Compliance and Soft Science


Childhood Obesity News pointed out some similarities between adults who participate in trials of pharmaceutical products, and young people in weight-loss programs. Although the circumstances are not strictly parallel, it is useful to look at related research for hints about paths to pursue, especially when not much literature on a particular demographic group exists.

Possibly, interesting details can be found in a study of cheating in an academic setting. Warning: the report gets very dark, very quickly. Here are excerpts:

Students who cheat in high school and college are highly likely to fit the profile for subclinical psychopathy — a personality disorder defined by erratic lifestyle, manipulation, callousness and antisocial tendencies, according to research published by the American Psychological Association…. First, they sought to get the grades to which they felt entitled; second, they either didn’t think cheating was wrong or didn’t care.

Apparently, teenagers feel there are two chief justifications for cheating on tests — a sense of entitlement, and a disregard for morality. As a thought experiment, how do those two factors impact the case of a child who takes part in a study, and then knowingly under-reports his or her food intake?

In pragmatic terms, the first rationale is useless, in any kind of diet, mainly because of the laws of nature. It matters not how many servings of chocolate-covered bacon a person feels entitled to eat. If calories cause pounds, no amount of entitled attitude can result in weight loss.

This report inspires contemplation of the many different ways we use the word “cheat” in English. As categories, active non-compliance and passive non-compliance might be more useful, like the old theological distinction between “sins of commission” and “sins of omission.”

Taking an extra cookie is active; neglecting to enter it in the food diary is passive. Ideally, the participant does neither. In regard to cheating on academic tests, the report also said:

Analysis unearthed subgroups of students who felt that cheating was an appropriate strategy for reaching their ambitious goals, who were not afraid of punishment, or who were not morally inhibited.

Again, with overeating, the first condition does not enter the equation. No matter how strongly a person believes that cheating on their designated food program is an appropriate strategy for reaching a weight-loss goal, their conviction is irrelevant. It doesn’t work, that’s all.

As for the second condition — no fear of punishment — if overweight and obese people regard their body size as a punishment, is that healthy or useful? Whether or not society labels it as a punishment, it seems inevitable that obesity will be the unavoidable consequence of cheating with food.

A rebel can get away with a certain amount of misbehavior, and gain short-term satisfaction from sticking it to The Man. But long-term, the pounds will arrive — and they will stay.

Thirdly, when it comes to morality, humans have been arguing for millennia over the difference between right and wrong. Also, science is not supposed to dabble in that realm. So there are built-in difficulties.

Part 1 of the research team’s Self-Report Cheating Scale concerns admissions (confessing to wrongdoing) and tells scientific colleagues:

The 18 items marked with an asterisk are included in self-reported cheating score. They can be summed to create an overall cheating admissions scale. The other items are fillers: They were included to take the focus off cheating to more general misbehavior.

If the object is to conceal from the students that the quiz is actually about their cheating habits, it is humorously transparent. Among the 26 items are eight “filler” questions and 18 cheating questions. The method seems so unsophisticated that it might have come from the pages of the old National Lampoon. There is also something risible in the idea of asking people to candidly reveal the truth about their own cheating.

Because professionals in all the soft sciences deal with humans, these are the challenges they face.

Your responses and feedback are welcome!

Source: “Personality Predicts Cheating More Than Academic Struggles, Study Shows,”, 09/07/10
Source: “Identifying and Profiling Scholastic Cheaters: Their Personality, Cognitive Ability, and Motivation,”, September 2010
Photo credit: TwisterMc on Visualhunt/CC BY-SA

Science and Compliance


Once upon a time, some pundit declared that, in the real estate business, the three most important factors are location, location, and location. That witticism became a meme in the original sense — not a word and picture combo for the Internet, but a mental construct that catches on because of its infinite adaptability. This explains why, about a hundred years later, academics were inspired to title an article “The Secrets of a Successful Clinical Trial: Compliance, Compliance, and Compliance.”

Let it be understood that the authors are talking about drug trials. This is not an exact parallel to child obesity studies. But human nature has a way of being impressively consistent across disciplines, so there may be something here to learn. The report says:

The extent to which patient noncompliance has marred clinical research has in some cases been underestimated, and one step to improving the design of clinical trials may lie in better attempts to analyze patient compliance during drug testing and clinical development.

