There’s something missing from Weight of the Nation

There was scary news as well as news to inspire coming out of the first presentations at the Weight of the Nation, the forum sponsored by the U.S. Centers for Disease Control and Prevention taking place in Washington, D.C. The meeting began on Monday and ends today. It’s supposed to “highlight progress in the prevention and control of obesity through policy and environmental strategies, and is framed around five intervention settings: early care and education; states, tribes and communities; medical care; schools; and workplaces.”

According to NPR’s Shots health blog, the scary news was this:

In the new study, researchers estimate that obesity will continue to rise and will affect 42 percent of adults by 2030. (Obesity represents a body mass index score, a ratio of weight to height, of 30 or higher. Separate estimates for children aren’t calculated.)

The news that should inspire us to figure out a way to reduce obesity was this:

Slowing the rising rates of obesity in this country by just 1 percent a year over the next two decades would slice the costs of health care by $85 billion.

Keep obesity rates where they are now — well below a 33 percent increase that’s been expected by some — and the savings would hit nearly $550 billion over the same 20 years.

Today, the LATimes Booster Shots blog posted a review of the upcoming HBO four-part series “Weight of the Nation”, which begins airing May 14.

The program, produced in conjunction with the Centers for Disease Control and Prevention’s “Weight of the Nation” conference in Washington, D.C., balances on a knife’s edge between determined hope and realistic discouragement. In detailing the multiple health consequences of obesity, which now affects 36% of American adults and 17% of our children, the documentary sounds an alarm that is difficult to ignore: “To win,” says the series’ subtitle, “we have to lose.”

According to its web site, the HBO series divides the issue into four parts:

  • Consequences — “the scope of the obesity epidemic and the consequences of being overweight or obese”;
  • Choices —  all about fat, “revealing what science has shown about how to lose weight, maintain weight loss and prevent weight gain”;
  • Children in Crisis — looks at “school lunches to the decline of physical education, the demise of school recess and the marketing of unhealthy food to children”;
  • Challenges — examines “the major driving forces causing the obesity epidemic, including agriculture, economics, evolutionary biology, food marketing, racial and socioeconomic disparities, physical inactivity, American food culture, and the strong influence of the food and beverage industry”;

Here’s my concern:

Nowhere in the Weight of the Nation meeting agenda could I find any presentation that addresses this question: Why do people eat too much? It may be included in the HBO series, but there’s no indication from the series description.

This is a little ironic, considering that the CDC’s own Adverse Childhood Experiences Study (ACE Study) discovered the link between 10 types of childhood trauma and the adult onset of chronic diseases, many of which are caused by obesity. Specifically, heart disease, diabetes and some breast cancers.

What kind of childhood trauma? I’m not talking about falling on a playground and breaking a finger here. This trauma is relentless, gut-wrenching, life-bending, mind-warping: Living with an alcoholic parent or a parent diagnosed with depression or other mental illness. Witnessing a mother being abused (physically or verbally). Being physically, sexually or verbally abused. Losing a parent to abandonment or divorce. Although the study did not examine more than those, you can probably name a few others, such as homelessness, being bullied, having a serious illness such as cancer.

The study’s researchers came up with an ACE score to explain a person’s risk for chronic disease. Think of it as a cholesterol score for childhood toxic stress. You get one point for each type of trauma. The higher your ACE score, the higher your risk of health and social problems.

A whopping 70 percent of the 17,000 people in the ACE Study had an ACE score of at least one; 87 percent of those had more than one. With an ACE score of 4 or more, things start getting serious. The likelihood of chronic pulmonary lung disease increases 390 percent; hepatitis, 240 percent; depression 460 percent; suicide, 1,220 percent.

(By the way, lest you think that the ACE Study was yet another involving inner-city poor people of color, take note: The study’s participants were 17,000 mostly white, middle and upper-middle class college-educated San Diegans with good jobs and great health care – they all belonged to Kaiser Permanente, a health maintenance organization and one of the sponsors of the HBO series.)

