(Part One of a Two-Part Post)(View Part Two)
by Robert A. Pretlow, M.D.
Why Does The Obesity Community Reject Addiction?
In September 2009, I conducted a plenary session presentation at the European Childhood Obesity Group (ECOG) scientific meeting in Dublin, Ireland, in which I proposed that comfort eating and resulting addiction to highly pleasurable foods is what’s causing the childhood obesity epidemic, based on the anonymous posts of thousands of overweight and obese kids on my open-access website over the past 10 years. After my talk, it was notable that hardly anyone asked questions. The conference chair, Grace O’Malley, confided to me, “The attendees were stunned by what the kids said in your presentation.”
At that same conference, a research paper was presented by a pediatrician from Austria, which “proved the relevance of food craving/addiction in childhood obesity” (Abstract, PDF). In the summary session at end of the conference, an attendee remarked that my plenary presentation and the addiction research paper were “new information.” He proposed that ECOG issue a statement on “addiction and childhood obesity.”
The response of the president of ECOG, Margherita Caroli, was, “Well, we don’t know what we’d say!” The proposal went no further. The response of the ECOG president, as well as that of the stunned attendees, illustrates a point: Medical science is having difficulty fathoming the idea of food as an addictive substance.
I recently submitted a paper to the new journal, Childhood Obesity, entitled, “Food Addiction in Children,” based on 134,000 posts from 29,000 overweight and obese kids. My article was rejected. The reviewers legitimately pointed out flaws in my paper, however, their comments included: “overly provocative title”, “sensationalistic language”, “inflammatory conclusions,” and a declaration that the compelling posts of the kids “read like a laundry list.” The kids’ posts speak for themselves. The kids speak for themselves.
Why is Medical Science So Foreign to the Idea of Food Addiction?
For one thing, mainstream medicine lacks a framework with which to understand food addiction. Comfort eating and addictive dependence are “touchy feely,” and my physician colleagues deride “touchy feely” medicine. Medical science is based on measureable physiology. Comfort eating and food addiction are difficult to quantify, much less statistically validate. I heard a commentary on NPR the other day referring to the fact that medical people have a tough time with any conditions related to the mind-body connection, e.g. habits of mind that determine behaviors. Even the psychiatric royalty is waffling over whether to designate obesity as a mental disorder in the new DSM-V diagnostic manual.
Conflicts and Vested Interests
The food industry doesn’t want the FDA to regulate food, which would likely happen if food addiction is scientifically established as causing obesity. Obesity medical science is supported by the food industry. For instance, here’s an article: “Should Pepsico fund obesity research at Yale?” Another example is that the high fructose corn syrup industry was a sponsor of the 2008 Obesity Society scientific meeting (see image, above). That same year, David Ellison, president-elect of the Obesity Society was forced to resign because of an article in The New York Times exposing his financial relationship with the fast food industry.
Ironically, some obesity researchers (and journal reviewers) are overweight or obese themselves. Kids note the hypocrisy of overweight health professionals promoting obesity treatment and research. Do such overweight or obese researchers have vested interests or hidden agendas? An obese physician at a university children’s hospital obesity clinic wrote, “Our nutritionists are opposed to such a weight-loss emphasis in a program… [W]eight loss diet programs in teens show little evidence of long-term success and indeed can at times turn into eating disorders.” At the 2007 National Childhood Obesity Congress an obese member of the Expert Committee on Childhood Obesity proclaimed in a presentation, “If McDonald’s closed every one of its restaurants, it wouldn’t affect the childhood obesity epidemic.”
Furthermore, there are enormous vested interests of researchers and journal reviewers in other obesity medicine research areas, such as genetics, metabolism, nutrition, exercise physiology, and the “built environment.” The premise that obesity may be due to food addiction threatens these vested interests. The Obesity Society scientific meeting (PDF) has no track on psychology, let alone food addiction.
Food Is Necessary for Life and Can’t Be Abstained From
There is the argument that the addiction model won’t work for obesity because “food is necessary for life and cannot be abstained from,” which was the response to a letter I wrote (PDF) that was published in the Pediatrics journal in 2008. However, medical science fails to realize that it’s not every food that kids are addicted to but only highly pleasurable foods, like junk food and fast food.
At the 2008 Obesity Society scientific meeting there was a session on “Assessment and Intervention for Food Cravings,” in which the speaker, Corby Martin, noted that chocolate is the “most craved food.” In the Q&A following his talk, I stood up and asked about treating food cravings with the substance-dependence model. Dr. Martin responded with the classic, “food is necessary for life” argument. I then asked, “Is chocolate necessary for life?” He did not reply. I detected darts from the eyes of many in the audience.
The problem is tricky, in that foods which are addictive are intermingled with foods needed for life. Food is not a substance from which children can abstain, but what is overlooked is that chocolate, chips, fast food and candy — the foods kids say they have the biggest problems with — are not necessary for life and can be abstained from. It’s difficult, but possible. Still, our culture has these everywhere, and there’s the rub.
Source: “What’s Really Causing the Childhood Obesity Epidemic? What Kids Say,” Weigh2Rock.com
Source: “Issues for DSM-V: Should Obesity Be Included as a Brain Disorder?,” The American Journal of Psychiatry, 05/07/1-
Source: “Should PepsiCo be Funding Obesity Research at Yale?,” Fooducate Blog, 04/07/10
Source: “Menu Fight Over Calories Leads Doctor to Reject Post,” The New York Times, 03/04/08
Source: “How do you feel about overweight doctors…?,” BlubberBuster.com poll
Source: “What food do you have the most problem with?,” BlubberBuster.com poll
Source: “Overweight and Obesity in Children” (PDF), Pediatrics, 2008
Image: Obesity Society meeting board, used under Fair Use: Reporting.
Robert Pretlow is a pediatrician and founder/director of Weigh2Rock.com, an online weight loss system for teens and tweens, used by clinics, hospitals, schools, private practitioners, community centers and health clubs worldwide. He lectures frequently on childhood obesity, both nationally and internationally, and is author of the new book, “OVERWEIGHT: What Kids Say: What’s Really Causing the Childhood Obesity Epidemic?”