Integration of ACEs science into obesity prevention programs (or programs measuring related outcomes)?

It's almost easier to say who is NOT incorporating ACEs into their work. Despite research showing ACEs contribute to the development of a number of physical health disorders, such as diabetes and obesity (and their clear inter-relationship) the English DESMOND program for Type 2 diabetes very clearly omits any reference to ACEs.

Perhaps we could get some more info from English members of ACEsC -- I only learnt about DESMOND today, when sharing info with a dietician about Acceptance and Commitment Therapy to help with lack of Acceptance (general style of responding to problems) of having Diabetes --- many different lines of activity coming together for health disorders. Gets back to the question -- do interventions around ACEs help the treatment of such disorders?

btw DESMOND is an acronym for Diabetes Education and Self Management for Ongoing and Newly Diagnosed. Some of the early outcome studies failed to find any significant improvement in health indicator (HbA1C)  for this condition -- improvement was noted for the ACT intervention. Seems the DESMOND program was largely educational and motivational, rather than "affective / values" focused.

good luck

Also check the work Dr Peta Stapleton is doing at Bond University AU with regard to obesity studies.

I'm so glad you're pursuing this! I've treated eating disorders in conjunction with significant trauma throughout my career but the two are often not linked outside of behavioral health and even then, in individuals struggling with over-eating I've noted a stronger resistance towards making the connection. I believe that's due in part to our cultural messages about food and lack of congruency within how we diagnosis obesity-as if the condition magically appears, or that a person has Binge Eating Disorder-sadly the DSM states under Development and Course for B.E.D that "little is known about the development of binge-eating disorder. Infuriating. Man-made food products (aka processed white sugar) light up the same places in our brain as cocaine. It's an addiction. I was fascinated to learn that nationally our smoking rates have gone down but our rates of obesity have gone up. So, we've been publically shamed out of smoking and turned to food because collectively we still haven't learned how to respond to the root of what is hurting: our ACE's. Address the root and my need to drink, smoke, over eat, cut, shop, starve whatever else, is gone (mostly, haha)

 The TOPS program (Florida) does address social and emotional health but during the time I led a training they did not appear to provide any comprehensive trauma screening. Overeater's Anonymous serves individuals across the eating disorder spectrum (bulimia, overeating, anorexia) and does address more specifically emotional triggers for eating, purging or self-starvation while also providing tools to address weight management, emotional health and addiction to processed 'food-products' (for which they have prescribed total abstinence for many, many years and of course that's not very public knowledge either because one sector of the processed food industry profits nearly 2 billion dollars annually and would not like it if everyone was suddenly cured from food addiction.) OA is the only program I know of that acknowledges and treats true 'food addiction', even the DSM doesn't qualify a person's maladaptive relationship with food as an addiction because it might have meant classifying certain foods under the same category as alcohol and tobacco, despite the fact that a person turns to self-medicating with food for the same reasons others choose other addictive and numbing substances. I remember reading a book years ago called The Monster Within; a woman described a binge so intense she reported symptoms of intoxication.

Long story short, OA comes close but I think it would great to see more programs available helping individuals get to the root of their choices and behaviors regarding substances and food and removing the shame which often comes with obesity and over-eating in making that connection. The answer is always unresolved trauma and the cure is mindful self-compassion. Good luck with your work!

A couple of things could be said about this -- and might need to be. 

The latest brain research on people with obesity indicates that the part of the brain that says, in effect, "that's enough" -- satiation -- is missing or not working properly in those suffering from obesity due to over-eating.

Secondly, I think if you do a more in-depth review of the literature you'll be more guarded in your support of "the self-medication response" to social adversity -- it's a lot more complicated than what you've outlined. Check out a special issue of the journal Addiction -- Volume 108, issue 4.

But, please don't be offended by the above comments -- I e"njoyed reading your response to the topic, just not the over-generalisation "the answer is always ..."

but better what you've written than the over-generalisations of the medical community 

Thanks for that gentle correction. I get all excited about trauma sometimes and forget to widen my lens

We are a nutrition education program in San Francisco and are also looking at developing tools and strategies for integrating ACES into obesity prevention programs-- www.leahspantrysf.org. I would love to connect with you Gail.

Thanks for those thoughts everyone.  I would like to widen my lens as well. I think the addiction model works to a point. But for low income communities, especially, the answer is indeed beyond personal self improvement, mindfulness, etc.  I am just not sure what that is. Thanks for the resource, Russell.

This is fantastic, Monica. I will email you privately to set up a time to talk.

Hi Gail,

This approach is further upstream, but California WIC (followed by other state WIC offices) had a campaign a few years ago called Baby Behavior to help new parents better recognize infant cues, rather than just giving babies bottles every time they cried. It had info on sleep cycles, reasons why babies cry, and how to tell if your baby needs a break (from being social). It seemed to me like Kathryn Barnard's work on infant cues reworked to be well-received and understood by a wider audience than just us maternal child/public health nurses and infant mental health advocates. I don't know if she is still there at UC Davis, but Jane Heinig worked with CA WIC to create the program. 

By looking at infant feeding coupled with attachment, we can consider how connected (or not) we are to our babies and how food literally feeds that need that we have for connection and nurturing from the beginning. Parents that are unable to be as present and connected miss important cues when they 'plug the kid up' with a bottle and disengage. There are a lot of perceptions out there about babies crying to "be manipulative" and parents not wanting to "spoil" them and "hold them too much". Something my discharge nurse told me when my daughter was born 18 years ago. I do a lot of unteaching about this concept in my work. I think this is the root for many of us that struggle with food addiction. Food=love got stuck in our brain while it was being wired from the start. 

When I first learned about Felitti's work, it made perfect sense to me that ACEs were discovered at an obesity clinic. Sexual abuse is one contributing factor to obesity and food addiction, but emotional neglect is a contributor as well. In my work with "high-ACE" parents, I have found that it can be very difficult to be present when their baby or child is upset. This is where helping parents learn about cues (and learning to recognize how they are feeling when their baby cries) can be very valuable for both kiddo and parents.

Thank you for tackling such an important issue!

Kim