Childhood Obesity and Food Addiction

INTRODUCTION

Based on an elaborate, 10-year study of overweight kids, this book searches the anonymous words of children to solve the puzzle of why they can't lose weight even though they hate being fat.

The excerpt, below, is an amazing riff on the controversial issue of whether or not obese children are addicted to comfort foods.

More information about the book, Overweight: What Kids Say, and author Robert A. Pretlow, M.D., follows the excerpt. Thanks for your interest in this vital issue.

The most frequent post by kids on our bulletin boards is, "How do I lose weight?" The answer is pretty simple: eat in moderation. But if it's that simple, why do these kids struggle so much to lose weight and maintain it? The answer to that question is also pretty simple: They 'use' food to cope with life. The postings on comfort eating in Chapter 9, stress eating in Chapter 10, and boredom eating in Chapter 11 reveal that these kids use the sensations of food and the action of eating to ease unpleasant feelings and relieve stress and boredom. The disaster is that they are unable to stop.

They overeat to the point that they make their lives miserable.

We don't feel pleasure and pain at the same time. Our brains are unable to focus on more than one emotion simultaneously, hence pleasure can displace pain, at least temporarily. And, one researcher stated, "If a behavior eases pain or boredom for only 30 seconds, the behavior will be repeated." [Gary D. Foster, Cognitive Behavior Treatment, Obesity Society Meeting, Boston, 2006]. It's likely simple pleasure, to begin with, which causes kids to overeat. They eat "because the food is there." But once their brains realize that pain is eased by the pleasure of the food and that stress is relieved by the displacement activity of eating, even if for only 30 seconds, kids may be driven to continue the behavior, even though they become distressingly overweight or obese because of it. They may become unknowingly 'hooked' on using food to comfort themselves and cope with stress. For the majority, this comfort eating appears to be unconscious.

Most kids hate being fat, yet they struggle to resist cravings for highly pleasurable foods, e.g. junk food and fast food, knowing full well that eating those foods will result in additional weight gain and further damage to their lives. Many kids post that their eating is out of control. This is compellingly suggestive that an addictive quality or substance dependence on highly pleasurable foods is a significant cause of the childhood obesity epidemic.

The common declaration by the kids on the boards that they feel out of control with food is confirmed by the poll results below. Most of the 145 kids responding to this poll feel that their eating is out of control.

POLL: Do you feel that your eating is out of control?
RESULTS:
YES: 96 votes (66%)
NO: 49 votes (34%)

This overeating addictive quality or apparent substance dependence on highly pleasurable foods is disturbingly similar to tobacco, alcohol, and drug dependence. Many kids have literally posted that they feel "addicted" to highly pleasurable foods, particularly junk food and fast food (see Chapter 9).

We asked kids what they thought about junk food and addiction in a poll. 154 kids voted:

POLL: Do you think that high pleasure food (junk food) is addicting, like drugs or cigarettes?
RESULTS:
YES, Losing Weight = Withdrawal (60%)
YES, But Only for Obese Kids (14%)
NO, Losing Weight is Not as Hard (9%)
NO, Kids Just Love to Eat (17%)

Most kids voting feel that junk food is addicting like drugs and cigarettes and that losing weight is similar to the 'withdrawal' of quitting smoking or coming off drugs or alcohol. It's notable that only a small percentage of the kids feel that losing weight is not as hard as quitting smoking or getting off drugs. Furthermore, most of the kids feel that they're addicted to junk food, per the results below:

POLL: Do you feel that you are addicted to junk food?
RESULTS:
YES: 104 votes (68%)
NO: 50 votes (32%)

Probably very few overweight kids know the scientific definition of "addiction." Nevertheless, they do know that something very powerful is driving them to consume large amounts of highly pleasurable foods, in spite of the dreadful effects of inevitable weight gain.

The scientific definition of 'addiction' is actually just that: being driven to a behavior, even though the individual knows that the action will later result in significant problems. An overwhelming need to ease pain or an unpleasant emotion outweighs the delayed consequences. The word "addiction" may seem too severe to apply to kids and uncontrollable eating. It conjures up ghastly images, and the word may be offensive to some individuals. Nonetheless, acknowledged addictive behaviors include shopping, gambling, sex, sports, TV, workaholism, and many others. Furthermore, some overweight kids on our boards literally say that they use food "like a drug."

~ WITHDRAWAL PERIOD ~

What these kids say suggests that in order to break their dependence on highly pleasurable foods, they must go through a 'withdrawal' period of intense cravings, antsiness, irritability, even depression - similar to coming off tobacco, alcohol, or drugs. Withdrawal is what happens when a substance or behavior, which eases pain, is suddenly removed. It's the brain's way of reacting to the jolt. The emotional discomfort of withdrawal may be worse than the emotional discomfort which started the addictive behavior in the first place. This is perhaps why many kids quickly give up on weight loss and go back to overeating again. Gastric bypass/banding probably works by an 'enforced' withdrawal period.

Fortunately, kids say that this withdrawal discomfort seems to get a lot better within a couple of weeks (see Success Stories, Chapter 14), again an occurrence similar to coming off tobacco, alcohol, or a drug.

