Kids Hooked on Food

1. Kids Hooked on Food Virginia Summer Institute for Addiction Studies Williamsburg, Virginia

2. My Favorite Food

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4. Addictions Drugs Alcohol Nicotine Caffeine

5. Addictions? Sitcoms Facebook Shoes Love

6. Food Addiction A real affliction or really fiction? Is food truly an addiction? What about compulsive overeating? Do they meet the necessary criteria?

7. Do You Have a Food Addiction? Has anyone ever told you that you have a problem with food? Do you think food is a problem for you? Do you eat large amounts of high calorie food in a short period of time? Do you find yourself fearful of gaining weight? Do you eat when you are disappointed, tense or anxious? Can you stop eating without a struggle after one or two sweets? Do find yourself preoccupied with gaining weight? Has being overweight ever affected any part of your life? Do you weigh yourself once or twice (or more) a day? Do you eat more than you planned to eat? www.addictionrecov.org/foodid.aspx

8. Do You Have a Food Addiction? Have you hidden food so that you would have it just for yourself? Have you ever felt angry when someone ate food you saved for yourself? Do you worry that you can�t control how much you eat? Have you felt frantic about your size, shape or weight? How many methods of weight loss have you tried in the past? (i.e., self induced vomiting, laxatives, diuretics, fasting, amphetamines, weight loss programs, etc.) Have you ever felt so ashamed of the amount you eat that you hide your eating? Have you been so upset about the way you eat that you wished you would die? Do you overeat more than twice a week? Do you invent plans in order to be alone to eat? Do you seek out companions who eat the way you do?

9. Alcoholism �Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic: impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial.� National Council on Alcoholism & Drug Dependence, 2009

10. Food Addiction Food addiction is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic: impaired control over eating, preoccupation with food, overeating despite adverse consequences, and distortions in thinking, most notably denial.

11. Definition According to Kay Sheppard, a pioneer in the treatment of food addiction, "the term food addiction implies there is a biochemical condition in the body that creates a physiological craving for specific foods. This craving, and its underlying biochemistry, is comparable to an alcoholic's craving for alcohol" (a refined carbohydrate). 

12. Just as alcohol is the substance that triggers the alcoholic's disease, there are substances that trigger a food addict's out-of-control eating. These substances are typically refined carbohydrates, sweeteners, fats and processed foods. These foods seem to affect the same addictive brain pathways that are influenced by alcohol and drugs. www.foodaddictionsummit.org

13. �The process of addiction is mediated through brain mechanisms underlying reward or reinforcement�The brain does not seem to differentiate whether the reward is provoked by natural rewards, licit or illicit drugs, gambling, or extreme environmental manipulations�� Gold, Frost-Pineda & Jacobs, 2003

14. Brain Food

15. Many of the food addiction studies involve the dopamine system, one of the two main reward systems of the brain Dopamine provides stronger and more immediate pleasure

16. Dopamine D2 Receptors

17. Paying Attention to Labels

18. Substance Dependence A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: DSM-IV-TR, 2000

19. Substance Dependence (1) tolerance, as defined by either of the following: (a) a need for markedly increased amounts of the substance to achieve intoxication or the desired effect (b) markedly diminished effect with continued use of the same amount of the substance

20. Substance Dependence (2) withdrawal, as manifested by either of the following: (a) the characteristic withdrawal syndrome for the substance (b) the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms

21. Substance Dependence (3) the substance is often taken in larger amounts over a longer period than was intended (4) there is a persistent desire or unsuccessful efforts to cut down or control substance use (5) a great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects

22. Substance Dependence (6) important social, occupational, or recreational activities are given up or reduced because of substance use (7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance

23. SD or BED? Binge-eating Disorder affects more than 8 million men and women and accounts for three times the number of those diagnosed with Anorexia and Bulimia together. BEDA, 2009

24. Binge-eating Disorder 307.50 Eating Disorder Not Otherwise Specified Bing-eating Disorder-recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of Bulimia Nervosa DSM-IV-TR, 2000

25. Binge-eating Disorder Recurrent episodes of binge eating Episodes are associated with three (or more) of the following: (1) eating much more rapidly than normal (2) eating until feeling uncomfortably full (3) eating large amounts of food when not feeling physically hungry (4) eating alone because of being embarrassed by how much one is eating (5) feeling disgusted with oneself, depressed, or very guilty after overeating

26. C. Marked distress regarding binge eating is present D. The binge eating occurs, on average, at least 2 days a week for 6 months

