Published online August 1, 2008
PEDIATRICS
Vol. 122
No. 2
August 2008, pp.
476
(doi:10.1542/peds.2008-1143)
Overweight and Obesity in Childhood
Robert A. Pretlow, MD
Department of Pediatrics,
eHealth International,
Seattle, WA 98121
To the Editor.—
The critique of the recommendations of the Expert Committee on Assessment and Treatment of Child and Adolescent Overweight and Obesity in the April 2008 issue of Pediatrics is exemplary.1 Although the efforts of the expert committee in generating best-evidence guidelines are to be commended, it is also noteworthy that there are no guidelines in regard to the emotional reasons for overeating in youth. Food is used as a stress coping mechanism (comfort eating, displacement activity), for self-medication (depression, anxiety), and for entertainment (to combat boredom). This is evidenced in numerous posts collected over a 3-year period from an open-access online forum for overweight teens and preteens (www.weigh2rock.com/emotional-eating). Moreover, the degree to which children and adolescents struggle to lose weight is striking (www.weigh2rock.com/struggles). This forum has existed for 7 years and receives 
4 to 10 posts per day.
Compelling evidence points to overeating as a form of substance abuse,2 which may constitute a significant contribution to the childhood obesity epidemic. Highly pleasurable food qualifies as an addictive substance per US Food and Drug Administration criteria (user craves it, user ignores risks to health, and it is psychoactive).3 The food industry overtly markets emotional benefits of food (eg, "Comfort in Every Bar" [MilkyWay candy], "Happy Meal" [McDonald's]). In the report "Stress in America,"4 48% of those surveyed felt that their stress had increased over the previous 5 years; 43% overate when they were under stress. The majority of foods eaten when under stress are high-pleasure foods: junk food.
A 16-year-old girl summed it up: "A teen who does drugs or smokes would get in trouble if their parents found out. But no one's going to ground you for eating, which can be equally as damaging, and is equally as difficult to stop" (www.blubberbuster.com/poll/comments_62.htm).
Perhaps overweight and obesity in childhood should be treated similarly to forms of substance abuse by (1) sequential weaning from each abused food or excessive portion size, (2) management of resulting withdrawal symptoms, (3) education on coping skills, and (4) long-term support to prevent relapse. Public policy would control exposure of children to abused foods.
REFERENCES
- Bowdoin JJ. A response to
the Expert Committee's recommendations on the assessment, prevention,
and treatment of child and adolescent overweight and obesity.
Pediatrics. 2008;121
(4):833
–834[Free Full Text]
- Food and Addiction, Conference at Yale University. Available at: www.weigh2rock.com/articles/Yale_Food_Addiction_Conference.html. Accessed December 8, 2007
-
Kessler D. Remarks by David A. Kessler, M.D., Commissioner of Food and
Drugs; National Association for the Advancement of Colored People,
Solomon's Island, Maryland: October 21, 1994. Available at: www.fda.gov/bbs/topics/SPEECH/SPE00058.htm. Accessed June 11, 2008
- American Psychological Association. Stress in America. Available at: http://apahelpcenter.mediaroom.com/index.php?s=pageA. Accessed June 11, 2008
PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics
