Did McDonald’s Invent the Most Lethal Slogan Ever?


Even to people who were not yet alive for its debut, the expression “You deserve a break today” is familiar. (McDonald’s gave up the trademark on the slogan a couple of years back, so now anyone can say it.) It is being examined here today because of a hidden link between the slogan and the obesity epidemic, and especially its connection with a phenomenon known as FOMO, or “fear of missing out.”

“You deserve a break today” might be one of the most harmful arrangements of words ever strung together. According to the McDonald’s Corporation, what, exactly, is it that you deserve? A fast-food exec put it like this: “A tasty reward for everyday living.” But many disgruntled critics here and in other countries characterize the corporation’s products as industrially processed pseudo-food with ingredients that compete with each other to be the most health-defeating.

Unpacking the winning propaganda

One of the most popular sentiments for a friend or co-worker to write on a card is “Thanks for all you do.” Everyone likes to hear that.

So McDonald’s took advantage of this human weakness, and elevated it to the next level. The underlying message is, “The Universe recognizes what an exemplary human being you are, and wonderful people like you must be rewarded. Food is a reward, so go eat some. (BTW you will pay for it at the register, and again in terms of your damaged health.)” They condensed that message down to “You deserve a break today.”

Commercial advertising is designed to work on human insecurity and all our other most vulnerable and deplorable traits. If the armor has a chink, advertising stands ready to exploit it. Ad Age (aka Advertising Age) named the McDonald’s slogan the top jingle of the 20th century. What that means in practical terms is, it’s the best at getting into people’s heads.

The intention of the slogan is to set up a subconscious chain of reasoning that goes like this: “Why yes, now that you mention it, I do deserve a break. It’s my due. I am entitled to wolf down 3,000 calories with no nutritional value. If I don’t get what’s due to me, I’m a sucker, a loser.”

The reality is the exact opposite

People who are influenced by hype are the suckers and the losers, and that includes all of us at one time or another. This is complicated by the fact that a sense of entitlement is basically a good and healthy trait, according to a more sane and helpful subconscious reasoning process that might go like this:

“I deserve the best possible food. It’s my due, as a human being on this planet, to nourish my physical vehicle with the full spectrum of vitamins, minerals, and all the other necessary components of a diet that will optimize the functions of this body and mind.

I am entitled to fresh produce that is not covered with poison or genetically engineered for color and size uniformity rather than flavor. If I don’t pursue these entitlements, I miss out on some of life’s blessings.

But, because we are human, things are liable to get twisted. The sensation of having a need and a duty to reward oneself can become an obsession. Dr. Pretlow says:

An 18-year-old boy in our third study passed by the cinnamon roll outlet in the mall but managed not to go in. When he got home he felt quite disappointed, and seriously considered going back to the mall. The next day the nagging thought persisted that he needed to go back to the mall and get the cinnamon roll. Even a week later the thought still bugged him.

Your responses and feedback are welcome!

Source: “McDonald’s Drops Rights to ‘You Deserve a Break,'” HuffingtonPost.com, 01/11/15
Photo by GollyGforceLiving on Visualhunt/CC BY

Act 1220 From Arkansas — the Rest of the List


Recently, Childhood Obesity News summarized some of the 10 things learned from a very major and important study. The state of Arkansas had an inspiration, and the Robert Wood Johnson Foundation saw an opportunity to document and guide a major project from its inception.

One result of the mutually beneficial association was the 40-page report, “Evaluation of Act 1220 of 2003: Lessons Learned, 2004-2012.” (The numbered Lesson headings are verbatim from the report.)

Lesson 7: Changing school environments was associated with only specific and modest changes in family behavior.

We left off with how changes in public school policies affected the home lives of children. The report goes on to discuss how the new school procedures impacted the customary ways and habits of teenagers. Subject to the same caveats as all self-reported data, the older kids seem to have bought less from the school’s snack and soda vending machines.

During the times when they were not at school, the adolescent subjects cut back on their fast-food intake. However, increased consumption of fruits and vegetables among this age group seems to be a mirage that may be glimpsed but never reached.

In the physical activity realm, the teens actually became less active over time, but the study authors take into account a series of severely hot summers in the geographical area. This underscores yet again the difficulties faced by scientists. To say the roots of the obesity epidemic are “multi-factorial” is an understatement.

Lesson 8: Changing school environments, practices, and policies is not sufficient to change student BMI at the population level.

To put it more bluntly, all the measures the school system took to address obesity pretty much failed.

Lesson 9: Focusing attention on childhood obesity and weight overall did not lead to increases in unhealthy student behavior.

