PATHS and Pathways to Health

[children dancing]

The school-based program called Pathways to Health, which is concerned with obesity prevention, developed out of an earlier program called PATHS that was designed to prevent violence and substance abuse. While they may appear to be very different problems, at the most elemental level violence, substance abuse, and obesity all qualify as risk behavior, and they all are rooted in Executive Cognitive Function (ECF).

Poor ECF, plus a dysregulation of emotion, contribute to undesirable behavior patterns. In obesity, the behavior patterns have to do with eating and physical activity, which at first blush don’t seem similar to drug abuse or violence. But drugs and hyperpalatable foods both affect the brain’s reward circuitry. Aggression and overeating are both connected with poor impulse control and other inadequately regulated emotions. According to this paradigm, they all come from the same place. This Oxford Journals article explains:

PATHS was based on the principles of emotion theory but more specifically the Affective–Behavioral–Cognitive–Dynamic (ABCD) model of development The ABCD model places primary importance on the developmental integration of affect, behavior, cognition and emotion language.

PATHS addresses impulse control, emotional regulation, and executive cognitive function. But it goes even deeper. The Pathways program also draws from STAR, a program said to successfully prevent substance abuse, which is described as follows:

A number of STAR constructs were applicable to Pathways, including resistance skills in response to peer pressure, self-efficacy, counteracting perceived social norms, healthy decision making based on perceived consequences of behavior and lessons involving parents (prevention communication, rule setting, leisure and family physical activity).

Decision-making and self-regulation count as “important modifiable risk factors,” which is another way of saying that people can change. When goal achievement is itself a goal, where does the ability to regulate behavior and make decisions come from? ECF covers the territory of working memory, planning, organization, emotional control, and inhibitory control. While the process may be lengthy and painstaking, all those skills can be taught and learned.

In obesity prevention, inhibitory control is obviously vital, especially for contemporary children whose environment is filled with cues for the overconsumption of hyperpalatable and obesogenic foods. These cues include advertising, cultural mores, social expectations, and the almost constant availability of food every moment of the day.

Those prompts come from the outside, but emotional control is equally necessary to quell the cues that come from inside — feelings of boredom, discomfort, rejection, emptiness, and all the other sources of strong affect and behavioral impulses that need to be cognitively managed if obesity is to be avoided. The literature describes a specific Pathways example in which students are asked to imagine a specific scenario:

…a vignette describing a Thanksgiving dinner, a student stuffed full of food and then a beloved grandmother bringing out her dessert in which she insists everyone must partake. Teachers prompt students for their internal feeling states, how others might feel, a behavioral choice students could make and the consequences as a result of that choice.

It’s like a dress rehearsal for a situation that could very easily arise in a child’s life. To sum up, Pathways to Health is an obesity prevention program whose intent is not to teach the principles of nutrition or exercise, but to help children develop the inner resources to know what to do about nutrition and exercise. The concept is for each person to create the mental and emotional tools to control the behaviors that lead to poor nutrition and cultivate the behaviors that lead to engaging in plenty of physical activity, and so on.

Your responses and feedback are welcome!

Source: “Translating evidence based violence and drug use prevention to obesity prevention: development and construction of the Pathways program,”, 03/13/12
Image by David Robert Bliwas

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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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