Ingestive Behavior Gone Awry

Dr. Pretlow says, “Leaders in addiction science concur that addiction and obesity both reflect the consequences of ingestive behavior gone awry.” In this context, gone awry almost invariably means “too much.”

In most cases, this boils down to meaning too much of the wrong stuff. Back when people had purer diets and more active lifestyles, it actually took some effort to become obese. Getting fat was an accomplishment, reflected by the fact that aristocrats were proud of their own portly figures, and a “trophy wife” was a plump wife, living proof that her successful husband could afford to feed her well.

Now, things are different. All day, every day, we are assailed by the wrong stuff. For a normal, unsuspecting person, it is quite easy to unthinkingly consume horrible junk on a daily basis without even trying very hard. Still, in the case of both addictive substances and mundane ones, the operative principle is that “too much” is where the trouble starts.

Dr. Pretlow speaks extensively of the core similarities between addiction and obesity, which will be covered in due time. But first, let us give some consideration to the major difference between the excessive ingestion of an addictive substance and the excessive ingestion of food.

Can’t say no

Nobody has to smoke crack. Everybody has to eat. You can, in the famous words of Nancy Reagan, “just say no” to alcohol, but you can’t not eat.

Okay, maybe for a while. Maybe there are fancy European clinics where a customer can pay a fortune to be put in a coma and fed intravenously for three months, while the weight just melts away. But eventually, even they have to eat again. We can’t stop eating, we can only stop eating too much. Ms. Reagan notwithstanding, there is no “no.” There is only “no more, right now, at this moment.” That line is a tough one to draw, over and over again, every day for the rest of your life.

No means no

A truth heard from many alcoholics is that the smallest sip of alcohol can send them out of control. In an interview, comedian Jayson Thibault admitted that after a restaurant dinner with friends he would lurk over the table and polish off any partially-filled glasses of wine they might have left. “I’ll throw up and keep drinking. There’s no shut-off valve.”

There are people who will eat in the same way. The difference might be that they carry a heavy psychological burden. Maybe they grew up in grinding poverty and with the constant fear of never having enough to eat. Maybe they work a 12-hour shift, seven days a week, and will clean up any scraps their children leave on plates, because the personal price to afford that food is so high.

This is where it gets complicated for those whose problem is food. A person who “can’t say no” to alcohol is labeled an addict. With unrelenting and vigilant determination, they actually can say no to alcohol, and prevent letting the addiction take over. For a substance addict to recover, strict abstinence is the only answer that works. In their world, moderation isn’t even a “thing.”

A person who can’t say no to eating may be an addict, but at least they stay alive, because to say no to eating means death. Saying yes to eating might also lead to death, but probably not for a while. Dr. Pretlow says,

A central barrier to the success of treatment for obesity that is distinct from drug addiction is the fact that food consumption is essential for survival; thus, abstinence is not a feasible or appropriate treatment goal.

We will be talking about that more.

Your responses and feedback are welcome!

Source: “#189: Catastrophic Alcoholic (@TheTeeb),”, 10/20/14
Image by BY 2.0

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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.

Food & Health Resources