Pat Hartman | Childhood Obesity News

Coke Legacies

Pat Hartman December 19, 2019 No Comments

According to journalist Stephen Blease, Santa Claus was not traditionally portrayed wearing any particular color of clothing. But….

It was Coca-Cola that popularized the idea that he dresses in red and white, by running a 30-year ad campaign in which Santa is shown sporting the colors of their brand. Now it’s so firmly embedded in our minds that it’s impossible to imagine him in anything else.

Having succeeded in influencing the Christmas-celebrating world to that extent, Coke is now accused of trying to accomplish another public relations coup: to convince England that the “countdown to Christmas” officially begins on the day the corporation’s big truck starts on its tour of the country, giving away free samples of its products. It has been nine years since this initiative began, but it’s not doing so well.

The year 2015 was a year of pushback against Coke and its arrogant corporate ways, including the “Holidays Are Coming” truck that the company wishes to make a cherished tradition, and many parents want to make disappear. Liverpool has put up strong resistance, and so have Carlisle, Cumbria, and other cities.

The 2017 Christmas truck tour included 38 locations, but in the following year the itinerary had sunk to 24 stops. The 2018 tour was severely curtailed, at the request of more than 80 organizations throughout Britain. This year, it was reduced to 19 stops, which Blease says involved driving 3,000 miles and using up an amount of diesel fuel that could have provided “shelter and food for 60 homeless people.”

Supposedly, allegedly, only a small percentage of the fizzy drinks given out by the truck are actually laced with sugar. That is not the point. People are starting to rebel against the corporate overlords, and some are mad because Coke is the world’s largest producer of the single-use plastic containers that clog waterway and oceans.

But wait, there is more. By the time British children are through with primary school, one-third of them are overweight or obese. Child obesity is not the only concern.

Dentists, who depend on sick teeth to make their living, are paradoxically in the forefront of the movement to prevent children from consuming sugar-sweetened beverages. In England, about a quarter of the 5-year-old children have painful cavities in their teeth, and dental professionals are extracting thousands of baby teeth every year — including from children two or three years old, who aren’t even accustomed yet to the idea of having teeth.

Meanwhile, the Coca-Cola corporation is the picture of blameless innocence, issuing such statements as,

We lead all our sampling with Coca-Cola zero sugar and expect more than 90 per cent of the samples we give away during the tour to be sugar-free. In line with our responsible marketing policy, we have a policy of not providing drinks to children under the age of 12, unless their parent or guardian is present and requests one.

And blah-blah-blah. In children’s diets, sugar-sweetened beverages are said to contribute more sugar than ice cream and all other desserts combined. Journalist Sarah Young quoted a National Health Services consultant in pediatric dentistry, Claire Stevens, who says,

All of the drinks are harmful, including the zero sugar version, as they cause erosion, which baby teeth are particularly susceptible to.

Your responses and feedback are welcome!

Source: “Stephen Blease column: Christmas doesn’t need a Coca-Cola tradition,” NewsAndStar.co.uk, 11/30/19
Source: “Dentists Condemn Coca-Cola Christmas Truck Tour,” Independent.co.uk, 11/18/19
Image by Khedara/Flickr

Projections and Holiday Collections

Pat Hartman December 18, 2019 No Comments

There is hope that the amount of taxpayers’ money spent on obesity-related problems can be reduced, and also of course that the human misery caused by these problems can be alleviated. The previous Childhood Obesity News post discussed how journalist Peter Ubel used a holiday hook from which to hang not a stocking full of treats, but a year-round message: “How to Keep Santa from Making Our Kids Fat.”

His Forbes article summarized the results of a study designed to predict which governmental interventions could actually make a difference, in terms of “bang for the buck”:

1. Sugar-sweetened beverage tax. A tax of one cent per ounce on sugar-sweetened beverages would cost about $50 million dollars to implement, but would […] prevent more than half a million cases of childhood obesity by 2025.

2. Eliminate tax deductibility of ads seen by children for unhealthy foods. This policy would cost less than one million dollars to implement while preventing almost 130,000 cases of childhood obesity.

3. Setting nutrition standards — for foods sold in schools that aren’t part of school meals. This policy would cost $22 million to implement while preventing almost 350,000 children from becoming obese.