In drug trials, the earliest basic decisions, such as, “Should we proceed with this, or not?,” are determined inside the controlled boundaries of the laboratory. But this omniscient degree of oversight must eventually end. As the authors put it:

In contrast, once a compound has progressed to efficacy trials, both economic and logistic considerations most often dictate that studies will be done in an outpatient population.

This delineation might be roughly compared to the difference between an immersive, residential, inpatient weight-loss program, and the unsurveilled life of an obese person in the wild. In the laboratory or at the “fat farm,” the time duration of the intensely observed stage of the study is predefined.

Transition from the lab or the institution to the real world is a major parameter shift. Now, the person must deal with the prospect of an extended time period, or even an open-ended one, and psychologically that makes quite a difference.

For that and other reasons, adjustments need to be made in attitude and behavior if the experiment is to go well. Also, it is worth ascertaining whether the subject unconsciously doesn’t care if the experiment goes well or not.

Similarities between drug trials and obesity studies

The authors point out that pharmaceutical trials tend to attract “professional subjects,” which may describe college students trying to make ends meet, but is unlikely to be true of kids trying to end their obesity. The authors qualify this by adding that the untrustworthiness factor arises particularly…

[…] when entry criteria and endpoints are “soft,” such as trials using subjective rating scales which can be “gamed.”

Now the situation sounds more familiar to the child obesity prevention community. Because weight loss is a gradual, long-term process, and because of the impossibility of monitoring subjects 24/7, much information is gathered via self-reporting, which cannot help but be unreliable.

The system, in other words, can definitely be gamed. The challenge in both cases is to convince the participants not to. Subjects in the outpatient phase of a drug trial, and participants in Dr. Pretlow’s W8Loss2Go program share a very important similarity: the absolute necessity of personal integrity, responsibility and accountability.

Your responses and feedback are welcome!

Source: “The Secrets of a Successful Clinical Trial: Compliance, Compliance, and Compliance,”, April 2011
Photo credit: marvelousRoland on Visualhunt/CC BY-SA

George Orwell’s Prophecy


The Road to Wigan Pier was published by George Orwell (of Nineteen Eighty-Four fame), to describe life in an English town where the people subsisted on potatoes, white bread, margarine, corned beef, and sugared tea. The author expressed a wish that the poverty-stricken people would make an effort to include more fruits and vegetables in their diets, but that would have been unlikely for many reasons.

Orwell felt that conditions had been dire for so long, the palates of the working-class Brits pretty much automatically rejected wholesome food. He wrote something really worthy of our attention:

A man dies and is buried, and all his words and actions are forgotten, but the food he has eaten lives after him in the sound or rotten bones of his children. I think it could be plausibly argued that changes of diet are more important than changes of dynasty or even of religion.

That was 80 years ago. And now here is a very recent quotation from Wigan Council’s director of public health, Professor Kate Ardern:

We recognize how important it is to instill healthy habits in young people and that by doing so will help them to go on and continue to lead healthy lifestyles into adult life.

These words, written by Rachel Howarth, were published about a week ago by

The number of Wigan children leaving primary school overweight has risen over the past five years, with almost four in 10 reported as medically overweight or obese by year six… 37 per cent of children in 2016/17 reached their last year of primary school with weight problem.

According to the National Child Measurement Programme, this is higher than the national average, which is a mere 34.2 percent.

A program promoted by the local government as an innovative project for the whole family. “Let’s Get Movin'” has a familiar sound to Americans, being so close to Michelle Obama’s “Let’s Move!” Professor Ardern mentions that the program includes specialist weight management service, health promotion work and healthy lifestyles intervention, and prevention education.

The family signs up for a 12-week intensive intervention. The later, followup support might consist of a gym or swim club membership for the family.

Prof. Ardern also mentions The Daily Mile, a program which currently encompasses more than 9,000 kids in 50 primary schools. In “early years settings,” similar to preschool, there is the Daily Toddle. Both help the youngsters to take part in and appreciate the benefits of daily exercise that becomes a consistent habit.