The good news, on the other hand, is that nobody got hurt. The report says:

Since the early days of the implementation of Act 1220 and throughout the 9-year period of the evaluation, concern has been expressed by policy makers, school personnel, mental health professionals, and parents about the possibility that the BMI measurement, in particular, and the attention being focused on weight status, more broadly, would result in adverse consequences, such as eating disorders, unhealthy weight loss behaviors, and weight-based teasing.

But that concern was needless, because as the text goes on to assure the public, no “unintended adverse consequences” were found.

Lesson 10: It takes changes in both nutrition and physical activity to make changes in BMI at the school level.

This section goes into detail about some of the variable factors the researchers had to take into account. Not all schools adopted all the suggested measures, and different schools put things into place at different times and with dissimilar levels of enthusiasm.

The study authors also describe their criteria for declaring a school successful, and report on their findings on “Case Studies of Successful Schools”:

Rather than a single key policy or practice, a combination of activities focused on wellness contributes to the success. The combination of nutrition and physical activity changes on campus made the difference over the years.

Your responses and feedback are welcome!

Source: “Evaluation of Act 1220 of 2003: Lessons Learned, 2004-2012,” RWJF.org, Feb 2014
Image source: highwaystarz/123RF Stock Photo

Lessons Learned From the Evaluation of Act 1220


The previous Childhood Obesity News post contained basic information about an audacious Arkansas public school system experiment backed by the prestigious Robert Wood Johnson Foundation. Here is the payoff the background knowledge leads up to. The authors of “Evaluation of Act 1220 of 2003: Lessons Learned, 2004-2012” list the 10 main things that became clear when an American state decided to get serious about obesity prevention.

The report goes into each point in great detail. We give the major section titles and a quotation or a few words about each one.

Lesson 1: Successful passage of legislation does not stop controversy and challenge.

Lessons Learned” looks at one of the obstructive factors that popped up.

Lesson 2: School environments, policies, and practices changed after the passage of Act 1220.

Followup surveys show that there has been meaningful change in school environments, policies and practices, and more than a dozen of these concrete achievements are listed.

Lesson 3: Policy change is not necessarily permanent change.

This immutable facet of the human condition was true in the context of the particular time and place it was written for, and has become even more true of the whole country since then.

Lesson 4: Administrative and financial support are critical to changing school environments, policies, and practices beyond legislative mandates.

Another unchangeable feature of contemporary human life. To influence people’s behavior on a large scale, a plan requires infrastructure, equipment, personnel, and time. Resources cost money — way too much of it.

Lesson 5: Parents and school personnel adapted to the measurement and reporting of BMI.

According to the report:

Opponents within schools, communities and even some national experts expressed concern about infringement on parental rights, the accuracy of measurements, and the likelihood of negative consequences (i.e., eating disorders, weight-based teasing).

Lesson 6: Parental awareness of children’s weight status and accuracy in categorizing their child’s weight improved.

This has been a stumbling block everywhere, and there has been national discussion about the ability of parents to practice selective blindness on the question of which kids are overweight — apparently, never their own.

However, regarding the BMI measurement program, the researchers found that…

[…] after one year of reporting, parents improved their ability to accurately characterize their child’s weight status…

Lesson 7: Changing school environments was associated with only specific and modest changes in family behavior.

In other words, not everyone is capable of change, and those who are able are not always ready to change within a time frame that suits the needs of researchers. Over time, parents actually did cut down on the amounts of soda and fatty foods they provided — but, weirdly, also dished out fewer servings of fruits and vegetables.

Parents started walking a bit more, but did not line up to join gyms or adopt other physical activities. However, over an eight-year period, the number of parents who enrolled their children in some type of extracurricular physical activity increased by 6%.

The most notable change affected only a small group. In 2004, 11% of parents were not in the habit of allowing their children to play outside after school. By 2012, that number had shrunk to 6%. While the change was significant for the kids who began to enjoy more physical activity, it was confined to a very small portion of the whole population.

(The next post will continue this discussion.)

Your responses and feedback are welcome!

Source: “Evaluation of Act 1220 of 2003: Lessons Learned, 2004-2012,” RWJF.org, Feb 2014
Photo by woodleywonderworks on Visualhunt/CC BY

Happy Thanksgiving!


Happy Thanksgiving!

Childhood Obesity News would like to wish you a safe and joyful holiday.

We will return tomorrow with a regular post.

Image source: evgenyb/123RF Stock Photo

More Lessons Learned


Back in 2003, by passing Act 1220, the state of Arkansas embarked on an extensive obesity prevention project that required collaboration among government institutions and many varieties of professionals who worked for the public education system. Anxious to be in from the start on such an ambitious undertaking, the Robert Wood Johnson Foundation put up the money for an “evaluation of the process and impact of the law’s implementation.” A research team designed the evaluation, and laid out the preparatory steps.

