Quagmire

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“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.

Another quote:

“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…

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123 thoughts on “Quagmire

  1. I couldn’t agree more. I’ve often thought of the morbidly obese as wearing their mental illness on the outside instead of the opposite. Oversimplifying to a degree, I know, but I cannot think of an obese person I know that is just a glutton. They use food as medication to help stuff down all that pain.

    And now that you bring up this issue, a family member came to visit this past weekend. He is now weighing in at just under four hundred pounds. And so privately we had the discussion, what does one do? What can one say? If he were a drug addict or an alcoholic, the family would stage an intervention. But this food addiction is met with shrugs and sighs and a general feeling of helplessness.

    Liked by 2 people

    • I think the key is to reserve judgement. Love. Always show love. I wish I had easy answers but I don’t. Virtually the entire medical establishment stinks at this. I want to help shout this ACE thing out, though. Hopefully more awareness will lead to more research and novel ways of addressing the issues.

      Liked by 3 people

      • There was just an article in the WSJ about “fat-shaming” by the medical profession. It was interesting to read how much goes undiagnosed, at least at first, because the physician is certain that the fat is the cause of the ailment. Such an interesting topic and so relevant to many of our lives. And you’re right, no easy answers.

        Liked by 2 people

      • I agree wholeheartedly. The medical establishment treats obesity as a disease, prescribing drugs or surgery. I feel the issues are deeper than mere physical. There’s emotional eating due to isolation, rejection, depression etc. And of course yo-yo dieting, binging/ purging, poor food choices due to finances. ACE is part of the problem, and the psychological stress of trying to lose weight, facing prejudice and societal judgement. There are no quick fixes or easy answers, and it’s becoming an epidemic in this country. Perhaps diet, exercise and meditation?

        Liked by 1 person

      • Yes, by all means reserve judgment, but refer the person to a therapist who does Eye Movement Desensitization and Reprocessing (EMDR) therapy. We can help them believe differently about themselves, so they don’t have to hide anymore. They can lose the weight, get back out into the world, feeling good about themselves, without hiding behind what happened to them.

        Liked by 1 person

  2. What is % of black obese people of the total population of blacks in our country? If the theory is right it should be the highest in comparison with any other group in US because of the breakdown of black families and the worst children experiences? Do you have data about obesity among blacks, latinos, orientals, whites?

    Liked by 3 people

  3. Hmmm. Interesting insight. Being a doctor, you can probably get them to talk enough to find out if they have an ACE score above 0, if not what it actually is. But does that give you enough of a handle to be able to help them? It seems that if the information doesn’t give you a way to help, all you have accomplished is to learn why you have failed. I suppose you could send them to counseling as a way to get started. And, as you pointed out, you could avoid recommending things that won’t work.

    Liked by 1 person

    • I think fat-shaming only compounds the trauma. My hope is that we will all approach our fellow human beings with respect and honor their survival, rather than piling on further shame. Counseling is an absolute requirement but I am afraid that there are many even in the mental health fields who either are not aware of this or choose to ignore it.

      Liked by 3 people

      • I think you must be right about fat-shaming. It strikes me as being in the same category as trying to cure bed-wetting by humiliating the child—not likely to have any good result.

        You commented “… childhood trauma causes increased levels of stress hormones which in turn permanently change a child’s developing brain.” This suggests there may be cases where treating people with respect and honoring their survival may be the best you can do—helping them heal without being able to “cure” them (in the sense of returning them to a healthy weight range, for example).

        Liked by 1 person

      • Yes! We may have to adjust our expectations. At least the focus should be less on the weight and more on the trauma. I would really encourage you to follow the link to the original article if you have not already done so.

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      • Yeah, fat-shaming, that’s a good idea…because in our real lives, 24/7, there isn’t enough of that already if you are fat (and even if you aren’t, these days, with all the distorted body image issues that society surrounds us with). Yup. Then, you know, most of us fatties just don’t realize we’re fat so we really appreciate the heads up. “OMG! I thought I was a size 7! When did THIS happen?!?!?!” :::sarcasm font:::

        You have to be very, very stupid and very uninformed and very isolated these days to not know that the prevailing current wisdom is that fat is unhealthy. Stupid, uninformed, isolated people do exist, and I have met them. You’ll also find a lot of obese people who are EXTREMELY knowledgeable about health and nutrition, more so than your average Joe on the Street.

        Liked by 1 person

  4. Scary statistic, isn’t it? Obesity is a multifactorial issue that requires multi-interventional approaches. This is a big interest area of mine and is the theme of my second novel. In fact, I have an upcoming blog post on the topic (whenever I can get back home–currently in NH helping my mother), so I really enjoyed your post on the subject. The more awareness people have, the better. Tackling obesity is not quite as simple as ‘eat less, exercise more.’

