PATHS, Pathways and Peer Pressure

[two small boys playing in a backyard]

Childhood Obesity News has been looking at the school-based intervention program Pathways to Health, which grew out of the risk-behavior reduction program known as PATHS. Pathways to Health is all about sharpening and strengthening Executive Cognitive Function (ECF). The object is to avoid and prevent obesity by learning impulse control, emotional regulation, and other related coping skills.

For each grade, kindergarten through sixth, different PATHS curricula have been designed and adapted. The third-grade program, for instance, comprises 46 lessons, of which 10 are introductory, 16 are concerned with feelings and relationships, 17 teach cognitive problem-solving, and three cover relationships and social competence.

The literature traces the process of adaptation for elementary school use. The abundant material that makes up PATHS had to be trimmed down for Pathways to Health.

The PATHS program teaches youth to recognize ∼55 affective states in addition to varying degrees of those states (e.g. angry, upset, furious). Labeling of affective states is a fundamental component of PATHS; thus, many of the earlier lessons are dedicated to recognition and labeling….

For Pathways, the content and mode of delivery had to be changed dramatically to accommodate time constraints. The number of affect states was limited to 39 of those that could be directly linked to physical activity or dysregulated eating behaviors (e.g. angry, bored, guilty, happy, humiliated, rejected, satisfied, tired, uncomfortable, worried)….

This decision was based, in part, on literature that identified categories of emotional eating or provided evidence of a relationship between specific emotional states and dysregulated eating.

For the endocrinological website, H.S. Shin explained a Pathways to Health trial study, showing how peer pressure contributes to behaviors that are called high-risk, including obesogenic behaviors. This was:

…an ongoing longitudinal, multicomponent study that included a childhood obesity prevention program, to determine whether peer influence moderated obesity or had any effects on obesity-related behavior.

Oxford Journals presented a table titled “PATHS lessons with application to obesity,” illustrating 30 points of similarity between an ECF-based drug abuse prevention program, and an obesity prevention program. The idea is fascinating — that the PATHS approach to treating both substance abuse and violence can be repurposed for such a seemingly different problem.

For fourth- and fifth-grade lessons, peer relationships are mentioned five times in the Focus column, under the categories of “Class rules,” “PATHS kid,” “PATHS jeopardy review,” “Feelings review,” and “Making good decisions 1 — self-control resisting peer pressure.” In the area of Applications to Obesity, peer relationships are mentioned four times, including the category “Getting Help from Others.”

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,”, 10/10/11
Source: “Childhood eating habits influenced by peers,”, 2014
Source: “Translating evidence based violence and drug use prevention to obesity prevention: development and construction of the Pathways program,”, 10/10/11
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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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