Incidentally, the meta-analysis by which these preferences were determined made allowance for the delayed reaction effect. The researchers acknowledge that it took typically 18 months, and as long three years, to observe a decrease in the BMI of the subjects in each of the interventions. This reconfirms the importance of longitudinal studies when trying to make sense out of how spending impacts results, farther on down the road.

A Sad Loss

“Another Compendium of Holiday Posts” mentions Dr. Billi Gordon, one of the most unorthodox and sensitive writers about the conjunction of obesity, holidays, and family. It has been almost two years since Billi Gordon was described by a Los Angeles Times obituary writer as “entertainer, model, writer, and neuroscientist.”

At one point, Gordon weighed nearly 1,000 pounds, and only made it back down to about 700. Holder of a Ph.D. in Integrative Behavioral Neuroscience, he was in the cast of the TV show “Married with Children” and the film Coming to America. Psychology Today published his column “Obesely Speaking.” The LA Times says he…

[…] studied emotion, the pathophysiology of race, minority health disparities, as well as a variety of work in gastroenterology and obesity — all issues that impacted him personally, and for which he felt a sense of duty to help others.

Billi Gordon saw the importance of admitting painful truths about the supposedly happy holidays. He talked about things like symbolic eating, about the double-edged sword of abundance. The holiday dynamic is that the hosts must prove they have a lot, and the guests must confirm it by consuming a lot. Eating and drinking everything that is on offer, and a huge pile of it — whether you really want to or not — is de rigueur. A guest is obligated to validate the host’s generosity by violating her or his own standards and self-promises.

Other guests either knew you when you were nobody, and want to gloat about that; or knew you when you were doing better, and now feel barely-concealed schadenfreude, rejoicing in your downfall. They warned you not to get fancy ideas, not to leave the old neighborhood, and now look at you — driving a borrowed car and bringing a rented fake girlfriend to Christmas dinner.

In ancient times, a Lord of Misrule would be chosen to preside over the holidays, to decree an authorized binge for everybody. Now, each person feels entitled to play the Lord of Misrule.

Your responses and feedback are welcome!

Source: “How To Keep Santa From Making Our Kids Fat: Three Ways To Reduce Childhood Obesity,” Forbes.com, 12/23/16
Image by Dan Lundberg/Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0)

Projections and Protections

Pat Hartman December 17, 2019 1 Comment

Writing for Forbes about childhood obesity and the holidays, Peter Ubel made some harsh points. When it comes to sustaining weight loss over the long term, who is able to succeed? Not, apparently, people who have suffered extensively and publicly to lose the weight, like those on a very popular TV show. He references a study of contestants on The Biggest Loser, “most of whom gained back most of the weight they lost.”

No, not even people who possess the advantage of every possible type of support that money can buy, like Oprah Winfrey. Ubel wrote,

Modeling indicates that excess weight accumulates slowly, and excess weight gain among young children is due to relatively small changes in energy balance… Changes needed to prevent excess weight gain and prevent obesity are thus quite small in childhood. By adolescence, however, excess weight has accumulated for more than a decade… Once people become obese, myriad biologic factors conspire against their efforts to lose weight.

In other words, only the littlest children have a fighting chance to stave off obesity via improved diet and physical activity, the tools available through the energy balance equation. With each passing year, that possibility fades into the unrecoverable past. By the time adolescence rolls around, obesity is, to put it politely, established. The fat cells have moved in, redecorated the place, officially registered their change of address with the Post Office, and made themselves at home.

The only hope lies in prevention, and while of course the family is vital, it is not all-important, because the efforts of society must contribute too. The writer does not want to hear from the “no government intervention” proponents, or from the “taxation is theft” zealots. If the government must step in and make laws to protect children from obesity, as he and many other people obviously feel that it must, what measures actually work?

In this instance, success is defined under the criterion of bang for the taxpayers’ buck. On which societal actions should we spend money now, to prevent spending a whole lot more in the future? Ubel found the answer in a multi-author meta-study that first identified seven popular interventions that have been tried by governmental bodies: tax sugar-sweetened beverages; end subsidies that enable advertising unhealthful food to children; include calorie counts on restaurant menus; raise nutrition standards for school meals; do the same for school vending machine items; improve early care and education; and increase access to bariatric surgery for adolescents.