Aside from being free, the Daily Mile program is quite simple and able to be administered by untrained staff. No special clothing is required, no equipment needs to be set up, and the time investment is little more than a quarter of hour each day. There is no competitive element, and every child succeeds.

The Daily Mile has ambitions and effects beyond the physical, improving the social skills along with mental and emotional health. Adults have observed other effects, like improvement in concentration, mood, behavior, and general well-being. Children often get better grades, and generally acquire increased awareness of health-related practices.

Of course this is not the first fitness program to be practiced in schools, and it probably won’t be the last, but every such effort has effects measurable not only in the present, but unseen effects that reverberate through the years.


Source: “The Road to Wigan Pier,”, undated
Source: “Rise in number of obese Wigan schoolchildren,”, 01/18/18
Source: “The Daily Mile,”, undated
Photo credit: Ben Sutherland on Visualhunt/CC BY

More About Cheating


For decades, researchers had to rely on self-reporting to amass large quantities of data about caloric consumption and calorie-burning exercise. They knew the information was flawed, but were unable to do anything about it. (We’ve started the discussion on this topic in our previous post.)

In 2015 a paper was published that really highlighted the gravity of the situation. A team from the University of Alabama’s Nutrition Obesity Research Center declared that such poor-quality data “no longer have a justifiable place in scientific research.” NPR journalist Eliza Barclay wrote:

That’s some strong language, considering that these data have been used in hundreds of major studies to inform hundreds of public health policies and clinical recommendations… New techniques using digital photography — that’s right, photographing subjects while they eat — and chewing and swallowing monitors show promise. The authors also note that short-term, though expensive, techniques of measuring energy balance in a metabolic ward also give more accurate results.

A 2012 study aimed to both determine whether survey participants are able and willing to self-report, and to assess the accuracy of this self-reporting. The researchers recruited young people between the ages of 16 and 29 from among the throngs of music festival attendants. Among the reported results were these findings:

Overall, 52% accurately self-reported height, 30% under-reported, and 18% over-reported; 34% accurately self-reported weight, 52% under-reported and 13% over-reported.

Males are more likely to overestimate their own height. In both sexes, weight tends to be underestimated. Sadly but (considering societal expectations) not surprisingly, women are twice as likely to under-report their weight.

An enormous 2008 meta-study systematically reviewed the literature “to determine the extent of agreement between subjectively and objectively assessed physical activity in adults.” Throughout the international literature on the subject, it seems there is no more thorough examination anywhere of “the relationship between self-report and directly measured estimates of adult physical activity.”

But despite its comprehensive nature, because of the differences in methodology and so forth, more than anything else this research seems to have highlighted the difficulties of completing such a study. The authors wrote:

At this time, it is not possible to draw any definitive conclusions concerning the validity of self-report measurements compared to various direct methods…

Why do participants prevaricate?

Paul Dolan has written, “Our propensity to cheat, just like our propensity to eat, has less to do with the type of person we are and more to do with the opportunity to do so.” Another suggested explanation is that people simply forget about casually consumed snacks and thoughtlessly quaffed beverages, and “sometimes believe that if something is healthy, the calories don’t count.” Bottom line, they have trouble being honest with themselves and this of course carries over into dishonesty, whether intentional or not, toward the researchers they are working with.

That observation segues nicely into a recommendation of a guide written by Linda Melone, titled “14 Ways You Lie to Yourself About Your Weight.” Of course, ideally a person will learn about these ways not in order to adopt them, but to avoid them. Since self-deception is a game played by almost everyone in our culture, this is a very useful article.

Your responses and feedback are welcome!

Source: “We Lie About What We Eat, And It’s Messing Up Science,”, 01/14/15
Source: “Measuring the accuracy of self-reported height and weight in a community-based sample of young people,”, 11/21/12
Source: “A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review,”, 11/06/08
Source: “Happiness by Design,”, 2015
Source: “To Lose Weight, You Need to Stop Lying to Yourself,”, 01/07/15
Source: “14 Ways You Lie to Yourself About Your Weight,”, 08/26/15
Photo credit: Ferrous Buller (lumachrome) on Visualhunt/CC BY-SA

On Cheating and Weight Loss


In this post we are not talking about the concept of the “cheat day,” the periodic safety valve which many weight-loss diets encourage to keep people from going completely off the rails. But a person who is kicking alcohol or cocaine does not get a cheat day, and Dr. Pretlow does not endorse that idea any more than a classic 12-step program would.