It's unclear whether stopping displacement activity eating (stress eating, binge eating) results in these withdrawal-type symptoms. Antsiness certainly occurs when trying to stop stress eating, similar to trying to cease nail biting, but the antsiness may not improve within two weeks, as it seems to do when kids stop highly pleasurable food comfort eating.

~ VICIOUS CYCLES ~

Once kids become dependent on using food to cope with their lives, they frequently become caught in vicious cycles, as described in Chapter 13, where they eat more and more to numb the shame, stress, and depression of being overweight itself. In addition, the more they engage in the addictive behavior, the worse the withdrawal cravings when trying to give it up, which tends to keep them hooked, again a vicious cycle. Even worse, they lose non-food coping skills, which makes it even harder to give up the addictive behavior. Plus, the more they fail at attempting to get through withdrawal, the worse the pain and need for the addictive numbing of food.

~ WHAT IS IT THAT KIDS ACTUALLY ARE HOOKED ON? ~

Although the kids' postings imply an addictive quality or substance dependence to their overeating, this may be an entirely new form of dependence, very different from chemical dependence (drugs, alcohol, and tobacco). It appears to be the action of eating (biting, chewing, swallowing) and the immediate sensations of food in the mouth (taste, texture) that these kids are hooked on, rather than a central chemical response, as with a drug. Any pleasurable food can be the culprit, not just highly pleasurable foods. Also, bulimic kids, who immediately vomit up the food they eat, still obtain comfort or stress relief from overeating and become dependent on the behavior.

Displacement activity eating, i.e. eating to relieve stress (see Chapter 10), seems to be a significant component of overeating in kids' postings on the boards, possibly as significant as emotional numbing by the pleasure of food, i.e. comfort eating. Does displacement activity eating, binge eating for example, have an addictive quality? It certainly causes severe problems in kids' lives and can make them feel 'out of control.' However, unlike comfort eating and other addictive behaviors, displacement activity eating simply gets rid of nervous energy or distracts from life, and does not numb pain, as addictive behaviors generally do. Nevertheless, certain addictive behaviors (e.g. gambling, shopping, sex) may include significant displacement activity with resulting relief of stress.

Note: Kids don't become dependent on just any food. They don't get hooked on broccoli or dry toast. They get hooked on high pleasure, high action foods. 'Junk foods' seem to be the most problematic foods, according to the kids who post on our site.

~ WHERE DID SATIETY GO? ~

Comfort and stress relief from eating highly pleasurable foods seems to override the fullness or 'satisfied' feeling, which normally stops kids from overeating. Many overweight kids say they eat until they feel "stuffed," which is uncomfortable, so they're finally able to stop.

Stomach stapling surgery and stomach banding cause weight loss because the stomach is made much smaller. As a result, the uncomfortable, 'stuffed' feeling occurs after only small amounts of food are consumed, which causes the person to stop eating much sooner. Some kids, however, say that they actually like feeling stuffed. Might this possibly be a feeling of relief (for a brief time) that the child is not compelled to eat?

Has food become so pleasurable that kids hardly recognize the satisfied feeling anymore? If so, kids need to consciously think about what amount of food their bodies need and stop when they have eaten that amount. Putting just the needed amount of food on their plates is also a good idea.

~ OTHER RESEARCH WHICH SUPPORTS FOOD ADDICTION ~

The assertion that a substantial component of the child obesity epidemic is due to an addiction to the pleasure of eating is corroborated by neuroimaging positron emission tomography (PET) studies. These studies reveal that the brains of obese individuals are strikingly similar to the brains of drug-addicted individuals [Wang GJ, Volkow ND, Thanos PK, and Fowler JS, "Similarity between obesity and drug addiction as assessed by neurofunctional imaging: a concept review," Journal of Addictive Diseases, 23(3): 39-53 (2004)].

A chemical in the brain, dopamine, is involved in the development of addiction to drugs, alcohol, and tobacco. Dopamine receptors, which absorb the chemical, appear on PET brain scans as dark areas. Dopamine receptor levels are much lower in both drug addicted and obese people, as compared to the PET brain scans of healthy weight people (control subjects). Similar to drug addicts, the brains of obese individuals also have been 'rewired' by dopamine changes.

A recent study found that fatty foods can cause cocaine-like addiction in rats [Johnson P and Kenny P, "Dopamine D2 receptors in addiction-like reward dysfunction and compulsive eating in obese rats," Nature Neuroscience, March 2010]. Rats fed bacon, sausage, cheesecake, and frosting became obese. After becoming obese, the rats would then endure electric shocks to get to the foods, indicating they had become addicted. Development of obesity and food addiction in the rats showed a drop in the same dopamine receptor in the rats' brains, as was observed in the above PET human studies. Moreover, the rats exhibited tolerance, where they needed more and more of the foods to experience a high (comfort?). In previous studies, rats had exhibited similar brain changes when given unlimited access to cocaine or heroin. Dr. Wang, an author of the PET study above, commented on the rat study, "We make our food very similar to cocaine now." [CNN , 2010]. He added, "We purify our foods," which concentrates the pleasurable ingredients, just as cocaine producers purify the coca leaves to make cocaine.

