“Where there is no struggle, there is no strength.” –Oprah Winfrey
We think we can speak for all who attended the CA Department of Health Care Services Learning Series on January 17th when we say we are immensely grateful to Dr. Felitti for sharing with us findings from the original CDC-Kaiser ACE study and inspiring us with his passion and heartfelt commitment to this body of work. Dr. Felitti, who turned 81 years old the next day on January 18th, was the co-principal investigator on the 1995-1997 ACE Study. More than 17,000 Kaiser patients completed ACE questionnaires, and findings revealed that early trauma and adversity are much more common than anyone fathomed. Sixty-seven percent of all respondents (middle and upper-middle class, mostly Caucasian, college-educated people with jobs and comprehensive health care), reported at least one (of 10) categories of ACEs, which include types of abuse, neglect, and household dysfunction, including divorce, living with a family member who’s mentally ill or one who is addicted to alcohol or other substance. Twelve percent had at least four ACEs. More startling, the study showed a dose-response effect between ACEs and numerous health problems decades later, such as heart disease, cancer, and obesity.
Since 1997, ACEs science has exploded, and “ACEs” is now a buzzword across sectors such as health care, education, and social services. In 2012 Jane Stevens, founder of ACEs Connection Network, posted an article to ACEsTooHigh.com called, The Adverse Childhood Experiences Study – the largest, most important public health study you never heard of – began in an obesity clinic, referring to Dr. Felitti’s experience while running an obesity clinic in San Diego in the 1980s, which led to the development of the ACE Study. Dr. Felitti was concerned about the clinic’s high dropout rate (about 50%). This prompted an investigation, and ultimately, a breakthrough. Most of the patients dropping out had been born at a normal weight. They didn’t gain weight slowly over many years; they put on quickly, and if they lost it, they regained it just as fast. By engaging with his patients and asking them questions, Dr. Felitti learned that the real problem lay not with the excess weight, but with excess adversity and trauma early in life. As he explained on the 17th to a smaller group of OMD staff working on an obesity prevention project called Project Connect, people do things often for very good reasons. People may be obese as a way of protecting themselves (such as from effects of child adversity including sexual abuse, emotional abuse, or bullying). In cases such as this, a very different approach than nutrition education and physical activity is required. After Dr. Felitti understood this, he changed how he introduced the weight clinic’s program to new participants. Instead of talking about being overweight as a problem, he introduced people to the program by asking them three questions: How old were you when you started putting on weight? Why then? What are the advantages of being fat?
“Nutrition is a nice subject and has nothing to do with obesity and anorexia,” says Felitti. “Teaching people about nutrition is essentially predicated on the assumption that people get fat because they don’t know any better.”
ACEs science is crucial for gaining a deeper understanding of the barriers Medi-Cal members and all Californians face. Health problems that present themselves in adulthood may have just as much or more to do with experiences an individual endured in childhood as they do with lifestyle, race/ethnicity, or income status. Dr. Nadine Burke Harris, a pediatrician, founder of Center for Youth Wellness, and a leader in promoting and implementing ACEs science into practice, emphasizes that ACEs are not a minority health problem. ACEs occur across all incomes and race/ethnicities, and though poverty is a risk factor, most children with ACEs are not living in poverty. The science shows us just how linked we are. In the U.S., nearly 35 million children have two or more ACEs. This is a problem for everyone to face together.
So what do we do? We know that the number one protective factor against ACEs is having a safe, nurturing relationship with a caring adult. Other protective factors include sleep, exercise, nutrition, mindfulness, and good mental health. Healthy relationships and social connections are critical to protect children, and adults, from adversity. We need to feel safe, and feel that we matter, in order to thrive. ACEs are not destiny, but children are not resilient on their own; like adults, they need support. Individuals, and communities, can overcome trauma and become the best versions of themselves if they are empowered and given the right tools for success.