The team looked at facts gathered so far, by searching the National Library of Medicine for articles containing the term “child obesity” up through 2014. Out of 31,000 published articles they found only 89 that also used the term “cost-effectiveness.” What, projected into the future, has a chance of working? They asked a computer program to make predictions:

We used systematic reviews and a microsimulation model of national implementation of the interventions over the period 2015–25 to estimate their impact on obesity prevalence and their cost-effectiveness for reducing the body mass index of individuals.

Three of the interventions studied were found to be cost-saving across the range of modeled uncertainty: the sugar-sweetened beverage excise tax, eliminating the tax subsidy for advertising unhealthy food to children, and setting nutrition standards for food and beverages sold in schools outside of school meals… These interventions were projected to save more in reduced health costs over the period studied than the interventions would cost to implement.

Your responses and feedback are welcome!

Source: “How To Keep Santa From Making Our Kids Fat: Three Ways To Reduce Childhood Obesity,” Forbes.com, 12/23/16
Source: “Cost To Implement,” HealthAffairs.org, November 2015
Photo credit: Kazuhito Hokamura on Foter.com/CC BY-SA

A Body-Focused Repetitive Behavior Surprise

Pat Hartman December 16, 2019 No Comments

Here is what Dr. Pretlow wrote in 2013, when no studies had yet confirmed that stress-induced eating could be attributed to displacement behavior:

Displacement behavior eating in humans involves the motor actions of eating — which appear to alleviate stress similar to other BRFBs. As with comfort eating and pleasurable taste, once the brain recognizes that the actions of eating ease stress, the brain will insidiously undergo changes to amplify and perpetuate the behavior. Thus, stress-induced eating may become compulsive overeating and lead to obesity.

The previous Childhood Obesity News post discussed a piece called “Creating a Self-Care Toolbox for BFRBs.” This is a special container that does not have to be made of metal or painted red, and it holds things like fidget toys, inspirational words, anything that might come between a person and the acting out of body-focused repetitive behaviors. The expression “skill set” is useful here, because each learned skill is a tool, and to cope with some of these problems does seem to require a whole set of them.

A BFRB we have not mentioned yet is cheek biting. It seems to be fairly common, and even has a Latin name (morsicatio buccarum) and an entry in the Diagnostic and Statistical Manual of Mental Disorders as one of the Obsessive-Compulsive and Related Disorders.

The website BFRB.org is a trove of information and suggestions. Psychotherapist Matthew Traube writes,

It is likely that biologic predisposition, acting through genetic mechanisms, activates the repetitive behavior. This process may be initiated or influenced by emotional states, and can itself cause an emotional feedback loop that results in the recurring behavior… Cheek biting can also be used as a coping mechanism to relieve emotional pain, physical pain or a blend of the two. Understanding the meaning behind the pain can be useful.

Not surprisingly, Traube uses the word “multifactorial” to describe the origins of these behaviors, but stress and anxiety are usually in the mix. Although not always, because there is such a thing as eustress, as distinguished from distress. He mentions that, in common with other BFRB activities like automatic, compulsive eating, the patient can go into a trance-like state and not even realize that self-destructive activity is taking place.

Every paragraph proves the folly of neglecting mental and emotional health, yet psychotherapy is beyond the reach of most people. Instead, Botox has been tried to prevent cheek biting, as well as lip biting, teeth grinding, and facial tics and twitches associated with Tourette’s Syndrome. Sticking needles in a face is, strictly speaking, as invasive as surgery. It seems like a treatment that should be chosen only as a desperate last resort.

Here is a little something for the toolbox, the surprise referenced in this page’s title. A very effective treatment for BFRBs might be watching pimple-popping videos. This is from Caroline Praderio, by way of BusinessInsider.com:

In comment threads and communities across the social media, a small but vocal group of people with trichotillomania and related behaviors report that pimple-popping videos — the internet’s vast collection of blackhead extractions, whitehead squeezes, and cyst eruptions caught on camera — are more than just documentation of human grossness. They make some lives better, and measurably so.

The writer mentions that BFRBS are “complex and highly individualized” — there is the old multifactorialism again — and that for some patients, these videos could be a trigger that brings on the unwanted compulsion. So use caution. Here is a helpful tip for free — in the bathroom, at the dressing table, or wherever grooming is done, dim the lighting.

Your responses and feedback are welcome!

