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Recognizing the relationship between adversity, chronic disease, and nutritional health is an important topic and something I am currently working on and learning in my doctorate of clinical nutrition program this fall 2022 semester.
UNDERSTANDING TRAUMA
Physically or emotionally harmful or life-threatening events can have lasting adverse effects on an individual’s health and well-being, including their relationship with food and their risk of developing chronic disease. There are three subsets of trauma as follows:
Historical trauma results from multi-generational trauma experienced by specific cultural or racial/ethnic groups. It is related to major oppressive events such as slavery, the Holocaust, forced migration, and the violent colonization of indigenous people.
Systemic trauma refers to the contextual features of environments and institutions that give rise to trauma, maintain it, and impact post-traumatic responses.
Adverse Childhood Experiences (ACEs) are potentially traumatic childhood events, such as abuse, neglect, and household dysfunction (i.e., untreated mental health, substance abuse, domestic violence, incarceration, family separation, or divorce) and other forms of adversity (i.e., bullying, natural disasters and wars, poverty, discrimination, infectious disease, and child welfare involvement) that can result in toxic stress. Prolonged exposure to ACEs can create a toxic stress response, damaging the developing brain and body of children, affecting overall health, and causing long-term health problems.
THE IMPACT OF TRAUMA
Exposure to ACEs can drastically increase the risk of:
Heart disease (i.e., hypertension, atherosclerosis (clogged arteries), CVD)
Stroke
Cancers
Chronic Obstructive pulmonary disease (COPD)
Asthma
Kidney Disease
Diabetes
Depressive Disorder
There are also health risk behaviors and socioeconomic challenges.
Health risk behaviors
Smoking
Heavy drinking
Drug use
Socioeconomic challenges
Unemployment
Less than a High School Education
No Health Insurance
ACEs are common- 6 in 10 people have had at least one ACE experience, and 1 in 6 have experienced four or more ACEs (CDC Vital Signs, 2019).
Some populations are at a greater risk than others. Women and several racial/ethnic minority groups are at a greater risk of having experienced four or more ACEs. Another group is food-insecure families at a greater risk of experiencing multiple ACEs or other forms of trauma.
WHY TRAUMA-INFORMED NUTRITION
Trauma and adversity can disrupt biology and exacerbate an unhealthy relationship with food, leading to poor nutritional health. The relationship between food, individuals, families, and communities must be treated with compassion and a holistic perspective that acknowledges individual, historical, and systemic trauma.
Adverse Food-Related | Experiences Dietary Behaviors That May Result from Adversity |
Unreliable and/or unpredictable meals | Hoarding food, binge eating, or compulsive overeating |
Restriction and control over food | High sugar, and/or salt diets |
Body shaming | Reliance on convenience foods |
Loss of food traditions | Eating disorders or food addiction |
Manipulation, punishment, or reward with food | Decision-making to meet short-term rather than long-term. |
Shame, bias, or stigma when utilizing food assistance term needs | Untrustworthy or inadequate nutritional support, plus a lack of planning and budgeting |
WHAT IS TRAUMA-INFORMED NUTRITION?
Trauma-informed nutrition acknowledges the role ACEs and other adversity play in a person’s life, recognizes trauma symptoms, and promotes resilience. A trauma-informed approach is characterized by an understanding that unhealthy dietary habits, chronic disease, and poor health outcomes may result from adverse experiences and not individual choices. It, therefore, aims to avoid shaming, stigma, and blame. Trauma-informed nutrition supports an integrative and functional approach to nutritional health that highlights six "Components of Care which are:
Nurturing caregiving
Supportive relationships/ concrete support systems
Balanced Nutrition
Quality of Sleep
Mindfulness
Physical Activity
HOW TO APPLY A TRAUMA-INFORMED APPROACH TO NUTRITION PROGRAMS
Acknowledge historical and systemic trauma
Acknowledge the strengths and skills of clients
Focus on holistic well-being rather than obesity and BMI
Inspire healing and a healthy relationship with food
Refrain from overemphasizing personal behavior change
Reduce shame, anxiety, confusion, and tension
Recognize some nutrition interventions may be triggering
Practice cultural humility
Identify the willingness or ability of clients to adopt new behaviors
Address conscious and/or unconscious bias
On a Trauma-Informed Nutrition Program Clients Experience:
Safety & Security- environments that consistently support stress de-escalation, healthy choices, and wellness practices.
