Obesity (Part 2) – Let’s Talk About Trauma

In my last blog I looked at the complexity that surrounds the issue of obesity in our society. We have become far too focused on the individual and personal choice, whilst clouding the whole issue in shame and blame through stigmatisation. My hope is that we can talk about obesity with humility and compassion and re-frame the conversation from the all too often over-simplified position of ‘calories-in-calories-out’. Let’s be really clear as we begin to focus on what we can do as individuals, that we do not all start on a level playing field. We have different genetics, different sexes, different body types, different ethnicities, grew up in different environments, have differing belief systems and different personality types. We are different and this should be celebrated! So, this cannot be a game of comparisons. Tough though it may be for me to accept, I am never going to look like Joe Wicks! When I started to write this blog piece on how we might think about obesity as individuals and communities (given all the other complicated factors which make living well in an obesogenic environment so much harder), I thought that I would be able to write it fairly easily. However, I’m discovering that it could easily turn into a book! And so, I’m going to continue this a mini-series and write several more posts, partly so they are not too long and partly, so that I can explore the issues in more depth. The series does not aim to be the answer to every practical question about obesity, weight loss or positive body image, but I hope that it will be really helpful in setting out a way of thinking about the issues affecting us. I will look at some of the deeper causes and then some possible ways to find ways forward.

 

The Impact of Trauma and Adverse Childhood Experiences

 

I think we have to start here.

 

In the 1980s, Dr Vincent Felitti, Director of Preventative Medicine at the Kaiser Permanente Health System in San Diego, California, began to discover something troubling in his weight-loss clinics: there was a very high drop out rate and he couldn’t understand why. What we went on to discover, in conjunction with Dr Robert Anda, over the following 15 years was that around 50% of people in his clinics had suffered from a significant number of ‘Adverse Childhood Experiences’. Initially his patients would do well and lose weight and then stop attending and put their weight back on.Something I think we see again and again in the ‘diet world’.

 

Further studies across the USA and UK have shows that 50% of us have been through at least one ACE and around 10% of us have been through at least 4 of them. Trauma, especially in our early years, but actually at any time, can have a profound effect on our lives. The eminent Professor of Psychiatry, Bessel Van der Kolk, writes in his book ‘The Body Keeps The Score‘ about what changes take place in our brains, our genes and our subsequent coping mechanisms and behaviours as a result. The issue for many of us, who are ‘overweight’ is not that there is something wrong with us, but rather that something happened to us which has deeply impacted us ever since. My friend Lesley, an incredibly brave woman, whom I really admire, puts it this way:

 

I wasn’t loved or nurtured as a child – I was abused. Sadistically. In every way. Although to the outside world we were a model family. I craved love and substituted it with food. I believe ACEs are a huge factor in obesity. In seeking comfort in food, I developed an emotional relationship with food. Rewards, celebrations, socialising, commiserating – we are all guilty of using food in these ways to a greater or lesser degree. Crack ACEs and I think we’d go a long way to tackling obesity and other ‘dependency’ type issues.

 

(If you are familiar with this blog, you will know that I have blogged several times about what ACEs are and why they can have such a profound effect on our lives. There is also a link to a book I have co-authored on this subject here, – we have a new one coming out soon!). If you prefer podcasts, we have done one here.

 

For those of us who work in clinical settings, giving someone the chance to tell their story, rather than just referring them through to some new service or other can have a much more healing effect than we realise and might significantly change the next steps the person in front of us chooses to take on their journey. Giving a bit of extra time, to listen with kind eyes and to understand someone’s experiences can make all the difference in bringing real and lasting change.

 

Although not all of us who are overweight or obese have been through a terrible experience or trauma – it is true for many of us. Recognising the hard reality of trauma in our society and how rife it is, even within ‘model families’ helps us realise again the complex relationship we can develop with food and the resulting issues we can have with our weight.  So firstly, let’s have some compassion in how we view ourselves and others, let’s not make assumptions about what people are like or what they may or may not have been through, because we don’t know their stories. Let’s also be committed to being trauma informed and a) help create the kind of society in which we see an end to as many ACEs as possible, whilst b) putting more protective factors in place to help children who are going through them and c) enable each other to get healed from the traumas we have experienced, without judgement. There are many things which can help us heal from trauma – the most important step is breaking the silence and the shame by telling someone we love and trust the truth about our story. Simply sharing the burden, being heard and validated is in and of itself deeply healing. Particular talking and psychological therapies like EMDR, family systems therapy and trauma-focused CBT are a helpful next step, alongside various physical therapies, which help us learn to live in our bodies without having to be defined by the traumas we have experienced. These can be available in certain NHS mental health teams, through various charities and private therapists.

 

 

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Our Nation’s Biggest Public Health Problem

The subject of this blog is sensitive and difficult. It may stir up some difficult issues or memories for you, as you read. If this happens, then please take time to seek the help you need. I believe this blog and ones to follow might be some of the most important I have written to date.