Source: “About Chronic Cheek Biting,” BFRB.org, undated
Source: “Those pimple-popping videos we’re all obsessed with could have a surprising medical benefit,” BusinessInsider.com, 01/29/18
Image by Joachim Schlosser/Attribution 2.0 Generic(CC BY 2.0)

Coping with BFRBs

Pat Hartman December 13, 2019 No Comments

The photo on this page depicts part of the coastline of the Sultanate of Oman, and was taken by Dr. Pretlow last week when he spoke at the World Obesity Federation 2019 Regional Conference on the displacement theory that Childhood Obesity News has discussed extensively.

The conference chair told him, “Everyone loved your presentation, because it was new,” and he was consulted about the country’s most difficult cases of obesity. Another attendee expressed interest in bringing Dr. Pretlow to an upcoming conference in nearby Qatar.

Oman, incidentally, is a geologists’ paradise, a living museum of rock varieties including peridotite, a kind found in only a few places on the globe. For The New York Times, Henry Fountain reported on this specially talented type of rock, which can perform direct-air capture of carbon from the atmosphere and, with the help of water, turn that carbon into stone.

Civilization creates close to 40 billion tons of CO2 emissions annually, and a startling amount of climate change. At great cost, the process of carbon mineralization could be accelerated. With the proper application of technology, scientists estimate that Oman’s rugged landscape could help to save the planet by transforming at least a billion tons of carbon into rock each year.

Back to the BFRB

The previous post talked about stratagems to avoid body-focused repetitive behaviors, by substituting with less harmful displacement activities. Another (uncredited) author at CanadianBFRB.org points out that we all cope with adversity in individual ways. Different people use different methods, and one person might use different methods on different days. In this area of life, experimentation is definitely encouraged.

To provide easy access to ideas you have tried, or heard of and intend to try, the article suggests creating a special box where these can all be rounded up and corralled together in one place, along with whatever gear might be needed for the suggestions, like a knitting project.

Your journal could be in there, and the visual equivalent, which is a sketch pad. The box could hold a notebook or list of quotations that get you fired up or calmed down, as the occasion may require. It might contain a large or small collection of fidget toys.

Other contents are more abstract, like reminders to exercise, or listen to music, or meditate, or watch your favorite movie, or actually to do any number of things that might captivate your senses sufficiently to crowd out the idea of engaging in a self-destructive BFRB.

The website My Anxiety Plans offers two versions, depending on whether the patient is a young person or an adult. The programs are based on cognitive behavioral therapy. Actually they are both for adults, since the plan for children and teens is described as a self-help program for parents, caregivers, and educators; a resource that teaches them to “coach” anxious kids using “practical strategies and tools to manage anxiety.”

It encompasses 46 lessons divided into six units:

Unit 1: Starting the Journey: Understanding Anxiety
Unit 2: Calming Strategies: Learning to Chill.
Unit 3: Helpful Thinking: Talking Back to Anxiety
Unit 4: Facing Fears: Exposure
Unit 5: Continuing the Journey
Unit 6: Special Topics

Then, each unit is broken down into learning sessions that take between five and 20 minutes. Unit 2, for instance, includes Calming Concepts, Relaxation Tools, Mindfulness Exercises, and Self-Soothing Strategies. BFRBS are a “special topic” addressed in Unit 6.

Your responses and feedback are welcome!

Source: “How Oman’s Rocks Could Help Save the Planet,” NYTimes.com, 04/26/18
Source: “Creating a Self-Care Toolbox for BFRBs,” CanadianBFRBb.org, 04/01/15
Source: “My Anxiety Plans,” AnxietyCanada.com, undated
Image by Dr. Pretlow

BFRB World — Still Strange

Pat Hartman December 12, 2019 No Comments

Sometimes a troublesome compulsion can be redirected to another channel that relieves anxiety and does not actually harm the individual. The knowledge of this is ancient. Several religions employ some version of the rosary, and many of them are in fact much older. In the secular world, “worry beads” are a recognized aid for self-soothing, which is what a body-focused repetitive behavior is all about.

Dr. Fred Penzel’s suggestions for avoiding hair-plucking and other undesirable BFRBs include some ideas that come under the heading of “lean into it.” If you compulsively fool with your own hair, find a substitute, or something equally absorbing to your sense of touch, and fiddle with that instead. The nervous tension is relieved, and you get to keep your hair.

