Self-Reporting Addiction: the Pros and Cons

Filling Out The Official Paperwork

After the most recent Gallup-Healthways Well-Being Index was published, an uncredited writer at questioned the means by which the 10 fattest and leanest states, and similar lists, are generated. The page states that “most of the coverage has been free of any critical thinking about the conclusions presented as definitive facts,” and goes on to say:

All these obesity prevalence numbers are based on how tall and heavy people say they are in anonymous interviews. Such numbers have two big problems. First, people are always taller and lighter when they get to self-report. And second, the little fibs people tell about their height and weight are not uniform.

The expression “pros and cons” is shorthand for the Latin words that mean for and against. But in this instance, the modern meaning of “pro” as a professional person, and “con” as a deceptive person, as in “con artist,” are strangely appropriate. If all you seek are public relations talking points and a bit of entertainment, these numbers may be acceptable. But for any serious purposes, they are not, because “comparisons based on self-reported data are inherently flawed.”

The Only Game in Town

Still, in the soft sciences, self-reporting is often the only tool in the shed. Childhood Obesity News has mentioned a piece by Steve Sussman and five colleagues that appeared in the Journal of Behavioral Addictions last March. For starters, “Prevalence and co-occurrence of addictive behaviors among former alternative high school youth” distinguished itself by saluting the importance of the First International Conference on Behavioral Addictions, a 2013 convocation at which Dr. Pretlow spoke.

The article by Sussman et al. offered numerous paragraphs that hinted at jumping-off places from which to visit complex questions worthy of entire books in themselves. The mere mention of so many byways and side roads shows an awareness that there are no simple answers. For instance, take this short, almost throwaway observation:

Future studies might address shifting trends in addictions and the implications of being addicted to certain behaviors versus others. That is, self-reported prevalence on measures of addiction may change as the acceptability of being addicted to certain behaviors changes, along with varying associations.

Inevitably, the more open-ended the questions posed by researchers, the more the results will be skewed. Humans being what they are, the acceptability factor is huge. People’s self-esteem is almost entirely other-directed, and they really, really care what the neighbors think.

For instance, even in the most securely anonymous survey, engineered to ensure truthfulness in self-reporting, how many people will report their nose-picking addictions? What about people with the behavioral addiction of messing around with barnyard animals? How many will be honest enough to out themselves?

Still, self-reporting is the best current source of information about addiction. On the question of whether a person will walk a mile in a blizzard at 3 a.m. for a pack of smokes, only the nicotine addict knows for sure. From people excessively attached to food, some equally disturbing admissions have been heard.

Your responses and feedback are welcome!

Source: “Obesity top 10 lists — the fattest and leanest states,”, March 2014
Source: “Prevalence and co-occurrence of addictive behaviors among former alternative high school youth, 02/03/14
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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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