To Build Consensus, Part 4

We have an exciting announcement, but first, here’s a refresher to bring anybody up to date on the ins and outs of BrainWeighve. The work of testing and tweaking is ongoing, but in such an ambitious project, that part is just a “given”. So here is the announcement:

The BrainWeighve app clinical trial at UCLA has been launched! Yaay!!! There will be two 3-week beta tests with 8 participants each, followed by the 4 month main trial.

And of course, “Stay tuned!”

Back to consensus

It is no coincidence that Dr. Pretlow’s recent presentation at a WHO Expert Workshop describes the method of treatment that BrainWeighve delivers. To quote from the 26-minute talk,

Theoretically, moving the opposing drives or behaviors out of equilibrium by avoiding or resolving the person’s problem or stressful situation should mitigate the displacement mechanism and stop it from firing, and the addictive behavior should cease.

Although its principles apply across the board, BrainWeighve is especially focused on eating addiction. The smartphone app intervention helps kids (or grownups, for that matter) to identify the problems and stressors that form the basis of opposing drives, and then works with the user to create strategies to deal with them.

A slight digression

Dr. Pretlow mentions that the addiction field emphasizes the reinforcement-reward mechanism. However, rewards are notoriously fickle. What a cruel joke it is, when the dependent person learns that the pleasure wears off. If there is one thing we know about heroin addicts, it is that they need increasing amounts of the drug in order to reach the desired stage of oblivion. But before long, the desired effect is no longer to be had, and they’re shooting up just to avoid getting sick. Some reward!

As Dr. Pretlow has said,

We acknowledge that the reward mechanism is a central component underlying addictive eating behavior, but we posit that rewards (e.g., pleasurable food sensations and celebrations) rather act as cues to trigger the displacement mechanism, leading an individual to lose control over eating, once started.

While it may be possible that some food could be addictive to some person, the “substance” in this case is nowhere near as powerful as many other substances. It’s the eating that is addictive.

As Dr. Pretlow says, “It’s not the cues (taste, texture, temperature), it’s the displacement (biting, chewing, licking, sucking, crunching, swallowing). Displacement is the brain’s goal. Nevertheless, cues (stimuli) are essential to trigger the displacement mechanism.”

Your responses and feedback are welcome!

Image by Lil Shepherd/CC BY 2.0 DEED

To Build Consensus, Part 3

Apparently, to a bird confronted by a hostile bird, a cue could be anything in the environment, like dry grass. It is normal for a bird to pick at dry grass, in the nest-building time of year, but if it is not nest-building time, it is a displacement activity with a different specific purpose: to use up what could otherwise be destructive energy. The energy becomes downgraded from dangerous to merely futile; the practical equivalent of a person binge-eating in response to a problem at work.

Here are some things Dr. Pretlow and co-author Suzette Glasner have written about the role of cues in displacement:

The displacement mechanism is triggered by sensory cues. Initially, a specific sensory cue (e.g., food taste) suggests to the brain that the behavior or drive (e.g., feeding) associated with the cue might be used as a displacement behavior to deal with problems/stressors/thwarting and overflow brain energy.

[H]enceforth similar cues trigger the displacement mechanism to activate that drive behavior (eating) in stressful situations.
[T]he displacement behavior may become excessive and destructive (e.g., overeating/obesity).

Rechanneling diverts the focus to a nondestructive medium…. Dealing with the displacement sources diminishes the focus on the destructive medium and cues.

We acknowledge that the reward mechanism is a central component underlying addictive eating behavior, but we posit that rewards (e.g., pleasurable food sensations and celebrations) rather act as cues to trigger the displacement mechanism, leading an individual to lose control over eating, once started.

“Displacement activity may explain addictive behavior”

When a behavior is potentially life-threatening, and a creature goes ahead and does it anyway, we call it irrepressible. If a sensible person were tempted to do that harmful thing, they would not. The fact that a person knows the action is harmful, either in the moment or cumulatively, and yet does it anyway, seems proof that it is irrepressible. Because, being a sensible person, they would leave it alone if they could.

When someone tends to handle stress by displacement behavior, environmental cues are a real danger. Take, for example, a person whose couple relationship has soured, and who is throwing belongings into boxes, preparing to move out. It might be that they happen to find an old backpack with a little bit of heroin in it. It might be that this person is a recovering addict, in which case an accidental discovery like this could have really bad consequences, up to and including eventual death. But this example would be a rare, almost freakish occurrence.

If, however, that person’s problem is not heroin, but eating… the cues are everywhere. Our modern environment, especially because of omnipresent media, is jam-packed with cues that say “Eat! Eat! Eat!” At every turn, the person is confronted with stimuli that could lead to big trouble.

Your responses and feedback are welcome!

Source: “Reconceptualization of eating addiction and obesity as displacement behavior and a possible treatment,” DOI.org, May 2022
Image by Kenneth Lu/CC BY 2.0

To Build Consensus, Part 2

When addiction is the topic, there are all sorts of side roads to wander down, like the Rat Park experiment, in which rodents were given the opportunity to live in a community, and the wherewithal to engage in interesting and satisfying activities. In this environment, they surprised everybody, except Prof. Bruce Alexander, by ignoring the free dope dispenser.

