Online Social Network Helps Obese Kids Resist Problem Foods

Daniel M. Keller, PhD

May 15, 2012

May 15, 2012 (Lyon, France) — Anonymous social networking — online and on smart phones — helps obese youth to cope with their condition, resist problem foods, manage their eating, and lose weight.

Robert Pretlow, MD, MSEE, from eHealth International in Seattle, Washington, has used an addiction medicine approach and designed a Web site and smart phone app to combat substance (food) abuse. He presented the program and some early results here at the 19th European Congress on Obesity.

His program involves anonymous social support networks, such as Alcoholics Anonymous and Gamblers Anonymous, Support groups are indispensable in addiction medicine, and anonymity is crucial to help avoid shame and embarrassment.

Users of the Web site enter their first names, heights, and weights; the system identifies them by their Internet protocol addresses so that the site can track them over time. Various information is stored on separate computer servers, and confidentiality is maintained.

From June 2000 to September 2010, 29,406 unique users 8 to 21 years of age (mean, 14.2 ± 2.0 years) anonymously posted 41,535 messages and 93,787 replies on the message board. Most users (94%) were female. Mean self-reported body mass index (BMI) was 33.7 ± 7.4 kg/m².

Social Networks Combat Food Addiction

Studies have found that overweight children eat more when they are out with other overweight kids; the group legitimizes members using food to escape their problems. When a person becomes obese, the risk of his or her friends becoming obese rises by more than 50%.

Problem foods are highly pleasurable, provide comfort, and the abuser seeks them out, Dr. Pretlow explained. Problem eating is associated with changes in the brain that are demonstrable with neuroimaging. These changes can reinforce the food-seeking behavior, setting up a vicious cycle.

Social networks can help counter overeating. is for preteens, teens, and parents, and attracts 50,000 to 100,000 visitors each month. The site extended its membership age to 25 years as members have aged out of the teen years.

The site provides questions and answers, a weight calculator, members' weigh-in results, information on foods, medical articles, polls, and importantly, success stories and social networking using chat rooms and message boards. A Kids Helping Kids section provides answers to other users' questions, advice about problems, plaudits, and other social support.

Each member is paired up with a "weight-loss buddy" for social support and acceptance to overcome the social isolation that can result in "comfort eating," and for motivation, accountability, mutual problem solving, and resisting cravings and binges.

"Over the past 12 years, these kids have posted more than 140,000 messages," Dr. Pretlow said. Of all the thousands of visitors each month, almost all of them are "lurkers," meaning that they read what is there but do not interact on the message boards. "A very small fraction actually do any interacting at all, but the others seem to benefit because they keep coming back," Dr. Pretlow said.

Messages can be very candid. One 15-year-old girl said she "was never this open" with anyone about her weight, "not even my family." Dr. Pretlow told Medscape Medical News that the message boards are moderated; inappropriate messages are deleted and the people posting them can be banned from the site.

Web Site and App Provide a Therapeutic Effect

Beyond social support, the Web site appears to provide a true therapeutic effect. Preteens and teens using the Web site lost a mean of 3.4 kg.

A free smart phone app for iPhones and iPod Touches, called W8Loss2Go, makes the system portable and gives members the tools to deal with food when they are out. It is designed so that all the tools are resident on the iPhone or iPod so that no connection to the Internet or cell phone network is needed to make it work.

Among the many tools in the program is one that allows kids to put a picture of their face (shot with the device's camera) on a body that they can make fatter or thinner to see how they would look, Dr. Pretlow explained. He said both views appear to motivate the users.

A tool to dissuade eating is a series of pictures of disgusting objects — bugs on food, rotting food, dead animals, a dirty toilet, and even worse. The kids say it really works when they have a food craving.

Dr. Pretlow has completed a 19-week pilot study with 12 participants, 10 to 23 years of age, who were in the 96th BMI percentile.

They lost an average of 4.8 kg and reduced their BMI by an average of 1.6 kg/m2. Mean weights decreased through week 5, rose a bit through week 8, and then decreased through week 16, when they essentially plateaued through week 19. A larger trial of the app involving 30 participants is scheduled to begin next month.

Although Dr. Pretlow said the weight loss from social networking is not as much as from face-to-face weight loss programs, the Web site and app are free and more widely available. They also are useful for weight maintenance or relapses, and can be used indefinitely. He hopes to be able to provide iPhones or iPod Touches to schools for them to lend to overweight students.

Session moderator Chantal Simon, MD, PhD, professor of nutrition at the University of Lyon Medical School in France, told Medscape Medical News that she is very interested by the approach that Dr. Pretlow is taking.

"The food industry is using a lot of these tools, [but] we don't use these," Dr. Simon said.

She sees this sort of system as a useful tool for physicians; Dr. Pretlow has heard from a pediatrician that he now has "a place to send overweight kids."

Dr. Simon said a potential danger of this anonymous system with rather open communication is that it could possibly counteract other supportive or therapeutic approaches, "through obesity modeling or other negative inputs." In addition, the anonymity and the fact that the system is computer-based could enhance social isolation.

She added that this was a small study. "I think that we need a better constructed and evidenced study with a control group."

Dr. Simon suggested that it might be good to test a similar system for adults. "The smart phone can give some messages during the day, even when you are not in front of your computer.... [It could be a] complementary strategy to increase self-esteem and behavior changes. We have to try this," she said.

Dr. Pretlow's research institute, eHealth International, owns the Web site and the smart phone app, both of which he has been funding himself. They are both free to users. Dr. Simon has disclosed no relevant financial relationships..

19th European Congress on Obesity (ECO): Abstract 46. Presented May 10, 2012.


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