Dr. Penzel finds that his patients deal with the urge to do damaging BFRBs by handling more benign objects, like a string of toothed lock washers, or a troll doll. They have also test-driven a number of commercial products, which he names:

— Koosh Balls™ or other feathery, rubbery type toys…
— a small hand toy known as Electronic Bubble Wrap…
— a miniature Slinky™…
— Bandai Edamame Soybean Pod Key chains that squeeze the little beans in and out…
— a Hairy Tangle™, which is very textured and can be twisted into many different shapes…
— a textured, spiky, squeezable ball known as a Nubby Ball™.
— Handle Kinetic Sand™ which is specially treated sand that is very tactile.
— Silly Putty™ or better still, try Theraputty™, which comes in several different levels of firmness…

Please note, these are secondhand recommendations from an expert in another specialty. However, it is possible that playing with an object that captivates the sense of touch could mollify a child who would otherwise be using his hands to convey snack food to his mouth.

Of course, there are quite a few handleable objects on the list that are not identified by brand. Elastic bracelet with textured beads. Loofah mitt. Spring-loaded hand exerciser. Textured pot scrubber. Wide-tooth comb. Rubber cement. Pipe cleaners, “especially like the extra-large and fuzzy type.”

Why bring up these suggestions? Because they might be useful to parents whose children eat obsessively. Something to fiddle with could be the key to tranquillity. Try it for travel. A child shouldn’t be eating in a car anyway, especially not if strapped in the back seat with a lone adult driving. Eating can lead to choking, and that kind of emergency can lead to a five-car pileup and multiple fatalities.

What does all this have to do with childhood obesity? Maybe a lot. Dr. Pretlow writes,

Displacement activity (the addiction behavior) is how the brain has learned to handle significant conflict, and displacement activity is innate, instinct-level, automatic behavior and essentially out of the person’s control, thus compulsive.

If displacement activity is the basis of addictions, including eating addiction, how might we treat this? Addiction treatments generally involve trying to stop the displacement activity, e.g. enforced sobriety, cease using the drug, and food restriction. Yet, the source conflict is not being dealt with, so the displacement mechanism will keep firing.

In the health care field, many clinicians and researchers are dedicated to finding ways to help people deal with the manifestations that are recognized as symptomatic. There is a strong desire to work toward the elimination of the symptom, whether it be hair-plucking, skin-picking, or chewing potato chips from dawn to dusk.

Many professionals are also interested in addressing whatever it is that makes people compulsively perform body-focused repetitive behaviors. Can patients improve to the point where the urge just falls away? What if all children could be so healthy they would never even get involved in these harmful displacement activities in the first place?

Your responses and feedback are welcome!

Source: “Source: “58 Stimulation Substitutes and Behavioral Blockers for BFRBs — Or “The Great Big List of Favorite Fiddles,” BFRB.org, undated
Image by Randen Pederson/Attribution 2.0 Generic (CC BY 2.0)

The Fascinating World of BFRBs

Pat Hartman December 11, 2019 No Comments

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,” BFRB.org, undated
Image by Dr. Pretlow

The Fine Art of Fiddling

Pat Hartman December 10, 2019 1 Comment

Various thinkers have qualified the possible categories of displacement behavior in several ways, and some of them are more arguable than others. The ones we have enumerated are: fight, flee, freeze, feed, fornicate, fool around (or fiddle), fidget, faint, and fun (actually laughter, but it doesn’t start with an F.) They all serve the same purpose, which is to avoid impending pain and/or soothe existing pain.

On the most elemental level, an amoeba’s sense of nociception warns of a nearby noxious stimulus, for instance, a chemical. Technically, an amoeba cannot even feel pain, but it can writhe in what very much appears to be a negative reaction. Preferring to escape rather than experience this, the amoeba can change direction. In the palette of displacement behaviors, the only available one is flight.

At a different place along the spectrum, there is a human being. The main difference is that a human has a brain capable of rationalizing a displacement activity, while a rabbit simply performs the displacement activity. It freezes or flees, and never gives the incident another thought.

The higher primates

The college student, facing exams and terrified of flunking, studies with a huge bowl of snacks within reach. This is not only feeding, but fooling around/fidgeting/fiddling. The jaws moves perpetually, chewing mouthfuls of chips. The hands are occupied, going back and forth to the chips bowl. The fingers are exercised, removing the wrappers from miniature Tootsie Rolls.

