Food Mediated Executive Dysfunction

2 January 2011


Oscar Wilde
Oscar Fingal O'Flahertie Wills Wilde is one of my favorite authors. By way of introduction (if you need one), he was an Irish writer, poet, and prominent aesthete who died destitute in Paris at the age of forty-six. I discovered Wilde  in my early twenties when I came across The Picture of Dorian Gray in the College Hill Bookstore in Providence, Rhode Island. Since then, I have read most of his works and have developed a keen appreciation for his intelligence and epigrams. One of my favorite Oscar Wilde observations is this: 

"The final mystery is oneself"

The pith of the epigram is both insightful and substantive. Insightful I assert because to a great extent he is right, people do not quite understand the network of factors that influence their own behavior. In my opinion, many people consider the controlling determinants of their behavior to be a bit of a mystery. I claim the observation is substantive because if people did understand the factors controlling their behavior they would be in a better position to manage the prevailing contingencies and promote their own health, abundance, and happiness. I have dedicated my career to the study of such influences and teaching others how to optimize their own lives and the lives of others. In fact, I would say that is my primary professional aim. Related to that goal, I have a particular interest in teaching people how to optimize their behavior in relation to food and exercise. 
B.F. Skinner and the Buffet Table
At the same time I was reading Oscar Wilde and advancing my literary interests, I was also reading another author, B.F. Skinner, while pursuing the study of experimental psychology. I was a freshman in college when I read Skinner's book Science and Human Behavior. I confess, I did not read the book because of a specific interest in behaviorism, rather, my motivation was induced by the human services organization that I worked for at the time. Specifically, the behaviorally-oriented administrators of the agency gave each employee $20.00 for every chapter read, providing the employee could pass an exam and show mastery of the material. I quickly learned that $20.00 (circa 1976) would fill my little red TR-6 with gas and stock my cupboards with groceries for seven days. In consequence, I read a chapter each week, took an exam, and pocketed the twenty dollars. However, something curious happened - by the end of the third chapter in the book, entitled Why Organisms Behave, I was fascinated and I began "studying" the text rather than reading for cursory comprehension and a $20.00 reward. I have been studying the philosophy of behaviorism and the science of human behavior ever since. I found Skinner's analysis of human behavior compelling. In fact, I recall one particular insight that is relevant to the current post, that is, Skinner asserts that there is no requirement for a person to understand the contingencies that control their behavior. I think that this observation has particular relevance regarding our actions in the presence of food, that is, many people are governed by food in ways they cannot describe. Anyone that has lost personal control connected to food will be able to relate to Skinner's observation. For example, you may be unaware of the network of factors controlling your ingestive behavior, such as: biochemical influences; your chemosensory system; social factors; time of day; the amount of time between meals; alcohol and nicotine usage; visual stimuli in your environment (e.g., the LOVIN IT sign on the side of a bus or commercials on the television); your private verbal behavior; the body weight of your closest companions, your spouse, or partner; your physical activity level; your hormone levels (e.g., Leptin); and prescription medications. In short, you may regard your eating behavior to be the byproduct of unidentifiable and unnameable forces. As a behavior analyst interested in human ingestive behavior, I can tell you that there are discoverable, identifiable, and manageable factors controlling your eating behavior that you can learn to manage. If Skinner observed the current obesity epidemic in the United States, he would encourage us to systematically study the ingestive behavior of individuals, identify the variables that give rise to unhealthy eating and weight gain, methodically manipulate putative controlling variables, and evaluate the results. I have no doubt that Skinner would encourage us to sharpen our pencils, observe people at the buffet table, and record their patterns of behavior as a natural scientist would observe and record any other phenomenon: with curiosity and without judgement. 
Healthy People Plan Actions 
For members of the Cameron Behavioral Medicine Network (CBMN) there are two practices that conduce a behavioral cusp. A cusp, incidentally, is "a behavior change that has consequences for the organism beyond the change itself, some of which may be considered important". A behavioral cusp provides a person with opportunities to: 

• Access diverse reinforcers (e.g., self control and self efficacy) 
• Make contact with new contingencies
• Access relevant environments
• Access new associated behaviors (generativeness)
• Engage in behaviors that compete with aberrant repertoires (e.g., nonstandard eating patterns)
• Impact an entire network of people that agree on the social relevance of the behavior change