Neurobiological research explains why the toxic stress of childhood trauma, which causes the continual release of an  overabundance of stress hormones, can lead to obesity: Toxic stress physically damages a child’s developing brain. This was determined by a group of researchers, including neurobiologist Martin Teicher and pediatrician Jack Shonkoff, both at Harvard University, neuroscientist Bruce McEwen at Rockefeller University, and Bruce Perry at the Child Trauma Academy.

Piece together these two major findings, and there’s a compelling story:

Children with toxic stress live their lives in fight, flight or fright (freeze) mode. They respond to the world as a place of constant danger. Their damaged brains lead them to fall behind in school or fail to develop healthy relationships with peers or develop problems with authority because they are unable to trust adults. With failure, despair, and frustration pecking away at their psyche, they find solace in food, alcohol, tobacco, methamphetamines, inappropriate sex, high-risk sports, and/or work. They don’t regard these coping methods as problems. They see them as solutions to escape from depression, anxiety, anger, fear and shame.

And there’s the rub when it comes to obesity. Many people who are obese regard eating as a solution, not a problem. When they get to the point where being obese is uncomfortable and even life-threatening, food still offers a temporary relief from horrific memories, shame, or guilt that are infinitely more painful.

Another scary bit of news from the NPR blog:

While increases in obesity may have slowed some, the health trends still bode poorly — especially for people who are roughly 100 pounds overweight, with body mass index scores of 40 or higher.

That rapidly growing group of severely obese people, who have the most medical problems and incur the highest health care costs, will rise from about 5 percent of the population now to 11 percent by 2030, researchers suggest.

According to Drs. Vincent Felitti and Robert Anda, the co-founders of the ACE Study, it’s this group of severely obese people who are likely to have high ACE scores, i.e., the most types of childhood trauma and therefore the most medical problems.

The Weight of the Nation meeting addresses all kinds of useful issues that can play a part in helping people become healthier: walkable communities, easy availability of healthy food, good nutrition, more exercise, healthy school lunches, etc. But until childhood trauma is included in these discussions — both in finding ways to address the subject with adults who are obese as well as to prevent trauma in childhood — I don’t hold out much hope for making a significant dent in our obesity epidemic.

8 responses

  1. Absolutely, the context of attachment (who are the adults who provide nurturing, are there adults that are providing nurturing) will have a profound impact on how the child is able to navigate through the experiences of loss/fear/futility.

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  2. I wonder if the concept of trauma needs to be explored even further. It isn’t only the ‘event’ that caused the trauma (including the experiences like watching violence, experiencing loss or abandonment, etc.) but also the way in which we each perceive these experiences. Some people are far more sensitive than others, and feel the experiences in a much deeper way than others. So, for some, the experience of divorce is painful but they are able to move on, while for highly sensitive children, divorce is felt at the very core of who they are. We have highly sensitive children and adults, who don’t require high levels of ‘trauma’ to experience them as significant. This is not to ‘blame’ the person who has experienced the trauma. This is to understand that the ‘perception’ of the trauma is what is the most critical.

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    • Thanks for your comment. There’s still so much that’s not known about the effects of a particular traumatic event. What’s clear is that if it is one of several traumatic experiences, then the cumulative effect is more profound. So a question to ask when a divorce occurs, for example, is: “What other types of traumatic events and experiences is this person living with now or in the past?” Also: “Who are the adults who provide nurturing for this child, and what’s their ACE score?” That may be another way to define “highly sensitive”.

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  3. Indeed they are systems thinkers — what a difference Family Policy Council & the networks have made in Washington!

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  4. Thanks for the tip, Steve. The book is “Thinking in Circles About Obesity: Applying Systems Thinking to Weight Management”. As far as I know it doesn’t address childhood trauma. But, by all means, correct me if I’m wrong.

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    • I suppose I was thinking that childhood obesity is a form of trauma, so perhaps my assertion was too vigorous. A good book though in that it encourages us to consider multiple causes, and distance (time) between cause and effect. In my experience, the Community Networks and Family Policy Council in Washington state(soon to disappear) are full on systems thinkers, so perhaps I was just looking for that kind of language in all ACES posts.

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  5. From a systems perspective, it would be helpful for all involved in this work to become familiar with Tarek Hamid’s book, “Thinking in Systems About Obesity”. I’m curious about why this important book does not show up in this post.

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