27. Life with BED

28. Profiles of BED Moody Blues Binger Angry Binger Low Self-esteem Binger Nail-biting Binger Running-on-empty Binger Bedroom Binger Midnight Binger Drive-through Binger Party Hearty Binger Buffet Binger Bulik, 2009

29. Profiles of BED Moody Blues Binger food=mood Angry Binger unable to address conflict directly suppressed angry feelings Low Self-esteem Binger food=relief from misery

30. Profiles of BED Nail-biting Binger stress, anxiety, tension Running-on-empty Binger prolonged periods of time w/o eating Bedroom Binger one night stand/longtime love affair

31. Profiles of BED Midnight Binger Night-eating Syndrome (over half of daily intake) Drive-through Binger-car can be a high-risk venue Party Hearty Binger-natural opioid system responds to sweets & alcohol in the same way Buffet Binger-getting the money�s worth

32. Eating DisorderorDisordered Eating?

33. Disordered Eating Comfort, Soothe, Nurture Numb, Sedate, Distract Attention, Cry for Help Discharge Tension, Anger, Rebellion Predictability, Structure, Identity Self-punishment or Body Punishment Protection or Safety Avoid Intimacy Self-blame

34. Common Ingredients

35. Common Triggers Breaking a Rule anxiety of a broken diet rule� Being Hungry to maximize pleasure drop in�blood sugar levels Feeling Bad negative (and even positive) emotions

37. Don�t Blow It!

38. Common Development Biological Genetics Brain Chemistry Central Nervous System

39. Common Development Psychological Low Self-worth Impulse Control Mood Regulation Anger Suppression

40. Common Development Sociocultural Strive to Attain Ideal Value Acceptance Relationship to Self and Others

41. Can Kids be Hooked on Food?

42. Childhood Obesity Food addiction is only one aspect of the complex issue of obesity. Brownell, 2007

43. Childhood Obesity For the first time in two centuries, due to the rapid rise in the rate of childhood obesity, the current generation of children will have a shorter life expectancy than their parents. The New England Journal of Medicine, 2005

44. Childhood Obesity Approximately 9 million children over the age of 6 are obese. CDC, 2008 Over the past three decades, the prevalence of obesity in children has nearly tripled. Ogden, Carroll, & Flegal, 2008

45. Is BMI interpreted the same way for children and teens as it is for adults? Although the BMI number is calculated the same way for children and adults, the criteria used to interpret the meaning of the BMI number for children and teens are different from those used for adults. For children and teens, BMI age- and sex-specific percentiles are used for two reasons: The amount of body fat changes with age. The amount of body fat differs between girls and boys. The CDC BMI-for-age growth charts take into account these differences and allow translation of a BMI number into a percentile for a child's sex and age. For adults, on the other hand, BMI is interpreted through categories that do not take into account sex or age. www.cdc.gov

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48. Childhood Obesity Outcomes Type II Diabetes Hypertension Cardiovascular Disease Sleep Apnea

49. Other Outcomes Disordered Eating Eating Disorders Poor Body Image Body Dysmorphic Disorder Psychological Difficulties Social Stigma Adult Obesity

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54. Anorexia Nervosa Self-harming Behaviors Anxiety Disorders Obsessive Compulsive Disorder Social Phobia Mood Disorders Substance-related Disorders

55. Pro-ana �We have ana pride. We do not want to be normal, we do not want to get fat again, we want to be skinny and perfect forever.�

56. Bulimia Nervosa Bingeing and purging are associated with higher levels of substance abuse. Cocaine and methamphetamines used to decrease appetite and lose weight. Ritalin and Dexedrine snorted for appetite suppressant and weight loss.

58. What is Body Image? A term that refers to a person�s inner picture of his or her outward appearance. It has two components: perceptions of the appearance of one's body & emotional responses to those perceptions.

59. Body Image 42% of girls (grades 1-3) want to be thinner 80% of these girls have dieted by age 10 50% of kids (ages 8-10) say they are unhappy with their size 81% of 10 year olds are afraid of being fat NIH, 2005

60.  Assessing Body Image

61. Diet�Diet�Diet

62. $$$$$$$$$$$$$$$$$$$$$$$$$$$$$ Americans spend over $40 billion on dieting and diet-related products each year!

