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HEALTHrecording a TED Talk that has been viewed more than 6 million
times. She was tapped for her new post by Governor Gavin New-
som in January 2019.
The research is so fresh that many clinicians are still debating
the best way to tackle the problem, most significantly whether the
science is mature and the interventions effective enough to imple-
ment universal screening. And the details of California’s approach
to screening are controversial in the world of public health. (The
epidemiologist who developed a key questionnaire being used as
a screening tool says it was never intended to be used to evaluate
individuals.) But there is broad consensus, at least, about one thing.
For all the buzz in public health and policy circles about “ACEs,”
few people have heard the term before. The first task, many people
on the front lines of health education agree, will be to change that
so that caregivers themselves can learn about the vicious cycle of
childhood adversity, and get the help they need to break it.The Science of Toxic Stress
the research on ace stems from a seminal 17,000-personepidemiological study published in 1998. The first clue came
years earlier, however, with the plight of an obese, 29-year-old
woman from San Diego named Patty.
Over the course of a 52-week trial of a weight-loss diet, Patty
dropped from 408 lbs. all the way down to 132. Then, over a single
three-week period, she abruptly gained 37 pounds of it back—a
feat that her doctors didn’t even know was scientifically possible.
Patty’s dramatic weight swings got the attention of Vincent
Felitti, the head of the preventative medicine program at the mas-
sive managed care consortium Kaiser Permanente, and the man
who had designed the obesity study. Felitti had been astounded
at the rapid pace with which the study subjects lost weight. “In
the early days of the obesity study, I remember thinking ‘wow,
we’ve got this problem licked,’” Felitti recalls. “This is going to be
a world-famous department!”
Then, for reasons nobody could explain, patients began drop-
ping out of the program in droves. Felitti found it particularly
alarming because the ones leaving the fastest seemed to be the
ones losing the most weight. When Felitti heard about Patty, he
arranged a chat. Patty claimed she was just as mystified by her
massive weight gain as he was; she assured him she was still vigi-
lantly sticking to the diet. But then she offered up a suggestive clue:
Every night when she went to bed, she told Felitti, the kitchen wasclean. Yet when she woke up, there were boxes and cans open and
dirty dishes in the sink. Patty lived alone and had a history of sleep-
walking. Was it possible, she wondered, that she was “sleep eating?”
When Felitti asked her if anything unusual had happened in her
life around the time the dirty pots and pans began to appear, one
event came to mind. An older, married man at work had told her she
looked great and suggested they have an affair. After further ques-
tioning, Felitti learned Patty had first started gaining weight at age
10, around the time her grandfather began sexually molesting her.
Felitti came to believe that for Patty, obesity was an adaptive
mechanism: she overate as a defense against predatory men. Felitti
began asking other relapsing study participants if they had a history
of sexual abuse. He was shocked by their answers. Eventually, more
than 50 percent of his 300 patients would admit to such a history.
“Initially I thought, ‘Oh, no, I must be doing something wrong.
With numbers like this, people would know if this were true.
Somebody would have told me in medical school,’” he recalls.
Felitti started bringing patients together in groups to talk about
their secrets, their fears and the challenges they faced—and theirƠ “ The social determinants of health are to the 21st century,
what INFECTIOUS DISEASE was to the 20th century.”