    Great post.

    Liked by 3 people

  5. I can certainly see where ACE trauma leads to unhealthy behaviour(s). Do pysicians need to be trained psycholigists and psychotherapists in order to detect and/or treat ACE trauma patients? And what about those “normal” folks who’re overweight, or who have other abnormalities relating to health issues? Why can’t they choose healthier lifestyles after being told to do so? We’re not only a “fast food nation,” it also seems like we’re a dumb and fat nation too.

    Liked by 1 person

  6. I’m not obese or even over weight, but I am a survivor of most of the above list. I live with ptsd. As a survivor thank you for blogging about this.
    People will also eat and keep weight on to keep people from getting to close to them. They don’t feel safe if anyone gets too close.

    Liked by 1 person

  7. I feel that in psychiatry I often have difficulties in getting my point(s) across. I feel that there is a certain arrogance going on in the scientific world, as if “they should certainly know” (everything). I think you are being very alert with respect to the link between obese and ACE, as you brought up.

    Liked by 1 person

  8. Thanks for finding the time to look at my intermittently-published blog. We retirees have so little time, since as we go downhill, everything goes faster and faster. There are no more 24 hours in a day. That is why so many of us wake at 4 am, afraid of missing something of the day. Tempus fugit–and all that. I look forward to becoming one of your 983 followers. And that is why…so little time. Kindest regards. JO’N, BA, MA; E.D. ICD-9-CM Code 607.84; BMI 38. Damn! I try so hard, Doc!

    Liked by 1 person

  9. I really found this thought provoking. Yet I also feel that whilst the morbidly obese need much more help to try to overcome their issues/problems; we overlook any weight related problem if we say it (the ACE’ s) is only pertinent for these people.
    Admittedly they require more help, but does that, by the nature of your comments, automatically mean “ordinary overweight” people do not apply with this scenario? Is there a cut off for those with lower ACE scores?
    Apologies if this appears argumentative; yes I have a weight issue, a chronic pain issue from a car accident, ptsd and so on. I follow a strict regimen yet each time I try to become more active I am racked by pain. Is this a panacea or real? From someone who was an acknowledged “gym junkie” until my accident I long for a solution, yet I seem to fall through those cracks.
    Sorry for the epic whine. I believe all overweight people “may” have ACE issues – that simply haven’t been found or addressed.
    Thanks for such an illuminating post. You truly do go that extra mile for your patients. ☺
    Blessings, Susan 💖

    Liked by 1 person

    • That is something that I don’t know. ACE levels affect people even if they are not obese. You saw the list of issues it can affect. Some people with high ACE’s don’t have a weight problem. Is it playing into your weight? I don’t know. What would you say your ACE level is? (Don’t worry, you dont have to answer that here.) As for pain with activity, you don’t have to exercise to lose weight. The most important component is diet.

      Liked by 1 person

  10. I read this with anticipation. NOT with one single eye roll. It made sense to me. I have struggled with weight my entire life. Have had good success for a good many years, but it is WORK. And people don’t have a clue how difficult it is. I don’t want to spend the rest of my life putting this much emotional energy in to it. The physical energy to work out is nothing compared to the mental. I’ve never heard of this but I’ve always suspected it.

    Liked by 2 people

  11. As you suggested, I went and read the original article. One result for me has been to be further impressed by the “Quagmire” title you put on this post.

    The article has some stunning stats in it. Perhaps the most surprising to me was the possibility of long delayed effects (decades in some cases) of childhood trauma and of ongoing trauma having the effect of permanent changes in brain chemistry. I’m not in any health care field, so I’m sure that I think I know more than I really do, but I found those effects surprising.

    Hmmm. I went on for quite a while before I realized I should be writing a post of my own instead of cluttering up your space. Thanks for bringing this up. I didn’t know anything about it before.

    Liked by 1 person

      • I’m sure there are many I know nothing about. The interesting thing here, I think, is effects that show up after a long period with no apparent effect in the intervening time. Maybe shingles or post-polio syndrome would fit in this category.

        Liked by 1 person

      • Those would be infectious and their scope is limited in effect. I don’t know in the case of ACE’s that it is the effects are showing up later. Probably more like the consequences of the resulting behaviors are showing up later. Some of that is due to access. Food and drugs and tobacco generally would be more of an issue when they can be purhased.