 

UnknownI am currently reading a phenomenal book, sent to me in the post, by a dear friend of mine, who is a trained counsellor and knowing the work I do, felt that I should read it also. The book is called “The Body Keeps the Score” by the eminent Psychiatrist, Bessel Van Der Kolk. In my humble opinion, it should be compulsory reading for every person training in any of the clinical specialities, including public health and for those working in education. The book focusses on the detailed research and work done by Van Der Kolk and others at Harvard over the last 30 years in the whole area of Complex Post Traumatic Stress Disorder (CPTSD), or “Disorders of Extreme Stress, Not Otherwise Specified” (DESNOS). It is not a part of our vocabulary, unfortunately, because even now, after a huge evidence base and many studies, there still remains no such psychiatric diagnosis. However, it is a hidden epidemic affecting huge numbers of our population and is the root of many of our major public health issues. So what causes this problem and just how wide spread is it? The evidence shows so strongly that the cause of CPTSD or DESNOS is Adverse Childhood Experiences, which we more starkly call Child Abuse.

 

Child abuse falls into four main categories: Physical abuse, Sexual Abuse, Verbal Abuse and Emotional abuse – usually in the form of neglect. 10% of children suffer regular verbal abuse. 25% suffer regular physical abuse. 28% of women and 16% of men have suffered sexual abuse. 16% regularly watch domestic violence. 87% of all those who suffer one type of abuse, are also abused in other ways. Each of these forms of abuseUnknown lead to major health problems later in life and studies are showing that it is not just mental health issues (many of which lead to inappropriate diagnoses like Borderline Personality Disorder or Bipolar Disorder and ineffective treatments) but also major physical health problems. Those who have been abused are twice as likely than others to develop cancer and four times as likely to have emphysema. The more difficult a person’s experiences, the higher the chance of developing heart, liver or lung disease at an early earlier age with much higher chances of taking more health risks with smoking, becoming overweight or having multiple sexual partners. There is good evidence to suggest a link with autoimmune diseases, such a lupus, and other complex conditions like chronic pain, chronic fatigue and fibromyalgia. The body cannot be separated from the mind and literally keeps the score of the internalised turmoil. So, even if the abuse happens before memories are formed, or our minds manage to forget or block out what has happened, the body simply cannot forget and sometime and in someway, the damage will show itself. Studies show that the overall cost of this appalling reality far exceed those of cancer or heart disease. In fact, eradicating child abuse would cut depression rates by over 50%, alcoholism by 66% and suicide, IV drug use and domestic violence by 75%. Antidepressants and antipsychotics are now some of our largest prescribing costs. We know this, but are doing very little about it. Perhaps it feels too big. Perhaps we don’t want to face the demons involved. Instead, we are numbing the problem, trying desperately to get people to be just functional enough to keep on serving the needs of our economic system, but we are not facing up to or dealing with this horrific problem, nor its true cost.

 

What can be done in the face of such evil? How can we develop aimages culture of compassion and restorative justice in which we can find a new way through for humanity? It isn’t getting any better. It is just as widespread and far reaching in its consequences as it was a generation ago. Is it possible for us to face up to the startling reality we face? Van der Kolk offers much hope, but it is not within the gift of the health service and social services to tackle this alone. If we are to take this issue seriously, we must embrace what Bessel refers to (at the end of chapter 2) as four fundamental truths:

 

  1. Our capacity to destroy one another is matched by our capacity to heal one another. Restoring relationships and community is central to restoring wellbeing.
  2. Language gives us the power to change ourselves and others by communicating our experiences, helping us to define what we know and to find a common sense of meaning.
  3. We have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and brain, through simple activities such as breathing, moving and touching – (learning to be present in our own bodies is a vital way of separating out the memories of the past which can overwhelm us at times).
  4. We can change social conditions to create environments in which children and adults can feel safe and where they can thrive.

images-1People can be healed of trauma. We need this at both an individual and corporate level. We have become so focussed on saving money, on quick fixes to ensure the NHS and Social Care System can survive, but we are ignoring the root cause of many of our ill health issues. If we are willing to face up to the truth of child abuse in our society and its long lasting and far reaching impact on overall health and wellbeing, then we might just be able to find a way through to healing and restoration of what has become an extremely broken society. In the blogs that follow, I will look at some of the ways we might find a way through this crisis of epidemic proportions. One thing we must face straight away is that we are spending our resources in the wrong places and are focussing our attention in the wrong areas. We must protect our children and help people learn how to be good parents. We must strengthen our school teachers and sense of community. We must invest in the first five years of life far more than we are doing so currently, especially those key first 12 months of bonding and attachment. Together, if we want to, with love, care, bravery and determination, we can change the future. There is hope. There is healing. Our systems are not yet designed to cope with this, but we must speak the unspeakable, break the silence and face up to the truth. The truth will set us free and enable us to develop the kind of wellbeing that every human being should be able to live within.

 

 

 

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