63. Diet�Diet�Diet 25% of American men and 45% of American women are on a diet on any given day 46% of kids (9-11) are sometimes/very often on diets and 82% of their families are sometimes/very often on diets 35% of �normal dieters� progress to pathological dieting. Of those, 20-25% progress to partial or full-syndrome eating disorders Hoek, 1995

64. �Dieting� Children Parents often put overweight children on diets Dieting is a risk factor for body dissatisfaction Paxton, Eisenberg, & Neumark-Sztainer, 2006 �Pressuring� the child is ineffective & can lead to overeating Overweight children, teased by family members, are 300% more likely to consider suicide Eisenberg, Neumark-Sztainer, & Story, 2003

65. Body Dysmorphic Disorder Body dysmorphic disorder (BDD) is defined by DSM-IV-TR as a condition marked by excessive pre-occupation with an imaginary or minor defect in a facial feature or localized part of the body. The diagnostic criteria specify that the condition must be sufficiently severe to cause a decline in the patient's social, occupational, or educational functioning.

66. Body Dysmorphic Disorder The most common cause of this decline is the time lost in obsessing about the �defect.� One study found that 68 % of patients in a sample of adolescents diagnosed with BDD spent three or more hours every day thinking about the body part or facial feature of concern.

67. Psychological Difficulties Poor Body Satisfaction Low Self-esteem Mood Disorders Obese individuals almost twice the rate of depression as those with a normal weight Jones-Cornielle, Waden, & Sarwer, 2007

69. Social Stigma Latner & Stunkard (1961 then 2003) Rank 6 Drawings of Children 458 5th & 6th Graders Ratings for Obese Drawing Lowest Children as young as�three are more likely to consider overweight peers to be mean, stupid, ugly and sloppy.

70. Stigma �The quality of life for kids who are obese is comparable to the quality of life of kids who have cancer. These kids are facing stigma from everywhere they look in society, whether it's media, school or at home.�--Rebecca M. Puhl of Yale's Rudd Center for Food Policy and Obesity http://www.youtube.com/watch?v=bCJe42LGnB4

71. Stereotypes Are viewed as social deviants and are blamed for their condition Crandall, 1994; DeJong, 1993; Rothblum, 1992 Less hard working, less strong, less self-restrained, and less stable Hebl, 1997 Slower, sloppier, and lazier Ryckman, Robbins, Kaczor, & Gold, 1989

72. Stereotypes Are less likely to be hired Pingitore, Dugoni, Tindale, & Spring, 1994 More likely to be assigned to the least desirable sales areas Bellizzi & Hasty, 1998; Bellizzi, Klassen, & Belonax, 1989 Less likely to receive promotions Rothblum, Brand, Miller, & Oetjen, 1990 More likely to receive poor customer service King, Shapiro, Hebl, Singletary, & Turner, 2006

73. Stigma of Obesity Employment Discrimination Overweight employees are seen as lazy, sloppy, less competent & lacking self-discipline Health Care Discrimination Patients viewed as unintelligent, weak-willed & overindulgent BMI & appointment cancellations Obesity Specialists Educational Discrimination Average weight college students ? parents Overweight students ? financial aid & jobs Fairburn & Brownell, 2002

74. What is theSize Stereotypeof Minorities in the Media?

75. Norbit Big Momma Klumps Nutty Professor

76. Minority Differences African-American TV programming contains more commercials focusing on: Fast-food vs. Dine-in restaurants More candy, sweets, soda, meat, eggs, & baking mixtures Less on bread, grains, cereal, pasta, fruits, vegetables, & 100% juice, Even fewer commercials (0%) on a lighter, leaner diet Henderson & Kelly, 2005

77. Minority Differences African-American children are over-represented in food commercials & under-represented in toy commercials. Bang & Reece, 2003

78. �Big is Beautiful� Movement

79. MTV True Life Roxie�s Body Beautiful Project

80. Adult Obesity Prevalence 2003�2004 Men 31.1% Women 33.2% 2005�2006 Men 33.3% Women 35.3% Over 59 Million People Ogden, Carroll, McDowell, & Flegal, 2007 

81. Adult Obesity 2007 We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980. We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.

83. Where to Focus First?

84. Environmental Factors Lack of Physical Activity Portion Size High Fat/Energy Dense Foods High Glycemic Index of Foods High Fructose Corn Syrup Fast Foods Accessibility of Fast Food Low Cost of Fast Food Palatability of Fast Food

85. What is the Glycemic Index? Not all carbohydrate foods are created equal, in fact they behave quite differently in our bodies. The Glycemic Index (GI) describes this difference by ranking carbohydrates according to their effect on our blood glucose levels. Choosing low GI carbs, the ones that produce only small fluctuations in our blood glucose and insulin levels, is the secret to long-term health reducing your risk of heart disease and diabetes and is the key to sustainable weight loss.