In the book, The End of Overeating, Dr. David Kessler argues that obesity is due to what he calls "conditioned hypereating." He likens this conditioned hypereating and its treatment to tobacco, alcohol, and drug abuse - well acknowledged addictions - yet he never refers to hypereating as an addiction. Kessler also contends that conditioned hypereating results from simply consuming "hyperpalatable" foods, which he claims are "reinforcing" and, along with cues, spontaneously bring about "rewiring" of the brain, such that the individual becomes compelled to overeat those foods [Kessler, D., The End of Overeating: Taking Control of the Insatiable American Appetite, Rodale Books, 2009.].

Addiction to highly pleasurable foods in the kids posting on our boards appears to result from the pleasure of food easing emotional pain (comfort eating). It would be farfetched to suppose that such dependence and apparent dopamine changes in the brain would develop in the absence of easing emotional pain, from simply casual exposure, as Kessler implies. Do not individuals typically get drunk to numb pain or smoke two packs a day as an antidepressant and to cope with stress, rather than for casual recreation? Dopamine receptor changes would seem to constitute a neuro-behavioral 'callus' to shield against further psychological pain, such as stress. Similar to physical calluses, mental calluses would not be expected to occur in the absence of pain.

"Studies in humans and animal models indicate that stress can lead to both vulnerability to develop addiction, and increased drug taking and relapse in addicted individuals." [Briand L, and Blendy J, "Molecular and genetic substrates linking stress and addiction," Brain Research, Nov. 10, 2009, 2009]. Stress is always present, hence people may be oblivious to the fact that they are easing pain with pleasurable foods. Furthermore, treatment of substance dependence generally necessitates that the person learn how to cope with life without using the substance. Kids have posted that they've lost weight once they realized that they were using food to cope and had become addicted and that food should be used only for nutrition.

A poll on our site provides the definition of addiction. The kids are then asked, "Do you think that you are addicted to food?" Most kids responding thus far say "yes." Most of those specify, "only to certain foods."

As kids presumably become addicted to highly pleasurable foods in the process of comfort eating, this implies that, in order to break their addiction, obese kids must go through withdrawal and then develop other ways to comfort themselves and deal with stress, sadness, and boredom without turning to food.

Dr. Robert Pretlow graduated with honors from Princeton University. He received his MD from the University of Virginia Medical School, where he also did his internship and residency in pediatrics. He is board certified in pediatrics and is a fellow of the American Academy of Pediatrics. He has a Master of Science in electrical engineering from Old Dominion University.

Dr. Pretlow has published 13 articles, has been awarded 5 U.S. patents, and has presented 41 abstracts, keynotes, plenaries, panels, and tutorials at national and international conferences. He lectures frequently on overweight in children and teens and use of the Internet in medicine.

Dr. Pretlow is founder and director of Weigh2Rock, an online weight loss system for teens and preteens, used by clinics, schools, private practitioners, hospitals, community centers, and health clubs, worldwide. http://Weigh2Rock.com

He has two children, a boy and a girl.

Overweight kids are seldom heard and poorly understood. This book presents what kids say about being overweight - their stories, struggles, and successes - in their own words.

The source is 134,000 messages anonymously posted by overweight kids on website bulletin boards. With stunning honesty, these kids share their difficult lives and their frustration with parents and health professionals.

The degree to which these kids struggle to lose weight is striking. They turn to food to relieve depression, stress, and boredom. They get hooked on this 'comfort eating' and are unable to stop. They struggle to resist cravings for highly pleasurable food, knowing full well the dreadful effects of weight gain, which points to an addictive-type dependence. Their success stories are inspiring.

The book examines what's really causing the childhood obesity epidemic, the 'why now,' and what might be done about it from a treatment, prevention, and policy standpoint.

Praise for OVERWEIGHT: WHAT KIDS SAY:

"This outstanding book offers new insights into the causes of the childhood obesity epidemic by a pioneer in the field. The emotional messages from the kids themselves are oftentimes heartbreaking. The book offers fresh ideas for stemming the problem and preventing it from worsening. A major contribution to the field."
-- John Foreyt, Ph.D.
Professor in the Department of Pediatrics, the Department of Psychiatry, and the Department of Medicine at Baylor College of Medicine, Houston, TX.

"Dr. Pretlow's book reveals the pain and struggle of obese children from THEIR point of view, thus providing unique and valuable information about the childhood obesity epidemic. Dr. Pretlow presents solutions -- his take on what should be done to treat childhood obesity and to prevent it. A must-read for anyone seeking to hear the voice of obese children and the advice of a pediatrician who has been listening to these children for the past 10 years."
-- Barbara J. Moore, PhD
President and CEO of Shape Up America! Founded in 1994 by C. Everett Koop, former U.S. Surgeon General http://ShapeUp.org

"I must congratulate you on having the bravery to persist on this amazingly TRUE piece of work. It really resonates true because it is what they say."
-- Rose Marie Thomas, MD, FAAP.
Dr. Thomas is a pediatrician and directs the Frontier Kids weight loss program on Trinidad-Tobago in the West Indies.