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      • I don’t think the category (I defined) rules out infectious diseases. The operative distinction is that it lays around in your body for a long time without effect (assumption) and then appears without much warning. Shingles certainly fits that definition. I don’t know much about post-polio syndrome aside from having two friends that have had it with vastly different results, but it seems similar.

        You make an interesting, but subtile, distinction between consequences showing up later and consequences that can’t be expressed until later. I can’t comment meaningfully, but aren’t you saying that an ACE affected child would show effects right away if they had access to the means? Don’t most of them have access to food? And, don’t many children have access to alcohol and drugs generally much earlier than we want to believe? Some of these things should be testable. Are you up for a new big study? Fame and fortune awaits here.

        Liked by 1 person

      • Yes, kids have access to some food but that is limited to what is supplied for them. They do not have the means to buy it themselves. My parents were very restrictive about what I ate. Some parents are less so. Some bullied kids put on weight early. Tobacco, alcohol, and drug abuse effects take time to show up. The changes are not lying dormant. The stress changes brain structure, which brings on certain “survival” behaviors. Then with time the effects of those behaviors start to show.

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  12. We all cope in life with trauma in different ways. I was abused for many years and when i prosecuted I I got to meet some of the other victims. Some were young and morbidly obese. One of them said that after counselling she realised that she had unconsciously tried to make herself unattractive.
    I’m not sure if it is as simple as this but it definitely is worth considering.
    In our house I don’t care about diet. We are all relatively lean including my children. The other day my daughter who is 17 spoke about this and remarked that no food is withheld, but that we are advised that we have already had a snack etc. However her main point was, that I am obsessed with teeth, and as a result whatever she eats she does so with the thought of damaging her teeth. She told me she thought it was a very clever way of making sure they don’t have too much ‘rubbish’.
    If I did do this I have to admit it was not premeditated. Equally I think, imagine if I was a mother who obsessed about weight instead of teeth. I shudder.

    Liked by 1 person

  13. So would over indulgence be considered a childhood trauma? I’m just thinking that at this time in history the child has never been so catered to and yet obesity rates are at an epidemic level. Is the indulgence a form of abuse? Obesity rates, say 50 years ago, were far less. So, I’m interested in the historical narrative. If childhood trauma is a contributing factor to obesity then, could the amount of childhood trauma prevelant in a society be measured by the amount of obesity among its population? And could we investigate times in history where obesity was limited and study the parenting of this population to gather functional skills?

    Liked by 3 people

  14. I have a good friend, the only female in her family, who has not had bypass. Yes, the other’s, they gained all the weight back. My friend has struggled with weight all her life. She’s a mental health counselor. Last year she stopped trying “diet plans” and sought counseling to understand what lies beneath her relationship with food and why she eats when she is not even hungry. Um,hum – good article. Crazy big numbers too.

    Liked by 1 person

      • Not really sure. On one hand, I can see how certain experiences (such as our mom not giving us anything to eat or drink at times) could have an impact, but it is also hard to accept that something that happened so long ago could affect me now.

        Liked by 1 person

      • I am curious to see how people with high ACE’s feel about the studies so thank you so much you sharing this! An earlier commenter with a truly horrific childhood had commented that while obesity was not an issue for her, other things were. Certainly, no one should assume that everyone who is abused will be obese or obese because of the trauma. There are so many factors playing to our complex lives!

        Liked by 1 person

  15. Oh dear. While I’m happy to read an article that doesn’t reduce (pardon the pun) things to “calories in less than calories out” or “just do it”, I’m afraid this bit of insight is not a one-size-fits-all (again with the pun…) situation. I’m sure it IS absolutely correct for a group of people, but please do not lump (pun?) all of us morbidly obese people into the same pile. Take a group of 100 people and chances are you’re going to have more than one or two “reasons” why people are fat. This is certainly an area worth exploring with a patient, a friend, a loved-one; however, armed with this information I can see someone being asked out of the blue, “I’ll bet you were abused as a child!?!” Ugh.

    Liked by 1 person

    • You are right that odds are someone is not going to approach it with tact. AND you are also right that it does not fit everyone. It is a tool for understanding, though. I look forward to exploring it more! Tactfully and with discretion and respect.

      Liked by 1 person

      • You’re in an interesting spot as a physician. As a patient (and I won’t claim to represent all patients, this is just me), I understand and grudgingly appreciate a doctor who says something about my weight. Of course it depends on how and why it is done. In fact, in some instances if a doctor does NOT mention my weight I in connection with some issue (like right now my knee), I’d wonder about their skills as a doctor.