Dr. Pretlow has found that when a person’s drug is cheesecake or cheeseburgers, their particular “problem food” has the same calamitous potential as booze or blow. The problem foods have to be left behind, and that’s that.

A recent University of Eastern Finland study set out to determine (through blood tests) whether participants were following their prescribed diets correctly, and not telling fibs about their nutritional intake. The researchers’ perception was that deviation is more likely to happen when an entire food group is eliminated, or when there is no cheat day. However, we repeat that when a particular food functions as an addictor, there is no room for “planned hedonic deviation,” and no leeway can be given.

This next bit is somewhat counter-intuitive. In the trials of W8Loss2Go, the first stage, withdrawal from specific problem foods — the ones that acted like addictors for that person — went smoothly for most participants. Even the renunciation of snacking was not traumatic.

Where the subjects ran into trouble was with the everyday grind, the withdrawal from excessive portions at regular mealtimes. Dr. Pretlow says:

Participants displayed obfuscation, rationalization, deflection, denial, cheating, and lying — resembling drug addicts.

A paper titled “Addiction Model Intervention for Obesity in Young People” and co-authored by Dr. Pretlow and Carol M. Stock addressed the problem of cheating when measuring and weighing food amounts. Several study participants confessed to adding more to their plates than they recorded in their food logs.

Asking parents to oversee the process, or asking the kids to send in photos as confirmation, is a temporary fix. But of course ultimately the individual must take responsibility for accurate reporting. Apparently, for some obese people, the very fact that more food is available is the only impetus necessary to derail them.

Sometimes, the study subject might be guilty of an omission that is more charitably called resistance than an outright cheat, by skipping the weighing and measuring on the grounds that it takes too much time. But the end result — inaccurate reporting — is the same.

The gathering of anthropometric data is never a walk in the park. A 1995 study, written by academics who had also consulted other studies, concluded that “the population as a whole underestimates energy intake by self report and that the degree of underestimation is severe in selected subject groups.”

Not surprisingly, obese people are one of those unreliable groups, tending to both underestimate their caloric intake and to overestimate their physical activity, to the point where this discrepancy is characterized as a “consistent problem.” Even average-weight people tend to under-report their intake of food by as much as 50%!

(To be continued…)

Your responses and feedback are welcome!

Source: “Blood Test Reveals If Dieters Have Been Cheating, Avoiding Bias Of Self-Reports,”, 08/21/14
Source: “Eating addiction: there’s an app for that,”, 09/11/15
Source: “To Lose Weight, You Need to Stop Lying to Yourself,”, 01/07/15
Photo credit: Nina A. J. G. on Visualhunt/CC BY-ND

Smart Devices and Obesity


A very recent multi-authored paper is called “Smart Device-Based Notifications to Promote Healthy Behavior Related to Childhood Obesity and Overweight.” One of the devices referenced in the title hands out “snacking behavior notifications,” and we are told that the audience for these bulletins is the parents. They appreciate the reminders to prepare and serve up healthy snacks to their kids.

If it is one of these preparation notices, the gadget reminds the parent which kind of snack the child is supposed to take to school. It can be set up to represent several family members. The developers suggest keeping this device in the refrigerator. It includes “a feedback mechanism that is activated when someone opens and closes the fridge door.”

As for the second device, how is this for a selling point?

To the best of our knowledge, there are no further studies that attempts to persuade users to not forget their sportswear promoting physical activity through notification reminders in this context.

In other words, researchers invented this unique electronic memo gizmo, to remind kids to take along their clothes and equipment when they venture out to play team sports. This, in turn, will encourage more active participation in physical endeavors, and childhood obesity will be incrementally reduced.