Another group that confounded expectations was the heroin-addicted Vietnam veterans, as mentioned by Dr. Pretlow in the presentation introduced in the previous post. Once their life situation was improved by getting out of the war zone, most of them dropped the habit with few repercussions.

This is one of the odd circumstances that causes some experts to suspect that maybe it’s not the food or the additives, or even the urge to eat incessantly, that causes obesity. Maybe it is the environment, both outer and inner. In many ways, it appears that a person’s life situation has a lot to do with their predilection to become addicted.

This leads, in the presentation, to a discussion of the life situation experienced by an animal who “cannot readily face, yet cannot avoid, situations involving uncertainty, confusion, conflict, or feeling trapped, threatened, or thwarted.” Animals feel stress, just like people, and react to it in ways that might tell us something about ourselves.

Addictive behavior

To Dr. Pretlow’s mind, the universal source of addictive behavior is displacement, an “innate, instinctual biobehavioral mechanism.” It is an adaptation strategy, nature’s way of ending a standoff. The stress of finding oneself torn between two opposing drives, like fight and flight, generates a lot of brain energy.

When two opposing drives are in equilibrium, that energy can be channeled into a third behavior, which fulfills certain qualifications. The stalemate can be broken by a displacement activity.

This is about how the brain copes with overflow mental energy, and how it can be persuaded to handle things differently. Animals engage in displacement behavior in stressful situations, like when threatened by a predator. Or, it could be not necessarily when life is directly threatened, but when their sense of how things should be is violated.

In the presentation, the example is given of a cat that was upset when a strange cat came into the house and ate its food. The victim was so stressed out that it would lick itself so vigorously that eventually the fur was removed, down to bare skin and beyond. Normally, an animal is presumed not to do anything against its very strong instinct for survival. But in this kind of impasse, it will even harm itself, which suggests to the observer that the urge must be irrepressible.

Your responses and feedback are welcome!

Image by Pat Hartman

To Build Consensus

Readers will recall hearing about this virtual event, “Consensus Building Workshops on addiction-like symptoms related to consumption of certain foods.” It was created to persuade the World Health Organization “to include symptoms of addiction related to food, as a disease, in the International Classification of Disease, ICD-11.”

Childhood Obesity News also continued with a second post on the then-upcoming event. The purpose, as outlined in an internal preparatory document, “Introduction from the Facilitation Team,” was to define…

– what we know and can agree on about addiction symptoms as they relate to certain foods
– what we feel we know but can’t agree on, and
– where we need further research

The organizers outlined their concerns and observations about standard care, as currently understood and implemented. It appears that some vital elements are missing or ignored, and also that, in the area of food consumption, moderation therapy is ineffective.

This would seem to imply that some foodstuffs actually are literally addictive substances, a matter that is still rife with controversy. What happens if behavior is changed, but the psychological distress that caused it is still present? What if the person changes their eating habits but does not lose any weight? Also, there is a possibility that, without looking any further, doctors might tend to regard difficulties with the treatment as willful non-compliance.

Dr. Pretlow’s part

Dr. Pretlow’s 26-minute presentation is available online. In it, two fundamental questions are, “What should the disease be called?” and “Is the food the problem?”

The research organization NEUROfast seems not to care for the term “food addiction” because apparently, it implies that “food contains chemical substances that lead to development of Substance Use Disorder.” Well, is that proven to be not the case? It is hard to see this point of view, with all the evidence against, for instance, sugar. At any rate, one school of thought holds that “Eating Addiction” or “Addictive Eating Disorder” would be a more accurately descriptive name.

Others point out that not all foods are associated with addictive-like eating. (For some reason, many people particularly identify broccoli as characteristically non-addictive.) Dr. Pretlow mentions that the only behavioral addiction recognized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition is gambling disorder. (Some observers have remarked that, of all the addictions, gambling is probably the most unlike eating.)

Dr. Pretlow points out that while almost all binge eaters will go to town on whatever consumables are available, a relatively small number are more discerning. By this criterion, it sounds like the problem is the eating, and not so much the food. So it’s a sliding scale.

The presentation includes segments of interviews with, for instance, a young 400-pound fellow who admitted to having mistakenly believed that he was in control of his eating; that he was making the decisions. He eventually realized, “It was like an addiction almost. I had to.” This same patient poetically described his illness as being “consumed by consuming.”

(To be continued…)

Your responses and feedback are welcome!

Source: “Introduction from the Facilitation Team,” by Dr. Pretlow
Image by Pat Hartman

Selling Crap to Kids, Part 4

Ten years ago, Landon Hall interviewed Margo Wootan, who was Director of Nutrition Policy at the Center for Science in the Public Interest, and who opined that…

[K]ids used to eat what their parents ate. But the trend in recent years is for kids’ tastes to rule the family dinner table as well. Too often, that means chicken nuggets, hot dogs, pizza or something else from that fat-and-carb family of foods… Changing this idea of what is a kid’s meal is crucial to solving child obesity. You can’t solve obesity if kids’ food is mostly junk.

