Relapse — Word of Dread

With a substance addiction, like nicotine, total abstention is a possibility, and a total quit gives a person much better odds of not relapsing. A cliché is that someone who has not smoked in years can be rehooked with astonishing rapidity. Even when people try hard, the relapse rate is discouraging. With certain substances, like cocaine and alcohol, moderation cannot be the answer in the overwhelmingly vast majority of cases. Quit means quit.

With food, the inability to totally abstain is the hardest thing. Someone compared it to divorce. With alcohol, heroin and many other substances, it’s like a divorce without kids. You can just say “We’re done” and never have to see the person again. But if there are children, you have to deal with shared custody and child support and then the grandkids… You’re tied to your ex forever. And common decency does not allow cutting them out of your lives like a bad habit.

With disordered eating, what forbids a person to walk away is basic survival. Sometimes, beating a food habit requires a great deal of ingenuity, or it might wreck a life in other ways. To consume food is our fate, but it does not have to be our doom.

Moderation is not an option

There is plenty of discussion about food addiction versus eating addiction, whether some foods are inherently addictive, and many other variables. Still, no matter what philosophy a striving person chooses or what program they choose, relapse is always an open door that extends the invitation to “walk right in, set right down.” Dr. Pretlow has written,

Despite often repeated attempts to reduce or quit using addictive substances, relapse is common in the addiction recovery process, just as those with obesity who attempt to regulate their food intake through dieting frequently relapse and return to their elevated body weight.

Just last month, writer Addy Baird looked back and described her young life as “largely defined by my obsessive food and body rituals.” Baird notes that studies hope to hone the definition of what eating disorder recovery actually looks like, gauged by “a combination of physical, behavioral, and psychological indicators.” She then goes on to say,

Notably, one study found that a group considered “fully recovered” had similar results to a control group, but elevated rates of anxiety disorders.

She quotes therapist Carolyn Costin, who defined recovery as accepting one’s body and not having a “self-destructive or unnatural relationship with food or exercise.” In Costin’s words,

When recovered, you will not compromise your health or betray your soul to look a certain way, wear a certain size, or reach a certain number on a scale.

Baird also shared with and learned from a sobriety community and especially from Michelle Callahan, a substance abuse treatment therapist who rejects the limited duality of complete recovery/abject relapse. She prefers the gentler word “lapse” and speaks of a flexible type of ongoing, ever-present recovery that may include a lapse now and then.

Callahan wants people to understand that not all steps point forward, and to never get overwhelmed, or think that all their hard work was for nothing, and especially never to feel shame. Here is the crux of the matter:

They can also feel like they are a failure, are bad, or weak, which are likely the core beliefs that pushed them into addiction or engaging in their problematic behaviors in the first place.

Instead, it can be useful to regard a lapse as a pop-up research lab that teaches the person what not to do next time. Addy Baird wrote,

As my healthy self got stronger and my relationship to my food and exercise began to transform, it became clear that giving myself more space to learn (and sometimes fail) was vital.

Your responses and feedback are welcome!

Source: “Giving Up On A Perfect Recovery Actually Helped Me Heal From My Eating Disorder,” 03/25/22
Image by dynamosquito/CC BY-SA 2.0

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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.

Food & Health Resources