This item resembles not a refrigerator magnet, but a cabinet door hook. The report says:

The user interface of our system consists of simple smart devices with embedded screens and visual LED cues that provide important information to the users in the right place at the right time. The idea behind these smart devices is that they are normal objects…

When these inventions were reviewed by peers, they received high marks for comprehensibility, perceived effectiveness and clarity. The developers describe the stages of creation in great detail:

One of the most important characteristics is the use of visual cues. Even though sound cues (auditory notifications) were strongly suggested by developers during the design process, the use of the framework lead to the decision of avoiding such notifications. The main reason to avoid sound notifications is that this type of notifications can easily become overwhelming. Moreover, visual recognition memory is superior to auditory recognition memory. Furthermore, encoding messages in sounds is a difficult task; therefore, auditory notifications would have to present the full text of the notification to be effective.

They seem to have thought of everything! The system’s six main parts are described: physical activity tracker, central database, notification generator, notification dispatcher, and the two actual objects that were created specifically for their roles. The report even shows the circuitry of the innards of the two devices, and names the suppliers of the components. This conforms with the basic scientific tenet that all experimental outcomes should be replicable, and smooths the way for anyone who cares to try.

The co-authors also lay out their aspirations, which include improving the system, aided by evaluations made by families using it at home, as well as additional assessments made by experts. They go on to say:

Furthermore, we will investigate how human activities are affected by this kind of smart device based notifications. Also, if users make responsible and proper use to achieve what smart devices pretend by adding new functionalities regarding persuasion and motivation focused on other domains of application, not only childhood obesity and overweight.

Your responses and feedback are welcome!

Source: “Smart Device-Based Notifications to Promote Healthy Behavior Related to Childhood Obesity, and Overweight,”, 01/18/18
Photo credit: osseous on Visualhunt/CC BY

Meet the Internet of Things


Inventors have utilized technology to monitor biological processes in an astonishing number of ways, but we usually envision the gadgets as being employed one at a time. Bucking that trend, a data scientist from Stanford University holds the world record for the highest number of continuously-worn wearable sensors.

For period of time, neuroscientist Rachel Kalmar always had at least 10 devices attached to her body, and the total has gone as high as 38 simultaneously active sensors recording her vital signs and more. One of her goals was the achievement of maximal interactivity. Another was to confirm that the various sensors assigned to capture the same data were actually performing that function.

If one device says a person’s temperature is 98.6 degrees and another says 106, obviously this discrepancy needs looking into. Kalmar says:

I wanted to try out all the activity trackers and get a sense of how the data compared, and what I liked about which ones, how the data compared within a wearing position, and across wearing positions… How does the data coming from your ankle differ from the data from our waist?

She learned that there are built-in technical barriers to downloading and comparing the collected numbers. Devices have limitations. Maybe the gadget can count steps, but what if the person is biking or swimming?

Can the gadget be taught to meaningfully compare apples and oranges? Kalmar learned this succinct wisdom:

There’s a tradeoff between “How smart do you want your algorithms to be?” and “How long do you want your battery to last?”

On a more meta level, she came to understand that everyday, non-geekish sorts of people have little appetite for raw data, because they don’t know what to make of it. It became apparent that tons of raw data are not worth much, unless the material is transmogrified into comprehensible and actionable information.

Also, that information has to be conveyed to its destination uncorrupted, and in a timely fashion. Kalmar wants to create…

[…] some kind of app or product or service that sits on top of incoming data, and ideally can propagate value back to the device makers too… Things that use data to do things that we’ve authorized them to do, to help solve problems that we don’t even realize are problems…

A recent paper about smart device-based notifications is lengthy, detailed, and opens several areas of speculation and possibilities to the curious. Perhaps the most jaw-dropping feature of this paper is Table A1, a list of almost 90 electronic items that the researchers reviewed.

Just to appreciate the variety and versatility of the field, here are some of smart devices that exist as of now: wireless breathalyzer, blood glucose meter, baby monitor, health tracker, intelligent yoga mat, fitness tracker, nest cam, wearable for kids, portable fish finder, wireless blood pressure monitor, fitness band, digital video monitor with night vision, pet activity tracker, intelligent bracelet, virtual reality headset, button controller, wearable communication device, ring, firewall, programmable dash button, wireless music receiver, thinking music player, air quality monitor, pool cleaning robot, propane tank gauge, thermometer, herb garden, gesture control, home energy manager, smoke alarm battery, sprinkler automator.

