Undoing the BFRB Strand, Part 2

Red Knot

As of September 1, columnist Morton Downey had counted 98 possible causes for obesity. Childhood Obesity News has been exploring the idea that, since many different factors contribute to the obesity epidemic, one of them might be BFRBs, or Body Focused Repetitive Behaviors.

So the good news is that from the jumbled knot of causes, one strand can be picked loose. Better yet, this can be done with much less effort than, for instance, trying to make food manufacturers give up high fructose corn syrup. Dr. Pretlow’s presentation to the European Congress on Obesity included information that points the way to hope. In purpose and result, the very act of consuming food is often indistinguishable from body-focused repetitive behaviors like hair-plucking and skin-picking.

How can this be good news? Because the methods used by therapists and patients to quell BFRBs are also effective in dealing with compulsive grazing and snacking. It takes motivation, but the possibility is there. As the famous line from a popular TV series went, “We have the technology.”

Previously, Childhood Obesity News mentioned Visions Adolescent Treatment Centers which, as their name would suggest, have dealt with the problems of many young people. Their website offers the caveat that “What works for one person may not work for another,” always a good thing to remember, and one of the most frustrating truths for health professionals facing an obesity epidemic.

This institution names the therapeutic modalities that have been found useful in treating BFRB:

Cognitive Behavioral Therapy
Habit-Reversal Therapy
Comprehensive Model for Behavioral Treatment of Trichotillomania
Acceptance and Commitment Therapy
Dialectic Behavioral Therapy
Interpersonal Effectiveness
Emotional Regulation
Distress Tolerance

Fred Penzel, Ph.D., gives a little more detail on two types of therapy:

Behavioral therapy usually consists of two approaches: Habit Reversal Therapy (HRT), which teaches the sufferer a set of alternative behaviors that can help them focus themselves, interrupt, and block the behavior, and Stimulus Control (SC), which teaches them how to identify, change, and control the different triggers present in their routines, environments, and moods that lead to the behaviors.

Habits like hair-pulling are largely practiced without consciousness or volition, so using physical “barriers” that impede the habit, like finger band-aids or gloves, can also enhance awareness. Also, BFRB is one of the malfunctions whose victims benefit greatly from the fellowship and positive reinforcement found in a support group.

Dr. Robert W. McLellarn has written that BFRB treatment often begins with keeping a diary of trichotillomanic episodes, which helps the patient become aware of the circumstances likely to lead to acting out. These “triggers” have to be recognized before the next step can proceed, which is making plans for trigger avoidance.


Now let’s get back to Dr. Pretlow’s presentation, titled “Compulsive Eating/Addiction Intervention for Obesity Implemented as a Smartphone App: A Pilot Study.” As the title implies, he talks about the W8Loss2Go iPhone application, and its features that address compulsive eating as a body-focused repetitive behavior. Please give yourself the pleasure of learning more about this promising tool.

Your responses and feedback are welcome!

Source: “Body-Focused Repetitive Disorders,” Visionsteen.com, 03/29/12
Source: “Body-Focuesd Repetitive Disorder,” AAMFT.org, undated
Source: “Body Focused Repetitive Behaviors,” Anxiety-Treatments.com, 10/03/11
Image by Uwe Hermann.

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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