        On the other hand, I’ve had experiences with doctors who take one look at me and everything is weight related and they give up. Hang nail? It’s because I’m fat. Flu? Fat.

        Information is key. The more you have, the better you can problem solve. This ACE score is a good tool (it would seem) but like all tools there are ways of using it. But heck, I could have told you long term exposure to stress hormones messes up weight! 🙂 I could have made some money!

        Liked by 1 person

      • There are, admittedly some really horrible physicians out there. I have heard stories from people that make my jaw drop in disbelief. I wish there were a way to teach everyone empathy and compassion. And that is not to say that I am perfect. I am learning every day from my patients and I make mistakes, too. I am sorry you have had to go through what you have to this point, but I appreciate you talking about it here.

        Liked by 2 people

      • At any one time, half of the doctors out there are the ones who were in the bottom half of their class. 😀 My experiences around “fat” in doctors’ offices hasn’t been traumatic. I guess I’m too ornery and have too little white coat awe. 🙂 Like anything else, you vote with your feet and your wallet. But speaking of jaw dropping…you should hear the stories about the podiatrist I worked for. Oy. Zero social skills and less common sense. 😀

        Liked by 1 person

  16. A very enlightening post. I have known so many who have distanced themselves from others with their weight. Very complicated. I’m afraid to calculate my score, but it’s up there. I went the other way with weight. My reaction was to become dangerously thin, refusing to grow to maturity, developing late, almost into my 20’s before menses. I’m the only one of 6 who did not have the overweight issues, but I struggled to keep weight on…and it was painful, in spite of what you may think.

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  18. I suggest you give yourself full marks for being a caring physician who’s chosen to investigate your patient’s situation instead of taking the easy path of lecturing about weight loss. And thank you for this post – I’m 67, have battled weight all my life, and I now have insights on my childhood, the constant verbal abuse and standover behaviour of my father which I’ve never had before. I have never been slim except when I’m living on my own. I know I’ve pinpointed this but your comments have opened up a whole heap of worms for me which need examining in great depth. Thank you.

    Liked by 2 people

  19. What a fabulous post. A year ago, my BMI was 38. It’s now 23. I lost my mother at 20 and had a rather tumultuous childhood with an abusive alcoholic father. My mother and I were very close and after she died, I began using food as a source of comfort. She was a wonderful cook and because my culinary skills were on par with hers, I was able to recreate the foods she cooked. Eating them became a way of having her there with me. Of course, it took me a while to figure this all out and behavior mod therapy to replace my behavior with positive habits that make me feel close to my mother.
    Being overweight is horrible. It’s literally like wearing your heart on your entire body and not just your sleeve. I was fortunate to have a great team of doctors, trainers, and dieticians to help me lose weight without surgery. I’m proud to know that I honor my mother by taking good care of myself.
    I applaud you for delving deeper to better understand the needs of your obese patients. 🙂 ❤

    Liked by 2 people

  20. Yours is a very timely piece for me and other family members as well. I want to share this article that i read, i’m sure it is info that you already know, but it is the piece i read. I was thinking about your writing in terms of stress levels for my kids, and the article below in how it relates to my family history, and what i recognize in other family members. if you can comment on any of it, that would be most helpful. Also, I wanted to inquire about your husband, I hope he is doing well.
    http://www.newsweek.com/schizophrenia-actually-eight-distinct-genetic-disorders-according-new-study-271407

    Liked by 1 person

  21. I guess I have something in common with Gibber above, since I also have experienced a good number of those stressors, and made most of those same bad choices, but no problems with weight. I’ve had it confirmed by more than one doctor that I’ve pretty much lived my entire life in fight or flight mode, and I always assumed that that’s what kept me thin. Hyperactive doesn’t even begin to describe me. Even now, at the age of 57, my normal daily walking (weather permitting) is in the range of 10-12 miles, and I’ve never walked slowly in my entire life. I sleep an average of 4 hours a night, often interrupted by nightmares after which I seldom go back to sleep. All of that and more, but no weight problems. Maybe just a metabolism thing?

    Liked by 1 person

    • I would love, love, love to find a good one in my area that is affordable. Sadly, that does not exist for most of my patients. Insurance will cover their bariatric surgery but it will not cover a nutritionist/therapist. Incredibly frustrating.

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  22. I’m sure that stress and trauma all play a part in obesity in the relatively affluent parts of the world. What bothers me about these kind of theories is that it leaves poverty and culture out of the picture. How about the Somali child who was married at age ten and systematically raped by her legal husband? Childhood stress, trauma, she’s had a bellyful, but she won’t become obese. If you don’t have access to a rich over abundant diet, you don’t get obese no matter what your background. And it certainly doesn’t mean that only we in the affluent west suffer from these complex problems; we just have different mechanisms for dealing with them. I suppose. Just a theory.

