolescent obesity using the addiction model: A smartphone app pilot study,” will soon be published by the journal Childhood Obesity (and also online, of course.)
Watch this space!

Source: “Psychologists’ perspectives on the diagnostic classification of mental disorders: Results from the WHO-IUPsyS Global Survey, 2015
Source: “Director’s Blog: Transforming Diagnosis, 04/29/13
Source: “The Art of Case Formulation, 09/15/06
Image by Scott Dexter

W8Loss2Go Helps in Stages

staged withdrawal

The W8Loss2Go smartphone application is designed to halt food cravings and stop the urge to snack between meals. The 5-month program starts by eliminating the most tempting “problem foods” one or two at a time, a process which was shown by the preliminary studies to be surprisingly free of withdrawal symptoms. Dr. Pretlow says:

Successful withdrawal from a problem food was defined as self-reported resolution of cravings for the specific food, with a minimum required withdrawal time of 10 days for each food. The respective food would then be designated as “In-control” by the app, and the participant would proceed to withdraw from the next food.

Next, the participant is helped to curb snacking. So far, it has been possible for 70% of study participants to quit snacking entirely, while 30% were able to greatly reduce snacking frequency.

The most essential function, excessive food amounts withdrawal, takes place over 12 weeks. The method is reduction of mealtime amounts by small stages, which the app guides a young person through in an incremental manner. This “baby steps” approach of subtracting a bit each time minimizes discomfort and helps the user to not miss the customary amounts.

Let’s invent a 14-year-old named Skip. What Skip will do is weigh every food amount he typically eats at meals with a wireless food scale and record it, up to a total of 25 foods. After this information is recorded, the app guides Skip through the subsequent steps. At each meal he will place a plate on the scale, select a food for the meal in the app, and let the app tell him how much of the food to add or remove from the plate to achieve the next increment of amount reduction. He will repeat this for each different food that composes the meal, and then snap a picture of the completed plate, which is viewable by his mentor with the weights of the foods.

An Early Lesson

Of note from the W8Loss2Go pilot studies is that the technique did not work well when the young person was allowed too much discretion. In the beginning, after taking a serving of food, the participant was asked to merely return one-quarter of the amount. But this led to indecision about how much to serve out initially, and about how much to put back. This uncertainty was stressful, and as we know, the result of that is “stress eating.” Much better results are obtained by handing these decisions over to the app, interfaced to a wireless food scale.

The app allows no second helpings, of course, and the use of smaller plates or bowls has a helpful psychological effect. Parents are asked to lend a hand in several ways, including not keeping serving bowls on the dining table.

The concept of staged food withdrawal is shown to be readily acceptable by the kids who have tried it out, and quite feasible as an addiction-based treatment model. The smartphone platform, aided by input from health professionals, brings a lot of hope to the area of childhood obesity mitigation. So far, Skip is more likely than Sue to achieve real progress. Dr. Pretlow notes:

This approach has considerable potential to address a critical treatment gap in childhood obesity especially for boys. Future programs need to investigate tailored techniques to the addiction approach for girls and older adolescents.

So far, three pilot studies have been conducted of this intensive treatment using addiction medicine methods, and the potential is great for helping overweight and obese young people to help themselves.

The page titled Weight Loss App Pilot Study Information gives details on the next upcoming study which starts in early fall of 2015. Any parents of obese kids in the area of Seattle, Washington, might want have a look.

Your responses and feedback are welcome!

Everything You Know About Sugar Is Wrong

sugar ad

With one of the major eating festivals on the horizon, Childhood Obesity News looks to Scientific American’s Ferris Jabr for information on the toxicity (or not) of sugar. This topic also fits into the “everything you know is wrong” niche for contested theories, which seem to be particularly abundant in the field of obesity. As we have seen, a large number of health professionals are against sugar in any form, assigning it responsibility for the obesity epidemic, the rise in cardiovascular disease, and the surge in Type 2 diabetes and other metabolic disorders. However, there is contrary evidence. Jabr examined a 2011 study in which a team analyzed data collected from 25,000 Americans, noting:

They did not find any positive associations between fructose consumption and levels of trigylcerides, cholesterol or uric acid, nor any significant link to waist circumference or body mass index (BMI).

This result surprises no one, because the research was conducted by a big food processing company. But as it turns out, even some scientists who are apparently not backed by the high fructose corn syrup industry think that the widely-demonized HFCS is not so bad.

One such voice belongs to John Sievenpiper, of St. Michael’s Hospital and the University of Toronto, who conducted a series of meta-analyses in which he examined dozens of human-based studies. The research team found “no harmful effects of typical fructose consumption on body weight, blood pressure or uric acid production.” Sievenpiper suggests that a person with a weight problem would do well to cut back on sugars, but to expect a magic-bullet effect across the board, in all populations, would be unrealistic because, “obesity is more complex than that.”

Jabr gives a helpful explanation of the difference between fructose, glucose, and sucrose, and what High Fructose Corn Syrup is all about. Whether a person eats table sugar or HFCS doesn’t matter much, because it all breaks down into glucose and fructose molecules. But when a person’s diet is top-heavy with fructose, the liver has to work too hard because it is practically the only place where the body can convert the stuff into energy. A stressed liver pushes back by overproducing uric acid, which can lead to high blood pressure, kidney stones, gout, and medical bills.

Sugar’s Bum Rap

Fructose especially has a terrible reputation, being blamed for insulin resistance, stuffed-up arteries, and fatty liver disease. Jabr learned that, like many other laboratory explorations of substances, some of the major fructose studies bear little relation to reality. (Incidentally, some serious doubts have arisen in recent years about the diabetes mice.)

First of all, the subjects are rodents, which although similar to humans in some ways, are unalike in important respects. For instance, when fructose goes into rat bodies, their livers turn half of it into fats, whereas a human body only does this with one percent of the fructose it receives. This is only one example of differences in the metabolic processes of the two species.

Another factor is that humans rarely consume fructose molecules unaccompanied by glucose molecules, because food just doesn’t grow that way. Even table sugar contains both elements, and HFCS does too, only more of the fructose. But the lab animals get pure fructose, which is enough to make an experiment invalid in some critics’ opinions. Also, rodent experimenters tend to slam the subjects with grotesquely exaggerated doses of the substance being assessed.

How it All Adds Up

Jabr allows that one deleterious effect of fructose in humans might require further scrutiny. It seems to lead to production of the hormone grehlin, which makes people think they are hungry. Glucose, on the other hand, fosters the production of leptin, which makes people think they have been fed and are not currently hungry. To be in one or the other of those mind-states makes an enormous difference in eating habits. He seems to feel the appropriate response is to not worry about which kind of sugar is worse, but cut down on all of them. He says:

A small percentage of the world population may in fact consume so much fructose that they endanger their health… But the available evidence to date suggests that, for most people, typical amounts of dietary fructose are not toxic.

Exercising, favoring whole foods over processed ones and eating less overall sounds too obvious, too simplistic, but it is actually a far more nuanced approach to good health than vilifying a single molecule in our diet—an approach that fits the data.

Luc Tappy of the University of Lausanne sums up the argument in the phrase “entirely dispensable nutrient.” In other words, sugar is one nutrient we don’t need to worry about lacking. We get enough of it through ingesting a reasonably sane diet, and there is no need to sprinkle it on or stir it into anything. The adjective “dispensable” suggests a call to action: dispose of it.

Your responses and feedback are welcome!

Source: “Is Sugar Really Toxic? Sifting through the Evidence,”, 07/15/13
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