Few of these items relate to obesity or even health, and few are wearable, but they are scrutinized by open-minded scientists who peer under every rock in search of a fact or connection that will spark some marvelous new invention.

Your responses and feedback are welcome!

Source: “Rachel Kalmar on Data Ecosystems,”, 2017
Source: “Smart Device-Based Notifications to Promote Healthy Behavior Related to Childhood Obesity and Overweight,”, 01/18/18
Photo credit: Cory Doctorow (gruntzooki) on Visualhunt/CC BY-SA

More Wearable Tech


Childhood Obesity News has been discussing wearable technology, and this is more of the same. A couple of years back, the Mayo Clinic announced a partnership with Gentag Inc., with the intention of collaborating on the development of wearable biosensors, “designed to be painless, wireless and disposable,” that deal with diabetes and obesity.

In the bandage is a sensor that communicates via a closed-loop diabetes management system which is compatible with cell phones. The system will allow researchers to monitor movement and develop treatments for obesity and related conditions. Apparently, this technology is still on the drawing board, because there does not seem to be any more recent news of it.

A family affair

By 2017, health writer Tommy Peterson was able to point out that we had reached the point where an accurate electrocardiogram could be obtained with special software on an Apple watch. At Children’s Hospital Los Angeles (CHLA), Dr. Juan Espinoza presided over clinical trials designed to discover whether childhood obesity could be impacted by a structured weight loss program based on the Fitbit activity tracker.

A total of 150 participating families committed themselves to a two-month program that issued Fitbits to both the children and the adults of half the families. That group and the control group (with no activity trackers) were required to follow the same weight loss program. It seems that the main lesson had to do with compliance, as only 60% of the control group even finished the program, as compared to an 85% completion rate for the families with the Fitbits.

Looking ahead to the possibilities for wearable technology, Peterson mentioned voice-activated applications, and the inevitable shift of healthcare out of clinical settings and into homes, thanks to “the mobility and independence inherent in wearables.”

Incidentally, speaking of CHLA, that institution was the site last year of a study on the “Mobile Health Weight Loss Intervention Based on Addiction Approach in Obese Adolescents,” which compared Dr. Pretlow’s W8Loss2Go program with another tertiary care weight management program. This study concluded:

The W8Loss2Go App intervention is feasible to implement and useful in reducing zBMI. This represents a cost-effective, timely and labor efficient method for weight management in adolescents.

Neuroscientist Rachel Kalmar points out that more people will inevitably become involved with wearable technology, whether they want to or not. She mentions employee health programs where the opportunity to opt in and wear a tracking device is not a true choice, because people are penalized for not doing it. She brings up legal cases where Fitbit information has been used in court.

Higher education

Early in 2016, there was a swell of outrage when the public learned that Oral Roberts University required students to buy and wear Fitbits, whose data would be collected and recorded by the school administration. Obviously, such a rule is accompanied by a number of security and privacy implications. It was already mandatory to keep a fitness journal, which some students considered bad enough.

“This American Life” dug more deeply into the story and documented that the Oral Roberts tradition of regulating body size (also known as administrative overreach or outright fat-shaming) goes back almost half a century. In the mid-1970s, skin-fold testing — and in some cases, hydrostatic body fat testing — were obligatory, and at one point the famous clergyman and school founder considered denying graduation credentials to obese students. The radio journalist interviews a woman who was actually suspended from college for being too fat.

Your responses and feedback are welcome!

Source: “Mayo Clinic, Gentag partner to develop wearable biosensors for treating obesity, diabetes,”, 03/04/15
Source: “3 Healthcare Organizations Call on Wearables to Take Patient Care to the Next Level,”, 11/29/17
Source: “Rachel Kalmar on Data Ecosystems,”, 2017
Source: “589: Tell Me I’m Fat,”, 06/17/16
Photo credit: Global Panorama on Visualhunt/CC BY-SA

Trackers and Other Wearable Tech

abacus earring

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

The rise of wearable devices

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

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

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

A good idea?

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

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

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

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

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

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

Your responses and feedback are welcome!

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

This Thing Called Relapse


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

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

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

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

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

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

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

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

EMA revisited

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

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

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

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

Here is the crux of the matter:

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

Your responses and feedback are welcome!

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

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