The situation has not changed favorably since then. Should parents shoulder the blame? Actually, no. According to many experts, all the shame belongs to the food industry, which single-handedly invented the notion that children are entitled to have their “own foods,” and then sold the idea to kids and, unfortunately, even to some parents.

In January of 2014, Sean Poulter reported that according to the Food Standards Agency,

Nine in ten items at the check-outs of supermarket convenience stores would be considered ‘very unhealthy.’

The writer accused retail stores of being acutely aware of, and using, “pester power” (sometimes known as “nagging beyond endurance”). A display of chocolate never fails to trigger a barrage of whining, especially if the product is strategically placed in a low line of sight appropriate to humans age 3 to 5. He quoted Dr. Jason Horsley who said,

Youngsters […] will see something, want it and have a tantrum if they don’t get. It depends how brave the parent is as to whether they buy it or not.

We can’t show a direct correlation between these displays and rising obesity. But we can say that supermarket check-outs selling junk food, making it cheap and readily available, are not going to reduce the nation’s obesity.

At that point in history, the average American child was absorbing around 16,000 TV commercials per year, a great many of them featuring food — and not good food. But even if all the offerings had been supremely healthful, an increasing number of adults were ideologically opposed to the audacity the industry showed in presuming to deal directly with children.

Journalist Bruce Watson quoted a British source, Ian Barber, who pontificated thusly:

Advertising becomes a proxy for complaints about particular companies, brands or products. Advertising isn’t the issue. The sort of advertisements that children see is the issue. But then you get into a very objective debate about how people feel about certain brands or services.

That incoherent declaration came, by the way, from the communications director of the Advertising Association in the U.K., and it doesn’t even make a lick of sense. Angry outbursts from parents and health professionals are anything but objective. They are, in fact, the epitome of subjectivity. People have strong personal convictions about this sort of thing, which tend to show. But those corporate types are so accustomed to spouting nonsense, they don’t even recognize it when it pours out of their own mouths.

Your responses and feedback are welcome!

Source: “When did kids start to eat apart from adults?,” OCRegister.com, 12/17/13
Source: “Supermarkets accused of using ‘pester power’,” DailyMail.co, 01/24/14
Source: “The tricky business of advertising to children,” TheGuardian.com, 02/24/14
Images by Jeff Boulter, Marco Verch Professional, Joe Shlabotnik/CC BY 2.0

Selling Crap to Kids, Part 3

We are still wallowing in a topic so controversial, it has been newsworthy for decades. A little over 10 years ago, Susan Linn and Michele Simon wrote:

Marketing to children does not get First Amendment protection because it is inherently misleading. If a young child cannot even understand the purpose of an ad, then marketing anything to that child is both unfair and deceptive.

At around the same time Simon, a public health attorney and advocate for plant-based foods, framed one of the moral issues. In protecting children’s health, is encouraging the food industry to market healthful food to kids important, necessary, or even ethical? She wrote,

[I]f the only issue was marketing fruit and vegetables to kids and if the only people engaging in such tactics were parents, I would be far less concerned. But let’s not confuse well-meaning adults trying to get kids to eat right with profit-driven multi-national corporations targeting children to hook them on a lifetime of consumerism.

In the same year, the journal Health Education published the results of a study of child-oriented food advertising. The uncredited piece about it from PRLog.org said that “Health-related messages in food advertisements targeting children” was the first document to scrutinize not just the health messages conveyed by ads, but the actual content and virtue of the foods they referred to and promoted. Here is the problem, or one of them anyway:

[I]t may actually be the advertising techniques… that are being changed in response to concerns… It found that health messages which appear in foods marketed at children do not necessarily indicate their nutritional value. Conversely, these health-related messages were frequently found to be used to promote unhealthy foods to children, and were mostly likely to appear in commercials for fast foods, sugared cereals and salty snacks.

In other words, instead of doing the right thing, the industry engaged in some fancy bait-and-switch machinations, no more honest than a traditionally rigged carnival ring-toss game. The new method is, in fact, even worse, because it takes advantage of the trusting nature of children and their often deep, if sometimes well-camouflaged, desire to do the right thing.

Children, like adults, perceive products more positively when they are presented with a health message, and exposure to food advertising is linked, not only to their dietary preferences and food selections, but to their understanding and beliefs about nutrition.

Is that devious, or what?

Your responses and feedback are welcome!

Source: “The Dark Side of Marketing Healthy Food to Children,” EatDrinkPolitics.com, 06/17/13
Source: “Is a Nutritionism Approach to Marketing to Children the Best We Can Do?,” EatDrinkPolitics.com, 06/26/13
Source: “Can childhood obesity be linked to clever marketing tactics?,” PRLog.org, 10/01/13
Image: Genius.com/Public Domain