Obesity and Addiction, the Discussion Goes On

Kudzu takes over Spartanburg
Kudzu takes over Spartanburg

There has been a lot of public discussion about how to classify obesity, compulsive eating, and food addiction. It is the kind of talk that proliferates like kudzu, which would be fine if we had nothing better to do than sit around and wag our chins. But even as we speak, millions of children are panting and sweating, bursting through the seams of their clothes, and feeling like shameful failures at life.

Obesity exists without addiction. Addiction exists without obesity. Someone has listed over 100 possible causes for obesity. To stop people’s compulsive behavior, what is justifiable? Can consumers insist that insurance companies pay for, just as a random example, cognitive behavioral therapy? And if the patient doesn’t get better, can he try another thing, like acupuncture? And if that doesn’t work, can the insurance company insist that the person be lobotomized?

How far can a society go to protect itself from the destructive extremes of individual behavior? How far can it go to protect children? Don’t people have the right to do as they please with their own bodies? How much human behavior should be criminalized? Should the legal system just leave everyone alone to flush themselves down the drain in their chosen ways? Should the energy go instead to more funding of research?

Speaking of Research…

One conclusion of a study titled “Prevalence and co-occurrence of addictive behaviors among former alternative high school youth” is that there are not enough other studies of the same kind. Written by Steve Sussman, Thalida Em Arpawong, Ping Sun, Jennifer Tsai, Louise A. Rohrbach, and Donna Spruijt-Metz, and well worth reading in its entirety, it concerns youth with functional problems, who were enrolled in non-mainstream schools designed to give them a second chance.

One interesting aspect of this document is how it harks back to the First International Conference on Behavioral Addictions as a landmark event. It took place in Budapest in March 2013, and Dr. Pretlow, who called it an “an extremely valuable meeting,” spoke on the topic of “Addiction model intervention for obesity, implemented as a smartphone app: A pilot study.”

Depending on what parameters are set by the designers of research, it can be shown that, for instance, nearly 50 percent of American adults are addicts, or that 75 percent of college students are addicted to something – neither of which is necessarily true. Still, enough voices are heard, from enough different directions, to suggest that a new approach is needed. The creators of this particular study do not doubt that addiction is widespread, and more so than we are comfortable in admitting. “Focal addictive behaviors” include:

…cigarettes, alcohol, illicit drugs, eating disorders [obesity, anorexia, and bulimia], gambling, shopping, relationships/love, sex, exercise [running], and work), along with additional addictions (e.g., caffeine), violence, and emotional disturbance constructs…
Theoretically, as an example, one might think of these 11 addictions as grouping to reflect active-nurturance (e.g., Internet, shopping, work), active-pleasure seeking (e.g., sex, love, exercise), and passive-pleasure seeking (alcohol, cigarette, other drug use, eating) motives.

This might be over-thinking it. But the researchers MacLaren and Best made even finer distinctions in 2010, when they…

…examined the factor structure of a set of 16 addictions. Three factors were identified:
(a) nurturant (e.g., compulsive helping [dominant and submissive], work, shopping, food [binging and starving], exercise, relationships [dominant and submissive]),
(b) hedonistic (illegal drugs, alcohol, tobacco, and sex) factors, and
(c) another hedonistic-like factor (prescription drugs, gambling, caffeine).

Your responses and feedback are welcome!

Source: “Prevalence and co-occurrence of addictive behaviors among former alternative high school youth,” NIH.gov, 03/03/14
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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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