Dictators, Addiction, and Urge-Surfing


Urges, also known as cravings, are definitely unwelcome visitors that people strive to get rid of. Any grownup who has grocery-shopped with a child, and endured an hour of that child nagging “get me this, get me that,” can relate. To live with cravings is to have a needy kid permanently attached, like a conjoined twin who alternately wheedles and demands — morning, noon, and night.

Childhood Obesity News was discussing Dr. Alan Marlatt, who invented the term “urge-surfing,” and who quoted the observation made by a patient that “dictator” and “addiction” are words from the same root. Actually the root is a relatively harmless one that means “say.” A dictator is a tyrannical ruler who tells people what to do, and they do it or else.

An addiction is an equally autocratic despot who only says one thing. That single importunity might be “Give me my heroin” or “Give me my chocolate-covered bacon,” but the addiction repeats the demand over and over and over again. Luckily for us, that tyrant can be put in chains and exiled to a rocky island far away, where its voice can no longer be heard.

In political polls, and gauging the popularity of television shows and other types of information-gathering, small population samples are extrapolated into representing large demographics. Dr. Pretlow’s team receives information from a significant number of children and teenagers, and it represents the struggles and hopes of many others.

For Dr. Pretlow’s World Congress of Psychiatry poster, a young man described his plight:

Having that brain hunger, and thinking that I need to eat, so then I snack. My brain is telling me I’m stressed out and I need to eat to de-stress me. The only way you can really get the thought out of your mind is by eating.

But no. Eating does not dislodge the thought from the mind. Minds are going to have thoughts; it’s what they do. What happens next is what counts. Urge surfing is about not wishing for the impossible.

As Dr. Pretlow pointed out to his Congress audience, we can confidently assume that no urge lasts forever. Rather then drown in it, a person can ride out the urge like a carefree surfer who skims along the waves. In everyday life, no wetsuit is needed — only the knowledge that an impulse may be observed and acknowledged, but does not have to be acted on.

Dr. Pretlow says:

If clinicians would listen to their obese young clients and ask the right questions, it may become evident that what drives these youth to overeat is a psychological problem, suggestive of an addictive process.

Slides 23 and 24 of Dr. Pretlow’s presentation feature the voices of young people describing their experience with urge surfing. In Slides 26-28, Dr. Pretlow discusses the importance of distraction. One problem is, kids seem unable to figure out how to entertain themselves except through recreational eating.

A teenage girl quoted on Dr. Pretlow’s poster says:

I’m having trouble with the social eating thing. Whenever my friends come around I get this urge to go out to eat somewhere with them. I end up eating a lot.

Some are bored; others could maybe use a little boredom, a walkabout or vision quest in which to discover themselves.

Common sense suggests treating the boredom first. This would seem to indicate that obesity is in the realm of psychologists and psychiatrists. A grownup prisoner in solitary confinement is legitimately bored. However, when a young person suffers from existential ennui, perhaps more than an improved diet is needed.

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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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