Dr. Pretlow has encountered people who’ve successfully lost weight in the inpatient setting and then gained it back, inspiring this note:
Perhaps relapsing occurs mainly after participation in a formal weight loss program or camp? A 16 year old girl recruit for our upcoming study reported losing 30 pounds in 4 weeks at [name withheld] Camp last summer, and has gained 25 pounds of that back. She relates that they didn’t teach her how to avoid tempting food in her environment, so nothing about coping eating and re-addiction.
This seems anomalous, because residential immersion weight loss programs have always depended on Cognitive Behavioral Therapy (CBT), and they seem to have pretty good success, for the duration of the person’s stay, anyway. Maybe in this particular case, the young woman was not paying attention, or was going through a treatment-resistant phase.
No matter how long-lasting a live-in program is, or how complete with amenities, eventually the person has to go back to the real world. Since the world usually will not oblige us by changing, the answer is to send a different person back into that same world — one who, thanks partially to CBT, is prepared to cope. For real? It appears so.
CBT specifically targets the area of relapse prevention — the management of urges and cravings, the disarming of triggers, and so forth. Children, as we mentioned, experience food cravings that are stronger than those felt by teens or adults. By way of compensation, they seem to easily catch on to cognitive strategies that help reduce cravings.
This was affirmed by a Columbia University research team led by Jennifer A. Silvers, who points out to journalists that most childhood obesity interventions have concentrated on changing the environment in some way.
In general, there are three possibilities, however unlikely, to attempt improvement in a situation. A person can change the environment or the objects in it, like by removing soda vending machines from schools, or forming sports teams.
Generally, that is more of an adult thing. Kids don’t often have much control over the environment. A person can try to change other people, usually with little success. A child can ask family members to keep their tempting chips and chocolates out of his sight — but compliance may not be forthcoming.
The third opportunity to effect change is difficult, but actually easier than the other two, and that is to change oneself. Apparently, this is fairly easy for children to do, and in a relatively short time.
Silvers and colleagues hope to work with elementary schools, bringing in a cognitive training regimen that seems to promise real and meaningful change. Meanwhile, they are engaged in a longitudinal study of how individuals handle the regulation of cravings over time.
The Columbia team’s work product, published in Psychological Science, included this interesting observation:
Children with higher weight-to-height ratios (known as Body Mass Index, or BMI) showed relatively less prefrontal activity when using the cognitive strategy to regulate food craving than did children with lower BMI, suggesting that the areas of the brain involved in regulating craving may differ depending on body mass.
Your responses and feedback are welcome!