The body is given something to do that burns off nervous energy and holds panic at bay. The organism is temporarily placated by a body-focused repetitive behavior, or BFRB. It is a displacement activity that in this instance carries a heavy penalty, namely, obesity.

Speaking of fiddling…

BFRB authority Dr. Fred Penzel offers a mind-bendingly comprehensive collection of
“58 Stimulation Substitutes and Behavioral Blockers for BFRBs — Or “The Great Big List of Favorite Fiddles.” His suggestions range from the familiar and mundane — “Learn how to knit, crochet, quilt, embroider, cross-stitch, needlepoint, or sew” — to the original — “Apply Elmer’s Glue to your hand and pick it off” — to the counterintuitive.

By that, we mean a fiddling option like gaming, which in the context of obesity prevention is usually proscribed, because it involves sitting around rather than burning calories by moving. But this therapist boldly advises, “Play a very engaging video game with a controller that requires both hands.” Because it is better than snacking.

Dr. Pretlow’s work

Transcribed below are the final sections from the poster that Dr. Pretlow presented at ObesityWeek 2018 in Nashville, TN, a year ago — where he met a doctor from the Sultanate of Oman, which (historic note) led to this year’s presentations at the World Obesity Federation Regional Conference in that country.

Discussion

From our Study 2 results the development of an “Overeating Addiction Scale” that encompasses both the sensory and motor addiction components of overeating may be useful, in contrast to the Yale Food Addiction Scale, which seems to assess only the sensory addiction component.

Binge eating episodes decreased using staged food withdrawal/restriction in the intervention of this study, in contrast to the belief of the eating disorders field that food restriction increases binge eating.

Conclusions

The present study provides preliminary evidence that the addition of BFRB therapies increases the effectiveness of staged food withdrawal for treatment of obesity in young people.

Your responses and feedback are welcome!

Source: “58 Stimulation Substitutes and Behavioral Blockers for BFRBs — Or “The Great Big List of Favorite Fiddles,” BFRB.org, undated
Image by Star Athena/Attribution 2.0 Generic (CC BY 2.0)

Some Thoughts on Displacement Behavior

Pat Hartman December 9, 2019 No Comments

Last week, in Oman, Dr. Pretlow spoke at the World Obesity Federation Regional Conference on the subject of displacement behavior. One of the things he says about that is,

Displacement behavior in animals likewise may become compulsive and destructive, e.g. “lick granuloma” in dogs and cats, which is excessive licking (grooming) of the fur in response to stress or social isolation, causing significant damage to the animal’s skin.

In the last post, we talked some less complicated creatures, and a dog. This time it’s a cat, whose owner even throws in a reference to OCD, or obsessive-compulsive disorder type behavior. Ailurophile (cat-lover) Michael Broad wrote,

Cats can lick the fur off their bodies and don’t even stop there, sometimes. A cat can lick exposed skin raw to the point where it bleeds and becomes infected.

He knew this through observing his own cat, Charlie, who felt threatened by a stray that was allowed to enter through the cat flap at will, and eat from his bowl. Feeling invaded, Charlie would growl, but was too polite to start a battle, and too possessive to run away and concede the kitchen to the interloper.

In that instance, neither fight nor flight could be found in his repertoire. Instead, Charlie displaced his bad feeling by taking it out on himself, and even when the intruder was not present, Charlie would spend much of his time overgrooming to the point of undeniable self-harm.

In a previous post, Childhood Obesity News mentioned zoologist Basil Hugh Hall, who believes that for people, laughter can function as a displacement activity, along with the more familiar choices. Feeding, for example, is another one of the F-words sometimes engaged in by animals faced with dread that can be neither resolved not tolerated.

That same impulse can show up in humans as compulsive eating. Hall says,

I view laughter in modern Homo sapiens as an exapted fight or flight displacement activity which has been co-opted by different systems in the brain to serve different functions.

One line really stands out, where he suggests how “inappropriate laughter that takes place in tragic circumstances, and seemingly causeless spontaneous laughter, are typical of individuals suffering from long term stress.” Everybody must have encountered at least one person with what is sometimes called a “nervous laugh” and sometimes a “tic.” It’s a strange, weird noise expelled after everything they say — including words that are not remotely humorous.