One of the original purposes was to provide body mass index (BMI) screenings for all students every year, and notify parents of the resulting scores. Objections came from many directions, including parents who were against the mandatory nature of the screening. That resistance was apparently based on a misunderstanding, because parents who did not want their children measured were allowed to opt out with no bad consequences.

Others objected to the cost of printing consent forms and mailing the test results to parents. Eventually, everything got underway.

The report, “Evaluation of Act 1220 of 2003: Lessons Learned, 2004-2012” is a downloadable PDF file, 40 pages in length, compiled from nine years of data. It is a massive resource, with pointers to other resources, as well the history of how all the parts fit together. There seems to be an awful lot of repetitive effort to “reinvent the wheel” in cities and states all over America.

Information about how one endeavor came into being is always helpful. Hopefully, other political and public service entities want to emulate success — and avoid pitfalls — when designing a program. To learn from the mistakes of others, as well as from their brilliant innovations, can obviously save lives, money, and time.

But that’s not all

Along with the annual BMI screenings, the law also required schools to disclose their contracts with food and beverage companies, and to restrict the access of elementary school students to vending machines. On the bureaucratic side, each school district was to create a Nutrition and Physical Activity Advisory Committees with membership open to teachers, community leaders, and of course parents. Also, a Child Health Advisory Committee would be established to review the evidence as it came in, and recommend further refinements of the policies regarding nutritional standards and physical activity requirements.

In 2005, the Child Health Advisory Committee fulfilled its role by making additional recommendations. The new rules forbade the use of foods or beverages, including vending machine access, as “rewards for academic, classroom, or sport performances and/or activities” — a precept that Dr. Pretlow highly acclaims. Using edible or drinkable treats as a reward is always a mistake, whether done by teachers or parents.

The Committee tweaked the portion sizes of the vending machine offerings and required that fruits and fruit juices be as readily available as junk food. Schools were told that all students must have 30 minutes of physical activity per day, and new rules were made about Physical Education (PE) teacher certification and PE class sizes.

Like so many other things, the success of a far-reaching, large-scale program is multi-factorial. The report includes this paragraph:

The co-occurrence of these programs and initiatives supporting the implementation of Act 1220 require a cautious interpretation of evaluation findings. Changes in school environments, policies and practices, as well as any changes in individual or family behaviors that may be observed cannot be attributed solely to the influence of Act 1220. However, it is clear that Act 1220 was an early stimulus for child health activity, particularly school policy and environmental change…

The resulting changes are broken down into 10 discrete Lessons, which we will look at next time.

Your responses and feedback are welcome!

Source: “Evaluation of Act 1220 of 2003: Lessons Learned, 2004-2012,” RWJF.org, Feb 2014
Image by Robert Wood Johnson Foundation; Fair Use

Up-to-Date Quality of Life Roundup


This should bring us up to date on all the previous Childhood Obesity News posts concerning the very important aspect of life known as quality, with a trio of pieces all based on the same question: Are obese kids miserable? According to many indications, the answer is yes, although getting confirmation of what seems rather obvious is not as easy as it sounds.

Outsiders are often tempted to break down large problems into well-defined categories, and consequently sometimes end up kidding themselves about what actually goes on. But there do seem to be three distinct groups.

Dr. Pretlow has found that children and teens who can express themselves anonymously, via his Weigh2Rock website, are very forthcoming about their sufferings. In person, not so much, as the participants in the various WeightLoss2Go studies have shown. When faced with a researcher or medical professional, a person’s impulse to give voice to feelings often fades.

When they grow older, the same people can be fountains of information, and this is true whether they are still overweight/obese or whether they have learned what keeps their particular bodies at a reasonable size. Sometimes, the stories of morbidly obese people wind up being told by third parties, and they can be horrifying.

Many influences on childhood obesity

Kids who are on the “no” side of obese-child misery are there for various reasons. If they are born into a family where pretty much all the relatives are overweight, in a neighborhood and culture where obesity is common, there may not be much reason for unhappiness. Eventually, incipient diabetes and other medical problems will gain prominence, but it is possible to have a very happy childhood.

However, it appears that an increasing number of teenagers have become infected by the “fat acceptance” mindset, to the point where this way of thinking is dangerous, and will certainly affect their quality of life somewhere down the line. When societal norms are harmful and hateful — like racism, misogyny, greed, and so forth — defiance of those norms can be a very good thing. But to fight for the right to be fat, while insisting on not only respect, but praise, for taking that stand, can lead to nothing but a bad end.

Why is quality of life question so urgent?

