“Doc, I just can’t keep track of my calories! Whenever I start recording it, I eat more.”
I blinked. Surely not.
“Let me see your record.”
She grimaced but still passed over her smart phone. I scrolled and scrolled and scrolled until I saw her issue.
“You only recorded half of a day!” I looked up at her. “You didn’t even really try, did you?”
Uncomfortable silence. Then tears started falling.
She is in the extremely morbidly obese category. In the over ten years that I have been her physician she has never lost weight and kept it off for any significant length of time, even though she says she wants to, even though she says that she understands that she needs to.
She is a genuinely nice person, beautiful inside and out, but her health is going to fail if we don’t address the weight. I don’t expect her to look like Nicole Kidman. I just want her to get into a healthier range.
Every time I see her, she cries. This is bothering her but she cannot help me pinpoint the source so I can help her.
Why can’t she lose weight?
What am I doing wrong?!?!!?
I have been wracking my brain, trying to figure out how to reach her and a few of my other patients with the same issue.
Clearly, I am missing something here.
Then this week I ran across a blog post that lead me to another blog post and I felt the floor drop out beneath me.
Some of you may read this next bit and roll your eyes at me, marveling at how out of touch and clueless I clearly am, but maybe, just maybe, it will give you an eureka moment, too.
Have you ever heard about ACE’s? Adverse Childhood Experiences.
The research was started by a fellow named Feletti, a physician who in 2005 was running a weight loss clinic. Tired of seeing his patients fail for seemingly no reason, he started interviewing them. What did he find? Over HALF of the extremely morbidly obese patients that he treated had been sexually abused as children. For these people being overweight helped them in some way. It made them invisible, less likely to be bullied or molested. It was not a problem for them, it was a solution.
This expanded into a larger study of over 17,000 people that has looked at far more then weight loss.
There are ten subtypes of childhood trauma: Three types of abuse including sexual, verbal, physical and then five types of family dysfunction — a parent who’s mentally ill or alcoholic, a mother who’s a domestic violence victim, a family member who’s been incarcerated, a loss of a parent to divorce or abandonment, and finally the more nebulous emotional and physical neglect. Experiencing trauma in one of these areas gives you one point. Two areas gives you two points. And so on.
Two thirds of the adults in the larger study of middle class Americans had experienced at least one form of ACE. One in six had an ACE score of four.
Is the rate of ACE’s higher in poorer families, I wonder?
To quote the article:
“Compared with people with zero ACEs, those with four categories of ACEs had a 240 percent greater risk of hepatitis, were 390 percent more likely to have chronic obstructive pulmonary disease (emphysema or chronic bronchitis), and a 240 percent higher risk of a sexually-transmitted disease. They were twice as likely to be smokers, 12 times more likely to have attempted suicide, seven times more likely to be alcoholic, and 10 times more likely to have injected street drugs. People with high ACE scores are more likely to be violent, to have more marriages, more broken bones, more drug prescriptions, more depression, more auto-immune diseases, and more work absences.”
Why? Because childhood trauma causes increased levels of stress hormones which in turn permanently change a child’s developing brain.
“Children with toxic stress live much of their lives in fight, flight or fright (freeze) mode. They respond to the world as a place of constant danger. With their brains overloaded with stress hormones and unable to function appropriately, they can’t focus on learning. They fall behind in school or fail to develop healthy relationships with peers or create problems with teachers and principals because they are unable to trust adults. Some kids do all three. With despair, guilt and frustration pecking away at their psyches, they often find solace in food, alcohol, tobacco, methamphetamines, inappropriate sex, high-risk sports, and/or work and over-achievement. They don’t regard these coping methods as problems. Consciously or unconsciously, they use them as solutions to escape from depression, anxiety, anger, fear and shame.”
So tossing someone into a bariatric surgery program does not fix their problem. This is why most of my patients who have had these surgeries end up gaining their weight back. This is why I feel helpless when trying to get certain patients to make healthy choices. It is not about the weight or the drugs or the cigarettes. It is about the childhood trauma.
This is something that I have always understood on an intuitive level but never realized there was actual data to quantify and back it up.
My ACE score? A two.
How does a two even have a clue how to help a four or a five or a six?
So, the next time you are thinking about that morbidly obese person standing in front of you at the supermarket checkout, think about them not in terms of pounds or failure. Think about their trauma. Think about their survival. Then think about your own trauma. Think about your kids and their trauma.
Stop the trauma before it happens. Think about what you are doing to your kids. The repercussions are far reaching…