86. High Fructose Corn Syrup Until the 1970s most of the sugar we ate came from sucrose derived from sugar beets or sugar cane.� Then sugar from corn--corn syrup, fructose, dextrose, dextrine and especially High Fructose Corn Syrup (HFCS)--began to gain popularity as a sweetener because it was much less expensive to produce. High fructose corn syrup can be manipulated to contain equal amounts of fructose and glucose, or up to 80 percent fructose and 20 percent glucose. Thus, with almost twice the fructose, HFCS delivers a double danger compared to sugar.

87. High Fructose Corn Syrup High fructose corn syrup is extremely soluble and mixes well in many foods. It is cheap to produce, sweet and easy to store. It�s used in everything from bread to pasta sauces to bacon to beer, as well as in "health products" like protein bars and "natural" sodas.

88. High Fructose Corn Syrup Fructose reduces the affinity of insulin for its receptor, which is the hallmark of Type-2 Diabetes. This is the first step for glucose to enter a cell and be metabolized. As a result, the body needs to pump out more insulin to handle the same amount of glucose.

89. Fast Food or Fat Food? McDonald�s is spread over the world and feeds more than 46 million people worldwide a day. McDonald�s accounts for 43% of the fast food market in the US. In Super Size Me, a documentary by Morgan Spurlock, he gained 10 pounds in one week eating only McDonald�s food.

90. Unhappy Meal A survey of more than 3,000 infants and toddlers (4 to 24 months) found that French fries are the most commonly eaten vegetable for toddlers aged 15 to 24 months. Mathematica Policy Research, Inc., 2002

91. Soda is being served to infants as young as 7 months old. Mathematica Policy Research, Inc., 2002 The average American child sees over 7,600 food advertisements on television each year. Super Size Me, 2005

92. Cultural Shift for �Ideal� Body Image

93. Model Behavior? Most models are thinner than 98% of American women.

94. Super Stars?

95. Super Stars? How do they look so �super?� http://vodpod.com/watch/816923-diet-com-the-photoshop-effect http://vodpod.com/watch/16419-dove-evolution-original

96. Why Focus on Families? Critical environment for development Child�s first social world Learned coping behaviors Food is used to reduce stress & comfort

97. The Apple Doesn�t Fall Far Parent Overweight best predictor of Child Overweight Whitaker, Wright, Pepe, Seidel, & Dietz, 1997 When behavioral cost for food increases, parents and children chose alternative Epstein, Dearing, Temple, & Cavanaugh, 2008

98. Family Factors for Eating Disorders Chaotic Family Environment Critical Comments Maltreatment Family Overconcern about Dieting

99. Families with an Obese Child Stereotyped as dysfunctional or emotionally detached Often stressed with time & finances Many doctor�s visits & medications Harper, 2006

100. Neglect? Connor McCreaddie, 8, from Wallsend, North Tyneside His mother, Nicola McKeown, 35, had been called to a child protection conference with the local authority. "He refuses to eat fruit, vegetables and salads - he eats processed foods. When Connor won't eat anything else, I've got to give him the foods he likes. I can't starve him. But I'm confident I can get his weight down with a bit of help." Doctors say that Connor, at 218 lbs, is considered three times the average weight for his age, is at risk�for�severe medical problems.

101. Neglect? Anamarie Regino is 7 years old, 5-feet-1-inch tall and 200 pounds. Four years ago, she became the most publicized overweight youngster in New Mexico history when the state took her away from her family for 2 1/2 months.

102. Families with an Obese Parent Non-obese parent may criticize Child may also feel attacked Child may fear being confronted Obese parent likely to diet & be critical of self around child Jacobi, Agras, & Hammer, 2001

103. A Recipe for Change

104. Recommendations for BED Eat Breakfast Be Aware of �Stealth Sugars� Move the Body Use Technology Self-monitor Get support Get information Get inspiration Bulik, 2009

105. ED Treatment Plan Medical Issues Emotional or Psychological Issues Psychiatric Disorders Nutrition Exercise Associated Disorders Spiritual Condition www.recoveryconnection.org/binge-eating-disorder.php

106. ED Treatment Plan Individual Therapy Process Groups A Personalized Exercise Plan Cooking Groups Menu Planning Restaurant Outings Expressive Art Therapy Nutrition Education Walks on the Beach Mindfulness Groups Fitness Fusion Trauma Resolution Coping Skills Shame Reduction Relapse Prevention Family Therapy Spirituality Group Online Cont. Care Individual Sessions with a Registered Dietician An Individualized Meal Plan That is Not a Diet! www.montecatinieatingdisorder.com

107. Common Treatment Options Cognitive Behavioral Therapy Family Therapy Support Groups Medication (antidepressants)

108. Family-based Treatment Entire family invested in: Reducing sedentary behaviors Increasing nutritional choices Controlling food stimuli Practicing problem-solving & cognitive restructuring

109. Warning Signs Rapid weight gain Frequently eats an abnormal amount of food in a short period of time Eats rapidly (swallowing without chewing) Feeling a lack of control over one�s eating Secretive eating habits-eating alone, hiding food, etc.