In order to undertake a big project like losing 50 pounds and (more important) keeping it off, a person needs plenty of motivation. Traditionally, people make significant life changes in order to escape unhappiness. So here’s the problem: If obese children and teens are happy, and satisfied with their quality of life, what other engine could possibly supply power for the difficult task of slimming down and reclaiming a healthier body? That makes it a vital topic indeed.

Allow us to recommend these previous gatherings of ideas:

“Quality of Life Roundup”
“Roundup: Quality of Life”
“The Continued “Quality of Life” Roundup”

Your responses and feedback are welcome!

Photo credit: johnyk_74 via Visualhunt/CC BY-NC-SA

More on EMA and Childhood Obesity


Recently we discussed a study carried out by a team from Children’s Hospital of Pittsburgh, and specifically from the Weight Management Center, combining Ecological Momentary Assessment (EMA) and Ecological Momentary Intervention (EMI). These researchers, who of course looked at previous studies before designing their own, mentioned a troubling side note — one indicating that, as always, more research is needed:

Moreover, given exclusion criteria in many pediatric obesity trials, children with mood disorders (depression) and medical comorbidities (sleep problems) do not receive the interventions. Domains such as mood and sleep may be essential dimensions of assessment as mediators or moderators of weight-loss treatment.

A 2010 study looked into “the feasibility, acceptability, and validity” of an EMA protocol using mobile phones. There were 121 kids between the ages of 9 and 13. The number of girls and boys were very close to equal, and 40% of the subjects were either already overweight or at risk.

They were monitored mostly outside of school hours, from Friday afternoon to Monday evening, and were surveyed between three and seven times per day. The report says:

Items assessed current activity (e.g., watching TV/movies, playing video games, active play/sports/exercising). Children simultaneously wore an Actigraph GT2M accelerometer. EMA survey responses were time-matched to total step counts and minutes of moderate-to-vigorous physical activity (MVPA) occurring in the 30 min before each EMA survey prompt.

The ideas behind EMA and EMI are obviously proliferating, reaching such institutions as the Center for Childhood Obesity Research. The Center conducts interdisciplinary research to help build the evidence base that will hopefully reveal what causes the increasingly alarming statistics.

The officials who make policy need to know these things, and so do clinical practitioners and therapists of all kinds. The Center’s literature states:

This center combines the research strengths of the College of Health & Human Development, including preventive interventions; attention to biology, behavior, and family relationships; medical and community partnerships; and real time ecological momentary assessment of health via data from sensors, accelerometers, and smartphone technology.

Making use of data already collected and curated, researchers in Warsaw, Poland, conducted a meta study whose results were published in 2013. Their goal was to “assess the value of ecological momentary assessment in evaluating physical activity among children, adolescents, and adults,” and also determine whether EMA lives up to the urgent need for validity, reliability, objectivity, norms, and standardization.

Frankly, there was not that much to pick from, because the whole notion of using EMA to evaluate kids’ physical activity is relatively new. The team looked at 20 journal articles, all concerning studies in which EMA procedures were “precisely documented and confirmed to be feasible.” The conclusions were:

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

Out of the 20 articles team scrutinized, 14 addressed physical activity versus sedentary lifestyle in kids and teens, and six were about EMA and adults. They found that the electronic tools like phone surveys and electronic diaries are used more with the younger set. Now, what about measurement characteristics?

The findings demonstrate that the EMA approach constitutes a valid, reliable, and feasible measurement tool, which clearly indicates that EMA can be considered a suitable method for assessing PA among children, adolescents, and adults.

Your responses and feedback are welcome!

Source: “Utilizing Ecological Momentary Assessment in Pediatric Obesity to Quantify Behavior, Emotion, and Sleep,” NIH.gov, December 2009
Source: “Investigating children’s physical activity and sedentary behavior using ecological momentary assessment with mobile phones,” NIH.gov, December 2010
Source: “The Center for Childhood Obesity Research,” Psu.edu, undated
Source: “Using Ecological Momentary Assessment to Evaluate Current Physical Activity,” NIH.gov, July 2013
Photo credit: kellybdc via Visualhunt/CC BY

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


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

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

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

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

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

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

Cohn writes:

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

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

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

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

Dr. Pretlow says:

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

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

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

Your responses and feedback are welcome!

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

Ecological Momentary Assessment and Childhood Obesity


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

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

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

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

EMA’s Adaptability

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

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

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

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

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

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

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

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

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

Your responses and feedback are welcome!

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

What Is Ecological Momentary Assessment For?


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

These meaningful words are from a 2010 study:

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

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

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

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

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

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

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

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

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

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

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

Your responses and feedback are welcome!

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

Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
Copyright © 2014 eHealth International. All Rights Reserved.