Trustworthiness & Transparency- staff- that are well-trained to deliver trauma-informed services.
Cultural, Historical, & Gender Issues- culturally- responsive interactions and experiences.
Empowerment, Voice, & Choice- opportunities to practice and grow tangible skills for self-efficacy.
Collaboration & Mutuality- opportunities to exercise voice, choice, & self-determination.
Peer Support- recognition of themselves and their community as wise and resourceful. skills and resources
**** This is why I follow an Intuitive Eating/HAES philosophy of listening to our bodies and not focusing on approaching nutrition as a means for weight loss but as a way to healing!
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References:
SAMHSA’s Trauma and Justice Strategic Initiative. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. https://store.samhsa.gov/system/files/sma14-4884.pdf
Silliman Ciohen, R., Moore, J. L., & Barron, C. E. (n.d.). Food Insecurity and Child Maltreatment: A Quality Improvement Project. Rhode Island Medical Journal.
http://www.rimed.org/rimedicaljournal/2018/09/2018-09-31-cont-cohen.pdf
Goldsmith, R. E., Martin, C. G., & Smith, C.P. (2014). Systemic Trauma. Journal of Trauma & Dissociation, 15(2), 117–132. doi: 10.1080/
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V.,Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine, 14(4), 245–258. doi: 10.1016/s0749-3797(98)00017-8
How ACEs Affect Health. (2017). Center for Youth Wellness. Retrieved from https://centerforyouthwellness.org/health-impacts/
Rayworth, B. B., Wise, L. A., & Harlow, B.L. (2004). Childhood Abuse and Risk of Eating Disorders in Women. Epidemiology, 15(3), 271–278. doi: 10.1097/01.ede.0000120047.07140.9d
Vaughn, M., Salas-Wright, C., Naeger, S., Huang, J., & Piquero, A. (2016). Childhood Reports of Food Neglect and Impulse Control Problems and Violence in Adulthood. International Journal of Environmental Research and Public Health, 13(4), 389. doi: 10.3390/ijerph13040389
Wonderlich, S. A., Crosby, R. D., Mitchell, J. E., Thompson, K. M., Redlin, J., Demuth, G., Haseltine, B. (2001). Eating disturbance and sexual trauma in childhood and adulthood. International Journal of Eating Disorders, 30(4), 401–412. doi: 10.1002/eat.1101
Preventing Adverse Childhood Experiences. (2019, December 31). Center for Disease Control and Prevention. Retrieved from https://www.cdc.gov/violenceprevention/childabuseandneglect/aces/fastfact.html
Markworth, A. (2019). Trauma-Informed Nutrition Security [Unpublished manuscript]. Leah’s Pantry.
Mason, S. M., Flint A. J., Field A. E., Austin S. B., Rich-Edwards J. W. (2013). Abuse victimization in childhood or adolescence and risk of food addiction in adult women. Obesity, 21(12),775-781. doi: 10.1002/oby.20500
Leah’s Pantry. (2018, December 12). Q&A with Monica Bhagwan About Our Trauma-Informed Work. Leah’s Pantry. https://www.leahspantry.org/leahs-pantry-team/qa-with-monica-bhagwan-about-our-trauma- informed-work/
CDC Vital Signs (2019) Adverse Childhood Experiences (ACEs) Preventing early trauma to improve adult health Retrieved from https://www.cdc.gov/vitalsigns/aces/index.html