The two practices that promote a behavioral cusp are: (1) meal and snack planing (including restaurant planning), and (2) recording your adherence to your food plan. In my experience with CBMN group members, I can say without hesitation that disorganization, poor regulation, and ambiguity around food is evidence of a certain kind of an executive functioning problem; in fact, I will refer to this problem as Food Mediated Executive Dysfunction (FMED). In order to develop structure around food, the following skills are required: 

1. Planning and decision making 
2. Dynamic adjustment and troubleshooting 
3. Preparation for unexpected events (e.g., being hungry while attending a social gathering) 
4. Preparation for events that require the overcoming of strong behavioral responses 

The skills outlined above are essential, and once acquired, differentiates the "thinking" person's approach to weight control and health management from a person who simply restricts calories and deprives themselves. More to the point, the thinking person's approach can be compared to a hypo-caloric diet wherein you severely restrict your caloric intake. The latter approach requires only a single thought (restrict calorie intake) and ultimately the thought, and the results, are unsustainable. The former approach requires the development of a rich repertoire of essential skills that will produce desired results and lasting change. 
The process for activating "a thinking person's approach" involves a food category preference assessment (i.e., an assessment of preferences for foods from the primary food groups: grains, vegetables, fruits, healthy oils, daily, and protein). Subsequently, multiple versions of meal and snack menus need to be created. The menu below (for breakfast) is an excellent example of food planning from one of the CBMN members. It is important to note that the options below are based on personal preference, nutritional balance, response effort (e.g., preparation time), and the desire for variation. 
"THE WEEKENDER # 1" BREAKFAST SANDWICH: 1 egg +1 white on Ezekiel muffin w/ 1 oz melted cheddar cheese, 1 slice fat free Canadian bacon & tomato (350 calories)
"THE WEEKENDER # 2" ENGLISH LOX: 3 oz lox, 1 T whipped cream cheese on Ezekiel muffin w/ red onion & tomato (350 calories)
VEGGIE CHEDDAR OMELET: 1 egg + 1 white, 1 oz Swiss cheese, onion, spinach omelet (275 calories)
HOT CINNAMON OATMEAL:1 C steel cut oatmeal, 1/4 C skim milk, 1T protein powder, 1/4 C pomegranate (or 2 T raisins) 4 crumbled walnut halves, cinnamon & cardamom (325 calories)
THE OLE': 1/2 avocado on Ezekiel muffin with red onion & tomato slices (300 calories).


Restaurant planning can be accomplished by viewing a restaurant's menu on-line and deciding what foods will be ordered prior to entering the restaurant. This practice allows a member to develop clear language around food rather than entering the restaurant with ambiguous intentions. Once a member has completed their menu and restaurant planning, they generate a daily "adherence score", that is, they report on the percentage of the plan they followed. Subsequently, they will report their adherence to their behavioral community. The process of menu and restaurant planning is particularly important around the holidays when the likelihood of defaulting to previous established behavioral patterns (e.g., eating until you have to unfasten your pant button or belt) is high.
I agree with Wilde, the "final mystery is oneself". However, I believe that Skinner has given use the conceptual frame to identify the variables that control human behavior. The Cameron Behavioral Medicine Network seeks to study each individual's pattern of ingestive behavior and identify the critical variables to promote their optimal health.
CBMN Summary Points

• There are multiple discoverable, identifiable, and manageable factors related to nonstandard eating patterns. Skinner would encourage us to study an individual's ingestive patterns. 
• Members must develop a rich repertoire of planning and problem solving skills and take a "thinking person's approach" to weight control and optimal health. This is in contrast to a hypo-caloric diet and a "single thought approach" (i.e., restrict calories). 
• Many of the difficulties centered on dysregulated eating can be traced to a general level of disorganization around food - I refer to this as Food Mediated Executive Dysfunction.
• An essential component of the CBMN model includes menu and restaurant planning. Planning is particularly important during high risk situations (e.g., weekends, holidays, vacation).
• Once a plan is develop, an "adherence score" should be generated on a daily basis and reported to the behavioral community.

I am here for me, I am here for you. Happy New Year!                                       Dr. Michael J. Cameron