The Fascinating World of BFRBs

At the top of the page we see a photo from Dr. Pretlow’s visit last week to Oman, where he addressed the World Obesity Federation Regional Conference.
(An official graphic from that event is here. His topic was displacement behavior, and today’s post looks at some of the more esoteric aspects of the subject, after this quotation from Dr. Pretlow.

Displacement activity is rechanneling of overflow energy from conflicted or thwarted drives into another drive.

Displacement activity permits the resolution of conflict between two antagonistic drives by acting as an outlet through which overflow energy can be discharged.

Displacement activity is an innate, hard-wired, instinctual, automatic biobehavioral mechanism.

Childhood Obesity News is interested in asking whether displacement activities are very similar to, or even the same as, addictions. As always, terminology can be a distraction. The important question is whether these activities can be treated with anti-addiction methods. Or by different means, or a combination of modalities, or by anything. Consequently, some of the ideas found in this area may be a bit of a walk on the wild side.

On the other hand, one school of thought says, “When all else fails, consult the (gasp!) anecdotal evidence.” If a trick to short-circuit addictive behavior works for one person, it just might work for someone else, and there should be channels for people to report their subjective experiences, and ways for other interested parties to receive that information.

Things people do to keep from doing other things

Childhood Obesity News briefly mentioned Dr. Fred Penzel, who talks about compulsive hair pulling, nail biting, skin picking, and other body-focused repetitive behaviors, but he might as well be referring to compulsive eating. Every time a patient can stave off an incident of this kind, a victory is won.

Dr. Penzel offers 58 “stimulation substitutes,” or replacement activities, including remarkably specific ideas for certain obsessions. If manipulating hair is your thing, you might try fiddling with dental floss, sewing thread, fine fishing line, a feather, or a bushy-haired Troll doll.

A person might pull the threads from cheesecloth, burlap, or other loose-weave fabrics. A person might brush or massage a furry pet, or “Get hair samples from beauty supply outlets or wig makers who often have leftover long hair, if only the real thing will do for you.” He suggests that either the patient or the hair professional could bind the hanks of hair into small bundles, for convenience.

Going into remarkable detail, Dr. Penzel includes almost 200 words on the uses of a marvelous variety of brushes. Here’s a brief excerpt:

Those who like to stimulate their cheeks or lips with hairs they have pulled sometimes find they can get the same type of stimulation with fine-tipped artists’ brushes. Some like to pull the bristles out of inexpensive house painting brushes. Plastic surgical brushes, which are used by medical personnel to scrub their hands have very fine bristles and come in one or two-sided versions…

Any of those fidget objects might also captivate the senses and divert the attention of a compulsive overeater. It is a personal matter, and no one can know what might take their mind off stuffing themselves, until they try it.

Of course, certain of Dr. Penzel’s suggestions are only suitable for people whose BFRBs are not related to eating. Involving the mouth with mint or sour fruit candies, sugarless gum, sunflower and pumpkin seeds, or even uncooked spaghetti, is probably not a good idea.

Your responses and feedback are welcome!

Source: “58 Stimulation Substitutes and Behavioral Blockers for BFRBs — Or “The Great Big List of Favorite Fiddles,”, undated
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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