    Liked by 1 person

    • You are absolutely correct. Access to cheap food gives us the opportunity to become obese. It cannot be a coping mechanism if it is not available. These theories only work in those countries. I live in just this sort of country so it is very relevant. It does not, however, lessen the impact of suffering that say a Somalian girl has experienced. Trauma Informed Care is something I have started reading about since finding this. It a focus on what has happened to the person rather than what is “wrong” with them.

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  23. You are so right, now here’s the thing. I am married to a morbidly obese man. He is a wonderful person. He also knows that he has issues from childhood, but, and here’s the rub. He says he has let go of them and verbally he has, but inside has not. I don’t know if admitting certain things about your parents and your childhood and what happened is too scary for fear of what will he have left inside of him. All the good memories will be gone. To his credit he did have bypass surgery and lost about 200 lbs. I love him regardless, I also feel sad for him because he is past 60 yrs. old and still is tormented at times. He has been to therapy many times and to me it seems he just can’t let go.

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  24. Before I got to the part about the abuse, I was nodding. Our relationship to food is not a food issue. Has to do with things far deeper, and yes – often from childhood, abuse or something else (but yes, you tapped something gravely common). Ties into issues of control, or pursuit of comfort (doing what s comfortable at ALL cost)…and yes, often self-image is in there somewhere. That was awesome you unlocked the truth that for people like her it’s the solution, not the problem – so to speak. You are amazing. If only a handful of other physicians would care as you do.

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  26. Thank you. This is very true for me. I have lived through some very extreme childhood trauma and I am morbidly obese. I am starting to believe I can look good, even at my weight, after many years of psychotherapy, and can see that some weight loss will come about in the future. But, not right now. And I am taking your article to my primary care physician (who is not judgmental at all).

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    • Thank you so much for reading and especially for dropping me a line or two to share all of this. And thank you for sharing this with other physicians (though I think the original article that I linked to is much better than my own). 🙂

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  27. I just had a moment to read through some blogs this morning and finally read this. I have to say, there are some people out there who I wanted to comment to but I thought this is not my blog. It made my head hurt with the narrow mindedness of some. And most doctors do think they have the right to shame their patients, which to me is outrageous. This is what large people put up with every day of their lives. So many readers got the relationship of trauma and weight issues. The ACE report also was an indicator for autoimmune disease, chronic illness such as lupus and cancer and other forms of addictive behavior. We do not shame the person who ends up with cancer do we, even when they get it from smoking? Yet being overweight is considered a failure and a self-inflicted choice. It infuriates me.
    I do not understand with all the studies of neuroscience and the connection of constant trauma on the physical body why people cannot understand the connection to weight gain and the inability to lose weight easily, if at all. If your mind is at war all the time, you will have some form of physical reaction.
    And for those who asked about the Somalian girl. You would have to understand the physical aspects of her life as well as how someone deals with trauma. Not all traumatized people are obese, plain and simple. But for some it is their reaction. It is like saying the warrior who comes home from war traumatized and drinks is weaker than someone who comes home from the same battle and does not drink. It is a personal reaction just like obesity.
    I liked the comment by someone who said something about the doctor who contributes everything physically wrong with her because of her weight. I so get that. It took two years for me to get a diagnosis of psoriatic arthritis because everyone chalked up my pain to being fat. By the time it was diagnosed I had permanent damage in my foot, toes and lower back.
    One more comment, which no will read anyways and I am going to put this all on my blog…. Just because someone is large does NOT automatically mean they are unhealthy. I weighed over 250 pounds most of my adult life. I played tournament level tennis two times a week all year long (means three hours of non-stop tennis and I was good) swam, hiked, rode my bike and took dance and aerobic classes. I was rarely sick, had perfect glucose readings and blood pressure. I will finish this rant on my own blog because there is a lot more I want to say. Sorry for the rant, Doc.

    Liked by 1 person

    • I appreciate the rant! You would be surprised how many people still end up here reading this post. It resonated quite deeply with a lot of people. You make excellent points about this not just being about weight or risky behaviors. It is farther reaching than that. I have so much more to learn about this myself but it is exciting to help with starting more of a dialog among clinicians.

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    • Also, as an aside, daveb42 did a great post from this on Trauma Informed Care. There are some links in his post on the subject that I highly recommend. I think it stemmed from mental healthcare but has application in the traditional medical setting, too, particularly when you recognize so many physical things have their roots elsewhere.

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