Treatment of child/adolescent obesity using the addiction model: a smartphone app pilot study

Robert A Pretlow, Carol M Stock, Stephen Allison, Leigh Roeger, Robert A Pretlow, Carol M Stock, Stephen Allison, Leigh Roeger

Abstract

Background: The aim of this study was to test a weight loss program for young people based on an addiction treatment approach.

Methods: A pilot study (n=43) was conducted of a 20-week child/adolescent obesity intervention based on an addiction treatment model (staged, incremental withdrawal from problem foods, snacking/grazing, and excessive amounts at meals) and implemented by a server-integrated smartphone app with health professional support. The primary outcome was standardized %overBMI measured at four time points. Secondary outcomes were participants' self-ratings of self-esteem, control over food, and the degree they turned to food when stressed. User satisfaction data were collected with an online questionnaire. Latent growth modeling techniques were used to identify independent variables and possible mediating treatment process variables associated with weight change.

Results: Mean age of participants was 16 years (range, 10-21), 65% girls, and 84% Caucasian. Twenty-seven (63%) completed the program. There was a significant decrease in %overBMI over time of 7.1. There were significant improvements in participant ratings of self-esteem, control over food, and a reduction in turning to food when stressed. Males, younger participants, and participants with higher levels of program compliance achieved better weight loss. Participants who reported that calling obesity an addiction made their guilt worse experienced poorer weight loss. Females were more likely than males to report "addiction guilt," and this partly mediated the overall gender effect.

Conclusions: The staged, incremental food withdrawal approach was feasible to implement and was useful in helping reduce excessive weight, particularly among boys.

Figures

Figure 2.
Figure 2.
Weight change %overBMI.
Figure 1.
Figure 1.
Screen shot of front app page.
Figure 3.
Figure 3.
Latent growth curve analysis path diagram for mediation model. *p<0.05; **p<0.01.

References

    1. Ludwig DS. Weight loss strategies for adolescents: A 14-year-old struggling to lose weight. JAMA 2012;307:498–508
    1. Waters E, de Silva-Sanigorski A, Hall BJ, et al. . Interventions for preventing obesity in children. Cochrane Database Syst Rev 2011;(12):CD001871.
    1. Pretlow RA. Addiction to highly pleasurable food as a cause of the childhood obesity epidemic: A qualitative Internet study. Eat Disord 2011;19:295–307
    1. Murray S, Tulloch A, Gold MS, et al. . Hormonal and neural mechanisms of food reward, eating behaviour and obesity. Nat Rev Endocrinol 2014;10:540–552
    1. Wang GJ, Volkow ND, Thanos PK, et al. . Similarity between obesity and drug addiction as assessed by neurofunctional imaging: A concept review. J Addict Dis 2004;23:39–53
    1. Lee A, Gibbs SE. Neurobiology of food addiction and adolescent obesity prevention in low- and middle-income countries. J Adolesc Health 2013;52(2 Suppl 2):S39–S42
    1. Volkow ND, Wise RA. How can drug addiction help us understand obesity? Nat Neurosci 2005;8:555–560
    1. Potenza MN. Biological contributions to addictions in adolescents and adults: Prevention, treatment, and policy implications. J Adolesc Health 2013;52(2 Suppl 2):S22–S32
    1. Merlo LJ, Klingman C, Malasanos TH, et al. . Exploration of food addiction in pediatric patients: A preliminary investigation. J Addict Med 2009;3:26–32
    1. Mogul A, Irby MB, Skelton JA. A systematic review of pediatric obesity and family communication through the lens of addiction literature. Child Obes 2014;10:197–206
    1. Overeater Anonymous. 2010 membership survey report [brochure]. 2010. Available at Last accessed March4, 2015
    1. Chehab LG, Pfeffer B, Vargas I, et al. . “Energy Up”: A novel approach to the weight management of inner-city teens. J Adolesc Health 2007;40:474–476
    1. Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics 2007;120(Suppl 4):S164–S192
    1. Fabricatore AN. Behavior therapy and cognitive-behavioral therapy of obesity: Is there a difference? J Am Diet Assoc 2007;107:92–99
    1. Li JS, Barnett TA, Goodman E, et al. . Approaches to the prevention and management of childhood obesity: The role of social networks and the use of social media and related electronic technologies: A scientific statement from the American Heart Association. Circulation 2013;127:260–267
    1. Cole TJ. The LMS method for constructing normalized growth standards. Eur J Clin Nutr 1990;44:45–60
    1. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, et al. . CDC growth charts: United States. Adv Data 2000;(314):1–27
    1. Kelly KP, Kirschenbaum DS. Immersion treatment of childhood and adolescent obesity: The first review of a promising intervention. Obes Rev 2011;12:37–49
    1. Paluch RA, Epstein LH, Roemmich JN. Comparison of methods to evaluate changes in relative body mass index in pediatric weight control. Am J Hum Biol 2007;19:487–494
    1. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986;51:1173–1182
    1. Wu W, West SG, Taylor AB. Evaluating model fit for growth curve models: Integration of fit indices from SEM and MLM frameworks. Psychol Methods 2009;14:183–201
    1. Muthén LK, Muthén BO. Mplus User's Guide. Seventh edition. Muthén & Muthén: Los Angeles, CA, 1998–2012
    1. Ifland JR, Preuss HG, Marcus MT, et al. . Refined food addiction: A classic substance use disorder. Med Hypotheses 2009;72:518–526
    1. Davis MJ, Addis ME. Predictors of attrition from behavioral medicine treatments. Ann Behav Med 1999;21:339–349

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