CBT and Appetitive Traits

Yella Mella Macra

Childhood Obesity News has been looking at the different varieties of cognitive behavioral therapy. The biggest stumbling block, in these or any modalities, is longevity. Something may work for six months or a year, or while attention is focused on the problem — in other words, as long as meetings with a therapist continue. The difficulty is that, left to their own devices, many patients will revert to their old ways.

In the long term, what messes things up is the difficulty of extinguishing appetitive traits. Whether these traits are inborn or developed in the earliest stages of life, to counteract them it is necessary to cultivate really strong, enduring new habits. The National Institutes of Health website mentions this in connection with the ways in which people respond differently to the “obesogenic environment,” saying, “One plausible mechanism for this variation is the early expression of appetitive traits.”

These appetitive traits are specific vulnerabilities linked to eating behavior and physical activity preferences. One vulnerability is impaired satiety responsiveness, the failure to recognize and respond to internal “enough”signals. Another appetitive trait is high responsiveness to external food cues, encapsulated in the old saying, “I can resist anything except temptation.” This is one reason why corporations are under fire for the way in which they advertise products to children. The temptation-resistance mechanisms of little kids are undeveloped, and they don’t have the wisdom or life experience to recognize flagrant nonsense when they see it.

“High motivation to eat” is an appetitive trait, which was characterized in the old days simply as “gluttony” and categorized as one of the seven deadly sins. Then there is impulsivity, which manifests in the inability to postpone an immediate reward, even if a greater reward is promised for the future.

Remember a much-cited study from the 1970s, the “Marshmallow Test”? Kids were given a choice between one marshmallow now, or two marshmallows in a few minutes. Some figured out clever ways to restrain themselves, and a follow-up study showed that the self-binders did better on their SAT scores and had more success in avoiding recreational drugs.

More recently, University of Rochester researchers wanted to know more about the rational process involved in making decisions when the stakes are short-term versus long-term rewards.

Doctoral candidate Celeste Kidd was lead author of the study, and the co-author was Dr. Richard Aslin, who teaches brain and cognitive sciences. Kidd references the children’s “belief about the practicality of waiting,” though it is unlikely that children so young could identify or verbalize such a belief. But from a very young age, we have all internalized beliefs about the practicality of waiting and about many other things, even if we can’t articulate them.

The Marshmallow Test revisited

The experimenters set up a mini-world in which a child is offered the chance to use a small, grungy set of crayons now, or a splendid set of art supplies in a little while. Some wait for the better art supplies. But this isn’t the experiment, yet. This is only the setup. Pretend you’re a kid who dutifully waited for the fancy set of markers, only to be told by an apologetic grownup that the nice art supplies can’t be found, but you can still color your picture with the grungy crayons.

An innate sense of unfairness kicks in. Even if you can’t clearly articulate your thoughts, they go something like, “Wait a minute. I met the challenge, I was good, I waited. And now I don’t get the reward? To heck with that. When the next opportunity comes to have a small reward now or a big reward later, I’m gonna be a YOLO kind of kid, and delayed gratification can go jump in a lake. Carpe diem!”

And then the researchers did the marshmallow test, and found out that the kids who had been disappointed about the art supplies were less likely to opt for delayed gratification in the marshmallow test. The trust bond had been broken, and now they knew they lived in an unreliable environment, one in which promises are not always kept and virtue is not always rewarded. They went for one marshmallow now instead of two marshmallows later. Celeste Kidd says:

Delaying gratification is only the rational choice if the child believes a second marshmallow is likely to be delivered after a reasonably short delay.

Dr. Aslin adds:

If they’re in an environment in which long-term gain is very rare, well then it makes perfect sense for them to behave impulsively, because that’s going to maximize their reward.

Your responses and feedback are welcome!

Source: “Appetitive traits and child obesity: measurement, origins and implications for intervention,” NIH.gov, 08/20/08
Source: “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents,” NIH.gov, 04/01/12
Source: “The Marshmallow Study Revisited,” Rochester.edu, 10/11/12
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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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