The involuntary response can quickly become intensely annoying, and people who do it are apt to be ridiculed and avoided. But it very likely signifies a deeply troubled person who, as Hall implies, suffers from long-term stress. Imagine feeling so threatened that whenever you say anything out loud your subconscious tacks on a “laugh” that is obviously not heartfelt, a thinly disguised footnote whose message is, “Please don’t hurt me.”

How is this useful in a clinical setting? In an interview with the parents of an obese child, if one of them appends that jarringly inappropriate pseudo-laugh to every utterance, something unhealthful is going on in that family. This underlines again the idea that psychologists and psychiatrists would do well to play a much larger part in addressing the childhood obesity epidemic.

Your responses and feedback are welcome!

Source: “First hand experience that anxiety can cause overgrooming in cats,” Pictures-of-Cats.org, 01/14/13
Source: “Laughter as an exapted displacement activity: the implications for humor theory,” ResearchGate.net, June 2009
Image by Gotardo Ronitis/Unsplash

Displacement Behavior in the Animal Kingdom

Pat Hartman December 6, 2019 1 Comment

As we have mentioned, yesterday Dr. Pretlow spoke at the annual Regional Conference of the World Obesity Federation. He presented some ideas about displacement activity, for instance:

Displacement activity is out-of-context behavior, behavior that is inappropriate for the situation at hand. It occurs universally among the animal kingdom… Displacement activity stems from situations of major opposing or thwarted behavioral drives, e.g. fight or flight.

Even an amoeba knows to avoid pain, or at least to avert damage. It may only have one cell, but it possesses the means to detect and avoid noxious stimulation. This mechanism, called nociception, functions as an alarm system that warns of existential danger. When an amoeba senses potential harm to its physical integrity, it moves away. Its arsenal of threat responses is limited to one rather unsatisfactory but often sufficient defense, namely flight.

As organisms become grow increasingly complex, they develop more complicated threat responses, all the way up to humans. Researchers have identified several human threat responses, although some of their arbitrary categories may overlap.

So far, they have come up with fight, flee, freeze, feed, fornicate, fool around, fidget, and faint. Even laughter has been proposed as a displacement activity, but lacks a suitable f-word. Maybe “fun”?

As above, so below

From the amoeba on up, every organism desires to escape a bad feeling and replace it with a good feeling, or at least a neutral feeling — or if that is not achievable, at least a different bad feeling. Is flight possible? A teenager might run away from home. Faced with adult cruelty, is a violent reaction unthinkable? Sometimes children invert the fight impulse and turn it back upon themselves with cuts or burns.

The human body does not deal much in nuance, and interprets deprivation of the TV remote device, or receiving a bad haircut, as a threat similar to being stalked by a tiger. Only the degree is different. But in either case, anxiety arises, coupled with an urge to do something to mitigate the dilemma. As Dr. Pretlow points out,

Displacement activity is a powerful mechanism. For example, a stressed dog or cat may lick its paws to the point of damage…

A dog-savvy website lists possible reasons for excessive paw-licking — dry skin, allergy, yeast infection, arthritis, or other pain. And then, there is anxiety:

If your dog is anxious or stressed, it might lick itself similar to the way humans bite nails when they’re nervous; it gives them relief. Take note if your pup starts licking its paws around the same time every single day, like right before a nap or going to bed. That’s a big sign that the licking is behavioral… Consider your own stress level too — you might be the problem.

Licking the paw pads to rawness undoubtedly hurts — but it is a different hurt, and apparently one that can supply relief. As the old saying goes, “A change is as good as a rest.” A dog that compulsively licks its paws is not seeking pleasure, but avoiding pain. The damage matters not, because the original, existential pain of threat has been circumvented and replaced by a different and somehow more acceptable pain.

Who knows? Animals may experience a rudimentary, instinctual version of a sentiment that humans sometimes express: Self-infliction of harm has more dignity than passive acceptance of the damage dealt out by fate.

A human who compulsively plucks hairs out of his or her own head is certainly not seeking pleasure, but avoiding the pain of anxiety. A person who compulsively consumes doughnuts may present a deceptive picture to the outsider, but in a very real sense, that person is not actually seeking pleasure but merely avoiding pain.

Your responses and feedback are welcome!

Source: “Can amoebas feel pain?,” Study.com, undated
Source: “Is Your Dog Licking Paws Uncontrollably? Here’s What You Can Do About It,” NaturalDogCompany.com, 05/28/19
Image by Tim Menzies/Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0)

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