Hangry January 5, 2020 Obesity and ACEs

My guilty pleasure in times of leisure is watching TV shows at the extremes – Hoarders, Tiny House, My 600-lb Life.

I hadn’t watched 600-lb Life for a while, and recently watched Erica’s Story (https://www.youtube.com/watch?v=9VJHYFQs4d0).

As usual, Erica had an enabler, her niece Jessie. If you are 600-lb plus, it is hard to grocery shop on your own, or, in Erica’s case, to just get out of the house. She hadn’t been shopping for five or six years. Jessie felt bad about buying the chips, cakes, pies, ice cream and sweet rolls, but felt trapped, because Erica would get really upset if she came back without them.

If Jessie were the ideal niece, she would have a lot of resources and spare time, and seek out grass-feed beef and take it to Erica’s and cook it with butter. She would buy and prepare just-ripe avocados and free-range eggs. However, that doesn’t seem realistic. As it was, once a week she would drive to her aunt’s apartment, clean up a bit, get the list, bring the groceries, put them away and go.

Also as usual, Dr Now (https://en.wikipedia.org/wiki/Younan_Nowzaradan) talked about calories (1200 a day), as part of an eat-less move-more strategy. However, for the first time, I saw him refer Erica to a Nutritionist (at 37:45). Erica told the Nutritionist Dr Now told her about the caloric limit, but also spoke about how she was advised to eat “high protein, zero to low carbs, zero to low sugar.” This is the first time I heard macros discussed.

The I-word! The Nutritionist went on to discuss blood sugars, how carbs affect insulin, and how dropping insulin causes hunger. This was also a first.

Dr Now also referred Erica to a Therapist (at 49:34): also new to me. Erica told the Therapist about the horrific sexual assaults she endured at age 16, and said she gained 100 pounds within a year. Her mom arranged for her to have her stomach stapled at age 17 but the “surgery failed,” the staple blew out, and she quickly regained the weight and then a lot more.

Wait, this is sounding familiar.

I stumbled across this when researching ACES – Adverse Childhood Experiences – to try to figure out what the heck happened to my childhood friend. Here it is: “The Adverse Childhood Experiences Study — the largest, most important public health study you never heard of — began in an obesity clinic” (Stevens, 2012).

“It was 1985, and Dr. Vincent Felitti was mystified. The physician, chief of Kaiser Permanente’s revolutionary Department of Preventive Medicine in San Diego, CA, couldn’t figure out why, each year for the last five years, more than half of the people in his obesity clinic dropped out.”

[…]“I had assumed that people who were 400, 500, 600 pounds would be getting heavier and heavier year after year. In 2,000 people, I did not see it once,” says Felitti. When they gained weight, it was abrupt and then they stabilized. If they lost weight, they regained all of it or more over a very short time.”

Deciding to administer a pyschosocial questionnaire, Dr Felitti misspoke. “Instead of asking, “How old were you when you were first sexually active,” I asked, “How much did you weigh when you were first sexually active?’ The patient, a woman, answered, ‘Forty pounds.’”

“He didn’t understand what he was hearing. He misspoke the question again. She gave the same answer, burst into tears and added, “It was when I was four years old, with my father.”

“He suddenly realized what he had asked.

“I remembered thinking, ‘This is only the second incest case I’ve had in 23 years of practice,’ Felitti recalls. ‘I didn’t know what to do with the information. About 10 days later, I ran into the same thing. It was very disturbing. Every other person was providing information about childhood sexual abuse. I thought, ‘This can’t be true. People would know if that were true. Someone would have told me in medical school.’

In a paper, Felitta et al (“Obesity: Problem, Solution, or Both?”) says, “Ultimately, we learned from our patients that in obesity, we are dealing with two core problems: the unconscious, compulsive use of food for its psychoactive benefits [and] the unrecognized and unspoken benefits of obesity.”

“A memorable response comes to mind from 1985 when a patient, going with us through a timeline of her life in which weight, age, and events were matched, told us that at age 23 she was raped and that in the subsequent year she gained 105 lb (48 kg). Looking down at the carpet, she then muttered to herself, “Overweight is overlooked, and that’s the way I need to be.”

The Therapist said to Erica, after hearing about the sexual assaults, “That is not your shame to carry.”

References

Felitti, et al. From https://www.acesconnection.com/fileSendAction/fcType/0/fcOid/473910123817723542/filePointer/473769385973923320/fodoid/473769385973923316/Obesity%20article%20TPJ.pdf

Stevens. From https://acestoohigh.com/2012/10/03/the-adverse-childhood-experiences-study-the-largest-most-important-public-health-study-you-never-heard-of-began-in-an-obesity-clinic/Hangry

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