Dialogue at CIOI 2017


In July, Dr. Pretlow travelled to Lisbon, Portugal, for the International Conference on Childhood Obesity where he attended and participated in a workshop about which he says, “It was an epiphany for me.” A talk by Dr. Tommy Visscher was followed by a discussion, and Dr. Pretlow found a great deal of value in both.

Dr. Visscher is an associate professor at the Windesheim University of Applied Sciences in The Netherlands, where he specializes in biomedical health sciences and epidemiology. His particular interests are the public impact of obesity and the promotion of health.

Dr. Pretlow says:

In his talk, Dr. Visscher described the terrible lives of obese young people. He said that obese children and adolescents are teased unmercifully, are unable to experience life fully, and have a quality of life rating at the same level as of young people with cancer on chemotherapy. Thus, he proclaimed that they are extremely motivated to lose weight.

Given this extreme motivation, what are the factors that stand in the way of losing weight, and, especially, of maintaining weight loss? Dr. Visscher names genetic and cultural factors, and the determination of food manufacturers to flood the market with cheap foods that are purposely engineered to be irresistible.

When the discussion opened, Dr. Pretlow had a question: “Do you agree that if obese young people simply ate less that they would lose weight?” This was Dr. Visscher’s answer:

No, I do not agree. When they eat less, their bodies go into starvation mode, which shuts down their metabolism, preventing weight loss. Also, their natural weight set point would prevent weight loss and especially maintenance.

The basic concept of the set point is that the body cannot distinguish between a famine and a reducing diet. All it knows is to make the defense of its fat stores a top priority. Consequently, the more strenuously a person tries to limit caloric intake, the more stubbornly the body fights back against what it perceives as a hostile attempt to starve it.

The seemingly intractable problem

This is why even successful weight losers will eventually “plateau out,” and why the great majority of weight losers regain the same amount they lost, or even more. Set point theory also explains why early-onset obesity is so much more difficult to overcome. Researchers now look back even further than infancy, to investigate whether in utero exposure to certain chemicals can influence the set point.

Dr. Jules Hirsch and Dr. Sandra Aamodt are two notable proponents of the set point concept. The eminent Dr. David Ludwig proposes that the body can be convinced to accept a new, lower set point. Some practitioners believe this can be accomplished through the practice of mindfulness.

To Dr. Visscher’s explanation of how the set point prevents weight loss and the ability to maintain it, Dr. Pretlow remarked that it seemed to imply that people in concentration camps and in famines would not lose weight. Dr. Visscher’s reply was:

Okay, if obese young people ate a lot less, eventually they would lose weight, but this is extremely difficult to accomplish, because of all the tempting food in our society, their genetics, and cultural factors.

Dr. Pretlow:

But if obese young people are so miserable and so highly motivated to lose weight, why aren’t they able to resist the tempting food, eat less, lose weight, and not be miserable anymore?

Dr. Visscher:

Well, I guess it’s like sort of like an addiction.

At this point, another audience member spoke up to say that addictions are treated by abstinence, and people cannot abstain from eating. Dr. Pretlow replied:

That is not entirely true. You can abstain from eating between meals, and you can abstain from eating excessive amounts at meals.

And, indeed, in his own workshop which he presented on the following day, Dr. Pretlow presented the addiction treatment techniques which make these very things possible.

Your responses and feedback are welcome!

Image by Dr. Pretlow

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Profiles: Kids Struggling with Weight

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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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