Moderation Is or Is Not the Answer

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.

But what about moderation? In discussions of addiction and recovery, one of the first principles is that moderation fits in there somewhere. However, some believe it works, and others say it is impossible.

People in the eating disorder community, or the diabetes community, are all about eating normally. That is their goal. But an alcoholic can’t pursue the goal of “normal” social drinking, like two cocktails a week or whatever, because addiction does not work that way. “Harm reduction” or “moderate drinking” does not work for addicts.

Billi Gordon, Ph.D., who was a Research Associate at UCLA’s Center for the Neurobiology of Stress and Resilience, was never shy about sharing his own experiences, including his weight which at one point reached almost 1,000 pounds. In a Psychology Today piece called “Moderation — Strategy or Fantasy?” he wrote,

I am a food addict — and barbecue is my favorite fix… My ultimate comfort food.

In other words, his #1 problem food. This was because of childhood memories of social approval and attention at family gatherings, and particularly of time shared with his father. As he aged, this need for connection did not fade, but became stronger:

[T]he dependence on the symbolic interaction with the comfort food grows. So finding replacements that completely satisfy the needs your symbolic interaction with comfort foods only partially satisfied, is how you achieve moderation…

Sure, on one or more holidays he tried saying no to barbecue, and the results were severe depression and bingeing. Apparently, such an iconic comfort food cannot be replaced, as nothing else is capable of satisfying the symbolic interaction need.

In addition, Dr. Gordon had looked up behavioral studies on goal achievement, which showed that the more specific a goal is, the more achievable it is. He concluded that moderation is “very unspecific and determined by what one’s brain considers as normal,” a goal too nebulous to be effectively pursued. He wrote, “I need a strategy, not a fantasy, and moderation is a fantasy — at best.”

Dr. Gordon wrote extensively on the similarity between binge eating and compulsive eating, and drug addiction. He suggested an “underlying neurobiological process similar to addiction.” Dopamine, of course, is involved, activating the brain’s reward areas, and repeated indulgence in stress-relieving problem foods alters the dopaminergic pathways. He wrote:

[D]rug and food stimuli cause the same type of conditioned gene expression and neuronal plasticity in the mesolimbic-cortical pathway (reward circuitry) and regions associated with learning and memory, e.g., the ventral striatum, where habit formation occurs. Dopamine and endogenous opioids are implicated in adaptations to reward circuitry in compulsive overeating, as well as drug usage.

Your responses and feedback are welcome!

Source: “Moderation – Strategy or Fantasy?,”, 07/06/16
Source: “Christmas Cookie Blue,” PsychologyToday, 12/06/13
Image by Kirt Edblom/CC BY-SA 2.0

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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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