110. Warning Signs Eating late at night Disgust and shame with self after overeating Hoarding food, especially high calorie/junk food Avoiding social situations, especially those involving food

111. Missing the Signs Slow and Steady Four Seasons (Fall & Winter) Hibernators Transitions Biology Loss Bulik, 2009

112. Tips for Parents #1 Make sure your child understands that weight gain is a normal part of development, especially during puberty.

113. Tips for Parents #2 Avoid negative statements about food, weight, and body size and shape.

114. Tips for Parents #3 Allow your child to make decisions about food, while making sure that plenty of healthy and nutritious meals and snacks are available.

115. Tips for Parents #4 Compliment your child on her or his efforts, talents, accomplishments, and personal values.

116. Tips for Parents #5 Restrict television viewing, and watch television with your child and discuss the media images you see.

117. Parent Power Model a positive body image. Explore own values and beliefs about weight, dieting, and body image. Examine current personal practices related to eating, exercise, and body image. Monitor your discussions concerning food consumption and body issues.

118. The Family Who Eats Together

119. Family Meals According to a survey conducted by the University of Minnesota, frequent family meals are related to better nutritional intake, and a decreased risk for unhealthy weight control practices and substance abuse. A Harvard study (March 2000) showed that eating family dinners together most or all days of the week was associated with eating more healthfully. The study showed that families eating meals together "every day" or "almost every day" generally consumed higher amounts of important nutrients such as calcium, fiber, iron, vitamins B6 and B12, C and E, and consumed less overall fat, compared to families who "never" or "only sometimes" eat meals together.

120. Family Meals Children who ate family meals consumed more fruits, vegetables and fewer snack foods than children who ate separately from their families. Children who frequently eat meals with their families tend to do better in school as well. And a survey of high-achieving teens showed that those who regularly eat meals with their families tend to be happier with their present life and their prospects for the future.

121. Family Meals About 18% of girls who eat only 1-2 family meals a week reported engaging in extreme weight control behaviors compared to 9% of girls who eat 3-4 family meals a week. More frequent family meals protect against tobacco, alcohol, and marijuana use, low grade-point average, depression, and suicide�particularly among adolescent girls. Dianne Neumark-Sztainer is an epidemiology professor in the University of Minnesota School of Public Health.

122. What a Healthy Relationship with Food Looks Like: A Lesson from Children

123. A Healthy Relationship with Food Stop eating when you are full. The goal is to feel content and satisfied after eating. If you feel sick or uncomfortable, you have eaten too much. Choose foods that make you feel satisfied, both in terms of taste and fullness. If you are craving a particular food and nothing else will do, then sit down, eat it and enjoy it. Depriving yourself of certain foods often leads to overeating later on. As well, experiment by eating more high fiber foods or adding a little protein or healthy fat at each meal - this can help you feel satisfied for longer. Make your food taste good. If you need to add a little sugar, fat, salt or some herbs or spices to make a food such as vegetables taste better, then do it. Who knows, maybe you will end up eating carrots because you enjoy them and not just because they are "good for you!"

124. A Healthy Relationship with Food Pay attention to what you eat. Focusing on the process of eating helps you tune into your body and makes it easier to stop when you feel satisfied. Sit down and savor each mouthful instead of distracting yourself by driving or watching television while you eat. Make family meal times a priority. Eating as a family can boost the enjoyment of meal times and actually help everyone eat more nutritiously. People generally prepare and choose healthier foods when eating as a family. www.homefamily.net

125. Resources for Parents

126. Other Resources BodyPositive: Boosting Body Image at Any Weight www.bodypositive.com/ Campaign for Real Beauty www.campaignforrealbeauty.com/ Dads and Daughters www.dadsanddaughters.org�� National Eating Disorders Association www.nationaleatingdisorder.org�� Body Image: Loving Yourself Inside and Out www.4women.gov/bodyimage Love Your Body www.loveyourbody.nowfoundation.org

127. Thank You!