This Thing Called Relapse


The cumulative effect of several W8Loss2Go studies has caused Dr. Pretlow to say this:

Caving in the moment of food temptation, with motivation getting pushed aside, but feeling remorse afterwards, has been a problem for kids in our studies.

Behavioral scientist Paul Dolan of the London School of Economics and Political Science is featured in a short video (under 7 minutes). Using tools and techniques that include “surveys, big data, lab studies, and field experiments,” he trains people to automatically repel temptation.

In addiction recovery, a relapse consists of an episode that turns into a spiral. The whole trick is to never take that first step back into bondage. Dolan’s work is to help his fellow humans form new habits and avoid the fateful episode. As one subject expressed it, “I found out things about myself that I never knew.”

Using a protocol that has been shown to work successfully for children, Dolan trains a young man to eat vegetables. Dolan says:

If we can get him into good habits, this will be a long-lasting, long-term impact on Pete, Selena, the children, and the children’s children. That’s how much this matters.

It sounds boringly earnest, but actually is rather entertaining. Because this show was made for television, with the need to attract ratings, romance was added to the mix by recruiting people who, as the title implies, aim to “Lose Weight for Love.” Dolan’s method of discouraging relapse has been effective for public speakers, people with anxiety disorders, and alcoholics. This time, it’s compulsive eaters.

A lot of compulsive eaters are more accurately compulsive drinkers. Their big problem arrives in cans and bottles. Dolan meets with Phil, who is obsessed with sugar-sweetened beverages, and shows him how to rewire his brain. The method involves a joystick, and slides projected on a screen. The obese youth is instructed to “push” away the fizzy drinks, and “pull” the healthy beverages toward him. Apparently, change can be achieved in as few as five daily 15-minute sessions.

EMA revisited

Because substance use is episodic and apparently related to mood and context, Ecological Momentary Assessment (EMA) seems to work pretty well on it. In fact, substance use research is where EMA is most often found, particularly in the areas of alcohol and tobacco, where the specter of the lapse episode — or “slip” — is a relentless stalker.

A 2010 study looked into the problem of temptation that leads to relapse, which had long troubled therapists because patients couldn’t describe it well, once the moment had passed and battle was lost. The results were bias and inaccuracy, which are the very difficulties that the immediacy of EMA appears to overcome.

As some researchers pointed out, drug use can’t really be understood unless information about periods of non-use is also available. Likewise…

[…] without a comparator or “control,” we cannot know what is particular to lapse episodes, versus being typical settings for the person or the person’s experience during withdrawal and a struggle to maintain abstinence.

Here is the crux of the matter:

Relapse investigators have been particularly interested in the initial lapse to drug use, as it represents a pivotal transition from abstinence back to use. This imposes particular challenges, because the initial lapse episode is a unique event — there is no second first lapse… The strategy in EMA studies is to engage subjects in ongoing monitoring, so that they are poised to record the first lapse if and when it does occur.

Your responses and feedback are welcome!

Source: “BBC One’s ‘Lose Weight for Love”’ (best bits),”, 07/11/17
Source: “Ecological Momentary Assessment (EMA) in Studies of Substance Use,”, December 2010
Photo credit: Les Chatfield (Elsie esq.) on Visualhunt/CC BY

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Profiles: Kids Struggling with Weight

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The Book

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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